The UN children's fund UNICEF has documented severe malnutrition among children in the besieged Syrian town of Madaya. The UN has called the starvation of civilians a war crime.
UNICEF said that out of 25 children under the age of five screened by its staff and the World Health Organization, 22 had "moderate to severe" malnutrition.
Another six out of 10 children aged between six and 18 showed signs of severe malnutrition, UNICEF said in its report. It acknowledged that, while the examinations were not a representative sample, they reflected the real-time situation on the ground.
UNICEF and WHO staff witnessed one 16-year-old die of starvation during their visit and said some people would need to be evacuated to receive medical care.
Rebel-held Madaya gained international attention as images emerged of emaciated men, women and children, and reports rolled in that at least two dozen people had died from starvation, children eating grass to survive after the besieged town went months without supplies.
In some of the first outside medical examinations in the town, UNICEF said people "were exhausted and extremely frail" and the two doctors remaining in the town were "emotionally distressed and mentally drained."
Nearly 450,000 people in 15 locations across war-torn Syria are under siege, including areas controlled by the Syrian regime, rebels and "Islamic State" (IS), according to the UN.
“While we express our shock over the situation in Madaya, let us not forget that, across Syria, there are 14 other 'Madayas,'" UNICEF said. "These are locations where different parties to the conflict have been using siege as a tactic of war, depriving children and innocent civilians from accessing lifesaving supplies and services."
Starvation as a weapon of war
UN Secretary-General Ban Ki-moon on Thursday said the use of starvation as a weapon was a clear war crime. UN High Commissioner for Human Rights Zeid Ra'ad Al Hussein said that those responsible should be prosecuted.
Syria's main backer, Russia, said on Friday it was urging the Syrian government to cooperate with the UN to deliver aid. It also called on all outside powers to use their influence on rebels to ensure humanitarian aid was delivered.
Aid deliveries from a joint UN, Syrian Red Crescent and International Red Cross operation arrived in Madaya, located 24 kilometers (15 miles) northwest of Damascus, this week as part of an UN-brokered agreement between the Syrian government and rebels. The aid shipment to Madaya was part of a deal that also includes the neighboring rebel-held Zabadani.
The Syrian opposition accuses a months-long siege of Madaya by regime and Lebanese Hezbollah forces for the dire situation, while the government accuses rebels of confiscating and hoarding food.
As part of the truce, aid deliveries also arrived at two government-controlled Shiite villages in northern Idlib province that have been surrounded by rebels.
The UN has called for the end of all sieges across the country as a confidence-building measure ahead of peace talks between opposition and rebel factions and the regime schedule for January 25.
The UN aims to build local ceasefires and humanitarian operations that could then be broadened across the country during peace talks.