BEIRUT • Situated in the hills near the Lebanese border and an hour's drive from downtown Damascus, the Syrian town of Madaya is controlled by rebels and encircled by pro-government forces with barbed wire, land mines and snipers.
Much of the town is starving, according to residents and international humanitarian workers. The people have been surviving on soups of grass, spices and olive leaves. They eat donkeys and cats. They arrive, collapsing, at a clinic that offers little but rehydration salts. Neighbours fail to recognise each other in the street because their faces are so shrivelled.
Syria, once classified as a middle-income country, now reports periodic malnutrition deaths. At least 28 people, including six babies, have died from hunger-related causes at a clinic in Madaya affiliated with Doctors Without Borders, medics there say. And the 42,000 people that the United Nations counts as trapped in Madaya are about a tenth of those stranded in besieged or hard-to-reach areas as conditions grow steadily worse.
Mr Hamoudi, 27, a business school graduate who took up arms after the government's crackdown on protests in 2011, said many people would surrender in order to eat, even though they expect arrests and retribution to follow.
"In the revolution, I was dreaming of democracy, freedom," Mr Hamoudi said slowly in an interview via Skype, exhaustion evident in his voice. "Today all my dreams are food. I want to eat. I don't want to die from starvation."
As all sides are seeking to maximise gains before the talks, they are inflicting new pain on civilians. About 400,000 Syrians are trapped behind front lines, denied access to food and medicine. That UN count has risen from 240,000 since 2014, when the UN Security Council unanimously adopted a binding resolution ordering the warring parties to allow aid delivery.
Even as the Syrian government promised to allow UN aid into Madaya yesterday - amid growing international outrage over reports of starvation - government forces are tightening a new siege on another rebel-held town, Moadhamiyeh, a suburb of Damascus.
Using hunger as a weapon flies in the face of international law. Yet global and regional powers - such as Russia, Iran, the United States and Saudi Arabia - are unable or unwilling to pressure their battlefield allies.
The UN says that just 10 per cent of its requests last year to deliver aid to besieged Syrians were approved. That puts the UN in an awkward position: helping to carry out local ceasefires that may permit aid for a time, but also reward commanders' siege tactics.
While the UN emphasises that it is not a party to the agreements, its officials are intimately involved in carrying them out - aid delivery and evacuations cannot take place without them.
FOOD, NOT FREEDOM
In the revolution I was dreaming of democracy, freedom. Today all my dreams are food. I want to eat. I don't want to die from starvation.
HAMOUDI, a business school graduate who took up arms after the government's crackdown on protests in 2011
Sieges are nothing new in Syria. Nearly half of the 400,000 Syrians the UN counts as besieged are surrounded by government forces, who have used the tactic systematically around Damascus and Homs.
But things were supposed to change in Madaya. It was part of a pact that was hailed last month as the most complex local ceasefire yet, involving Fuaa and Kafraya - which are encircled by rebel forces - on one hand, and Madaya and neighbouring Zabadani - which have been surrounded by government forces - on the other.
Wounded fighters and their families were evacuated simultaneously on both sides, and plans were made for more aid and evacuations. But those plans have stalled as people continue to become sick and die in Madaya - subject to one of the tightest sieges of the war, including what the UN calls "credible reports" of people being shot as they tried to escape.
Civilians also suffer in rebelencircled northern towns, although government helicopters make occasional airdrops.
There are divisions within the towns, too, with some accusing fighters of hoarding food and many debating what terms to accept.
In the meantime, dozens of people come daily to the Doctors Without Borders-affiliated clinic, said Mr Khaled Mohammad, a nurse anaesthetist there who shared photographs of a skeletal man, Mr Suleiman Fares, 63, who was found dead by activists taking food to his house. Such images have galvanised alarm about the siege.
Ms Samar Hussein, a nurse, was one of a dozen residents interviewed. She said she had spent US$40 (S$57) last month for a few spoonfuls of sugar for her 19-year-old daughter, who had fainted, and the baby her daughter was trying to breast-feed.
She and several families recently shared a soup made with one cup of bulgur wheat, gathering together to cook it because there was little wood.
On the street, she said, she had seen a woman picking grass to eat and did not realise at first that it was her neighbour. "She looks so different," she said. "So skinny."
NEW YORK TIMES