Aid agencies are evacuating critically ill Syrians from Eastern Ghouta, an area home to around 400,000 people that has been under government siege since 2013.
Children comprise around half of the population in one of the last rebel strongholds in the country, where medical supplies and food have been in short supply.
The International Committee of the Red Cross (ICRC), Syrian Red Crescent and the Syrian American Medical Society (SAMS) are among the organisations involved in the evacuation.
Robert Mardini, ICRC regional director, wrote on Twitter that he was “encouraged to see the beginning of a lifesaving operation”.
— ICRC Syria (@ICRC_sy) December 26, 2017
ICRC posted photos on the social media site showing ambulances and aid workers on site.
SAMS said evacuations had begun for at least 29 people in critical condition. Four were taken to medical care in Damascus on Wednesday. The remainder would be escorted out over the coming days.
“The list includes 18 children and four women suffering from heart disease, cancer, kidney failure, and blood diseases, in addition to cases requiring advanced surgery that are not available in the besieged area,” SAMS said, adding that a total of 641 people needed urgent medical care.
Because of the ongoing siege and the shortage of medical supplies, 17 patients at least have died over the past few months.
Medicine is being rationed, and people are dying of complications due to the limited availability of simple procedures like dialysis.
“The medical situation in East Ghouta has reached a breaking point. Because of the ongoing siege and the shortage of medical supplies, 17 patients at least have died over the past few months because they were not able to access medical care,” SAMS said.
Eastern Ghouta was supposed to be one of the “de-escalation zones” brokered a year ago by Iran, Russia and Turkey, but people there do not trust the agreements, and their greatest fear now is not having a place in their country.
Al Jazeera’s Zeina Khodr, reporting from Beirut in neighbouring Lebanon, said the evacuation of the 29 critically ill is a “welcome move, but is not enough”.
“It’s just a small fraction of those who need urgent medical care,” she said.
Last month, the UN called for at least 500 people in need of urgent medical attention to be allowed to leave the besieged region.
UN reports and Al Jazeera interviews in Eastern Ghouta confirmed reports that residents are drinking large amounts of water to suppress hunger, with food intake reduced to one meal a day.
The Assad government has allowed in some aid, but the UN says its current level of assistance covers just about 10 percent of the besieged population of Eastern Ghouta.
This year, the Syrian government has approved only 26 percent of UN requests to deliver assistance to besieged areas. The ministry of foreign affairs has the authority to remove any items from aid shipments.
People in Eastern Ghouta are eating boiled corn, cabbage and cauliflower because of a lack of cooking fuel, cooking oil and other essentials.
Syria’s conflict, which started with peaceful anti-government demonstrations in March 2011, escalated into a full-blown war that has claimed more than 300,000 lives and driven about half of the country’s prewar population of 22 million from their homes.
Forces loyal to Assad and those opposed to his rule continue to battle each other, as well as fighters from the Islamic State of Iraq and the Levant (ISIL, also known as ISIS) group.