In the Syrian town of Madaya, a 2-pound bag of rice now costs more than $150. People talk about sifting through garbage, eating grass and slaughtering cats to fend off starvation.
"I don't know what these grasses are that we're eating," a doctor said by phone, giving his name only as Khaled. "We boil it, we put salt and eat it. It's a modern-day nightmare."
Madaya, about 25 miles northwest of Damascus, the capital, has gained international attention in recent days as reports have emerged of a looming humanitarian nightmare. Doctors Without Borders, a medical charity that supports field hospitals in Madaya, reported that at least 23 people have starved to death since the beginning of December. Others put the death toll at much higher.
Madaya is one of several towns where the crossfire of Syria's civil war has made the delivery of routine supplies nearly impossible, leaving people short of necessities such as food and medicine.
"People are boiling water and adding spices, and there is nothing to eat at all," said a charity worker in Madaya contacted by phone on Thursday who, like several others interviewed, didn't want his name used because of security reasons.
"If you saw my body, you would wonder how I was alive," he said.
Help may soon be on the way. The United Nations announced Thursday that an interagency convoy would be allowed to deliver much-needed aid to three besieged towns, including Madaya. The others are Fuaa and Kefraya in the northwestern province of Idlib.
"We received clearance to move ahead in the next 48 hours from our office in Damascus," Abeer Etefa, senior regional communications officer for the World Food Program, said by phone from Cairo. Trucks were already loaded with humanitarian assistance and were waiting for final authority to get under way, she said.
Madaya, a former vacation destination, has been under siege by the Syrian army and the Lebanese Shiite militant group Hezbollah since July as part of a campaign to drive out rebels from the town of Zabadani, less than three miles to the north, and a few miles east of Lebanon. Hezbollah has been a steadfast supporter of the government of Syrian President Bashar Assad.
Originally a town of 16,000, Madaya swelled as thousands of refugees streamed into it and surrounding villages to flee the fighting. Hezbollah also forcibly transferred civilians to Madaya to increase pressure on the rebels, opposition sources allege, raising the population to an estimated 35,000 and exacerbating an already dire humanitarian situation.
Prices of goods have skyrocketed because of the siege, residents said.
"Even the little cookie we used to buy for 10 Syrian pounds now costs 4,500 [about $20]," the charity worker said.
Another resident, Amjad Ali, said Hezbollah cadres manning checkpoints will exchange small amounts of food for weapons or cars.
"A rifle gets you 20 kilos of rice; a car gives you 25," said Ali, who is a member of the local council. Twenty kilograms equal about 44 pounds.
Opposition activists flooded social networks this week with pictures of the gaunt corpse of a man they said was felled by the dire conditions in the town. Videos showed emaciated infants eating a soup of marmalade and water, or people preparing a leaf stew to fend off starvation.
The claims and videos could not be independently verified, but an International Community of the Red Cross spokesman, Pawel Krzysiek, said he could "not exclude the situation was extremely dire."
Krzysiek, who had visited Madaya in October, said that even then there were signs of desperation.
"I've seen hungry people, and it was very visible they were hungry and malnourished. Their faces were skinny, black-rimmed eyes," said Krzysiek by phone from Damascus.
"The people have been cut off from basic humanitarian supplies for months. This is why our utmost priority is to deliver the aid ... since we're also in the middle of winter."
He said, however, about 500,000 people were besieged across Syria and under threat.
About 135 rebel fighters are believed to remain in Madaya, mostly affiliated with the Islamist faction Ahrar al Sham.
The town has become a bargaining chip in a complex agreement between the government and a coalition of hard-line Islamist groups known as the Army of Conquest.
Its fate illustrates the cynical calculus used by the different sides of the civil war, in which siege tactics have increasingly become the modus operandi of the government -- and the rebels on occasion -- to extract concessions from its adversary.
In March, Army of Conquest fighters pushed into Idlib, driving out government forces and laying siege to Fuaa and Kefraya, two enclaves with a combined population of about 30,000 Shiite Muslims about five miles northeast of the provincial capital.
Shiites are a religious minority in Syria related to Alawites, a sect that includes Assad. Hard-line Islamists in the Sunni-dominated insurgency consider Shiites and Alawites to be apostates or infidels.
Fearing a massacre of the two towns' inhabitants, the government accepted a cease-fire deal that tied the fate of the towns to that of Zabadani, more than 200 miles away. It would evacuate fighters and civilians in Zabadani to the Lebanese capital, Beirut, in exchange for a simultaneous transfer of Fuaa and Kefraya's population to Antakya, Turkey.
The agreement has achieved little beyond the evacuation of a number of wounded and the delivery of one aid shipment in October.
"We were hoping that the aid in October meant we will have access to these areas on a regular basis," said Etefa, explaining that the shipment awaiting authorization on Thursday had been delayed for more than two weeks.
"We put a lot of requests to the government and the rebels that were rejected and we did not know why," she said.
Both sides blame the other for the delay.
"The regime and Hezbollah don't want this agreement. The fighters inside said they would surrender and sacrifice themselves for their families, but the regime said no," said Abu Hassan, head of Madaya's local council, by phone Thursday.
"It's a policy of submit or go hungry," he said.
Hezbollah denied the accusation, saying it was the rebels who were hampering the deal and preventing the exit of civilians from the town.
It also said there had been no cases of death in Madaya and that claims of a humanitarian crisis were part of a systematic effort to slander Hezbollah.
Bulos is a special correspondent.
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