Life has become a grim exercise in survival for thousands of families in the Syrian town of Madaya, where the consequences of a six-month siege have been exacerbated by the onset of winter.
Harrowing images of emaciated bodies have been widely distributed, showing wide-eyed babies without access to milk, and elderly men with cavernous rib cages. Around two dozen people have already starved to death and scores more are suffering from malnutrition.
"A lot of people are surviving on water and salt only," said a humanitarian activist in Madaya, who spoke to Al Jazeera on condition of anonymity due to security concerns. "They dissolve salt into the water just to kill the hunger pangs they are dying from. Malnourishment is killing people."
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The activist said that his family was the same. His children are now in Lebanon, but he and his wife are lucky to have a meal every few days - often just a single cup of rice shared between the two of them.
"Like others, we are living on water and salt most of the time, just liquids."
Citric acid is also used to stave off hunger pangs, he said.
Activists have begun documenting deaths related to the siege of Madaya, which is surrounded by landmines planted by the Syrian regime. In December, at least 22 people died from starvation, including six babies, according to the Syrian American Medical society. Mothers, often malnourished themselves, are unable to produce enough breast milk to feed their newborns.
At least four others died in landmine explosions in December, activists say, while several more residents were killed by sniper fire.
The Syrian regime announced late on Thursday that aid would soon be allowed into Madaya, but it was unclear how the aid would be delivered. Hezbollah, which has been working alongside the Syrian regime in border areas but denied responsibility for the siege, also confirmed that aid would soon be allowed in.
Ahmad Tarakji, president of the Syrian American Medical Society, which has been helping to organise the distribution of food in Madaya, said the announcement was expected. But he cautioned that similar aid deliveries in the past have been followed by mass forced displacement of civilians.
Many other areas of Syria remain under similar sieges, some having lasted for years, Dr Tarakji said.
She was kneeling on the floor, begging me for food. She tried to kiss my feet, and started crying. I tried to lift her up, and cried with her.
"The starvation in Madaya is not an isolated event," he told Al Jazeera. "Many other areas in Ghouta, suburban Damascus, are under a similar siege by the Syrian government. Without a clear accountability for war crimes, all of the current ceasefire agreements will, and have been, the result of starving communities to death followed by forceful displacement of the civilians.
"This is not the way to build peace."
Doctors Without Borders (MSF) welcomed reports that the Syrian government would allow food deliveries into Madaya, but also called for "immediate life-saving delivery of medicine across the siege line".
"This is a clear example of the consequences of using siege as a military strategy," Brice de le Vingne, MSF's director of operations, said in a statement on Thursday.
"Now that the siege has tightened, the doctors we support have empty pharmacy shelves and increasing lines of starving and sick patients to treat. Medics are even resorting to feeding severely malnourished children with medical syrups, as they are the only source of sugar and energy."
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For now, what little food is still available within Madaya has become cripplingly expensive, and prices continue to rise. Just over a week ago, a kilo of rice cost 40,000 Syrian pounds ($212), but today the price has skyrocketed to around 100,000 Syrian pounds ($530), activists said.
Working alongside humanitarian groups, the activist who spoke to Al Jazeera on condition of anonymity said that he had recently been helping to distribute mixed grains to the families most in need. Recently, a mother came to ask him for food for her children - but he did not even have enough food to feed himself.
"She was kneeling on the floor, begging me for food. She tried to kiss my feet, and started crying. I tried to lift her up, and cried with her," he said.
Some activists in Madaya blame not only the regime for their situation, but also the United Nations, which has been involved in brokering local ceasefires. In late December, rebel fighters withdrew from Zabadani, near Madaya, and civilians were evacuated from Fua and Kefraya, two villages in Idlib province under rebel siege. Some fighters also withdrew from Madaya.
"The wounded fighters left, but the siege never stopped," the activist in Madaya said. "The UN is the supervisor of this deal between the two sides, but they are not fulfilling their promises."
Source: Al Jazeera