As the siege of Eastern Ghouta, a Damascus suburb, enters its third year, swarms of children armed with buckets can be intermittently seen scavenging the streets and bombed-out buildings in between rounds of fighting.

They roam around on empty stomachs, hoping to find scraps of food and clean water. Some of them walk up to 15km a day for a single meal, feasting on anything from vegetable broth to stale bread made from animal feed.

Limited supplies of food have reached the markets since the siege of Eastern Ghouta began in October 2012, and this does not include fresh milk and meat. The increasingly scarce supply of staples such as bread and rice has created a black market for the coveted goods, with some shops raising their prices by 600 percent.

Eastern Ghouta was the site of a chemical attack in August 2013, during which Syrian activists say government forces killed hundreds of people. It is also one of the last remaining swaths of territory held by the Free Syrian Army in the Damascus area.

Several residents say they are suffering from the regime's collective punishment. Sending their children out with buckets to collect food has become a last resort for overburdened parents in Eastern Ghouta.

Schools are shut down as most were turned into shelters for families who lost their houses in the unrelenting war. "There's no food, water, heat or electricity. We lack all of life's basic necessities," said Refat, a fatigued young mother of two bucket children taking a rest from mopping the flooded floors of her shoddily constructed cinder block home.

"I don't send my children out in the streets to ask for food, but at the same time I don't stop them either," she told Al Jazeera with a sigh. "Sometimes they wake up in the middle of the night demanding food, but there is none in the house."

Searching for food in groups allows children to see this survival task as fun [Mohammed Abdullah/Al Jazeera]

Oddly enough, smiles and a sense of cheery camaraderie can be seen emanating from Eastern Ghouta's bucket children as they leap over the town's rubble searching for food.

Tony Hoffman, an expert who specialises in the psychological effects of war on children, says the novelty of activities such as searching for food in groups allows children to perceive these means of survival as fun activities.

"These are children who are largely living in a situation of boredom and confinement," Hoffman told Al Jazeera. "[They] want happiness and can experience it in the most meagre and dire of situations as long as there's something that gives them stimulus."

Still, this does not change the fact that these children are operating in what UNICEF says is "one of the most dangerous places on earth to be a child". Walking in public places carries the risk of being caught in sniper crossfire, along with the potential for physical or sexual assault.

"We've seen alarming rates of neglect and labour exploitation, as well as physical and sexual abuse among these children," Manal Eid, programme manager at War Child Holland, a charity organisation based in Lebanon, told Al Jazeera, referring to children in areas such as Eastern Ghouta.

The organisation's country director, Andre Gonzalez, added: "There is a lot of fear that comes from high incidences of abuse among these children even after they arrive here in Lebanon."

Reaching out to support the bucket children of Eastern Ghouta and others at risk, has been particularly challenging for the international community. The Syrian government must grant groups access to operate in Syria, and only about 15 or 16 international NGOs currently have authorisation to do so. "We hope they will be open to more international NGOs because we're ready to help the children affected most by the war," Gonzalez added.

Even those who have been granted access still face numerous obstacles in reaching children with the most critical needs. Earlier this month, UNICEF announced that its aid trucks successfully reached the town of Afrin in northern Syria - the first time in 12 months that humanitarian aid has reached the Kurdish enclave previously under siege by the Islamic State of Iraq and the Levant (ISIL) and other Islamist affiliates. The breakthrough followed a UN announcement of cuts to the food aid received by over 4.2 million Syrians due to a budget shortfall.

Aid can only enter Eastern Ghouta at the government's discretion, while it finds its way to seep through the cracks of less centralised rebel-held areas such as Afrin. Efforts by Kurdish forces, the People's Protection Units (YPG), and Free Syrian Army rebels has allowed aid to flow in brief spurts to northern towns like Afrin, while Eastern Ghouta remains stonewalled.

Children feast on anything from vegetable broth to bread made from animal feed [Mohammed Abdullah/Al Jazeera]

The World Food Programme had been pushing for access to communities under siege "to provide life-saving assistance and also to assess the scale of the needs" - but so far, these calls have gone unanswered.

The longer these bucket children wait for aid, the graver the effect will be on their mental and physical wellbeing. Makeshift clinics staffed by a few volunteer doctors and community members in Eastern Ghouta have reported a recent increase in cases of malnutrition and kidney failure.

"At the beginning of the fighting, we'd see just a couple of instances of treatable malnutrition every so often," said one doctor, speaking to Al Jazeera on condition of anonymity for fear of regime persecution. "Now, there are children brought to us with severe malnourishment symptoms regularly."

Even after malnutrition is treated, affected children often continue to suffer from long-lasting impacts on their cognitive development. Hoffman says that the bucket children will, for a long time, have difficulties focusing on activities such as reading or writing because they have become trained to be on guard, looking for food.

"The longer the period of malnutrition, the worse is the life outcome," he said. 

Meanwhile, the sounds of war pierce the silence of Refat's house, as her two children sweep the roads outside for anything edible.

"They don't understand the situation around them much at all," she said. "They only understand their hunger, which I'm afraid they're starting to think is a normal feeling."

Source: Al Jazeera