Aid workers on a relief mission to the besieged Syrian town of Madaya were horrified to witness the death of a severely malnourished 16-year-old boy who a U.N. official said "passed away in the town's clinic in front of our eyes."
The boy was one of nearly 30 children who showed signs of moderate to severe malnutrition during screenings this week at a makeshift clinic, Hanaa Singer, the United Nations children's agency representative in Syria, said in a statement Friday.
Although the findings may not be representative of overall nutrition conditions in Madaya, she said they provide a "real-time reflection of the situation" in a town that has become a focal point of the information war that has accompanied five years of deadly armed conflict in Syria.
"The people we met in Madaya were exhausted and extremely frail," said Singer, of UNICEF. "Doctors were emotionally distressed and mentally drained ... It is simply unacceptable that this is happening in the 21st century."
Madaya, about 25 miles northwest of the Syrian capital, Damascus, has gained international attention in recent weeks as reports have surfaced of a looming humanitarian disaster in the opposition-held town that has been surrounded by pro-government forces for months.
Local doctors and humanitarian agencies say dozens of people have died there of starvation and a lack of medical care. Pro-opposition activists have circulated harrowing images on social media of emaciated civilians said to be subsisting on water, grass and anything else they can scavenge in the town.
The images generated an outcry against the Lebanese Shiite Muslim group Hezbollah, which was accused of enforcing the siege in support of the government of Syrian President Bashar Assad.
Hezbollah and its supporters, however, have denounced some of the images as fabrications. They blame the country's rebels for Madaya's plight, contending that opposition gunmen prevented the departure of residents and hoarded supplies.
Trucks from the United Nations and other international aid agencies were allowed into Madaya for the second time this week Thursday, providing a rare opportunity for an independent assessment of conditions in the town.
Abeer Pamuk, who was part of a team sent by SOS Children's Villages in Syria, said none of the children she saw looked healthy.
"They were all incredibly pale and skinny," she said in a statement. "They could barely walk or talk. Their teeth are black, their gums are bleeding and they have lots of health problems."
The situation was so desperate, she said, some parents were giving their children sleeping pills to stop them from crying for food.
Doctors Without Borders, which supports medics in the town, said five people had died of starvation since the arrival of the first aid convoy Monday. It warned that providing treatment for severely malnourished people was medically complex and said medics had identified 18 critical patients who need to be immediately evacuated to a hospital.
The U.N. said its teams had worked with local health staff to set up a stabilization center and outpatient services for the treatment of malnutrition in Madaya.
At the clinic Thursday, aid workers from UNICEF and the World Health Organization screened 25 children younger than 5 , Singer said. Twenty-two of them showed signs of moderate to severe malnutrition. They also screened 10 children between 6 and 18, of whom six showed signs of severe malnutrition.
Speaking in New York on Thursday, U.N. Secretary-General Ban Ki-moon said the scenes in Madaya represent "shocking depths of inhumanity."
"Let me be clear: The use of starvation as a weapon of war is a war crime," Ban told reporters. "I would say they are being held hostage, but it is even worse. Hostages get fed."
Both government and rebel forces are using such tactics in Syria. This week's aid operation also included deliveries to Fuaa and Kefraya, two pro-government towns that have been besieged by rebel forces in Idlib province, about 180 miles north of Damascus.
But the U.N. and its partners have only been able to reach about 1% of the estimated 400,000 people living under siege in Syria, officials said.
"While we express our shock over the situation in Madaya, let us not forget that across Syria, there are 14 other Madayas," Singer 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."
The United States, Britain and France called an emergency meeting of the U.N. Security Council on Friday to put pressure on the waring parties to lift the military sieges.
But Russia's deputy U.N. ambassador, Vladimir Safronkov, accused the three countries of politicizing the humanitarian crisis, a strategy he said could derail peace talks scheduled to begin Jan. 25 in Geneva.
The countries have long been on opposing sides over Syria. Russia has provided critical support to Assad's government, which the U.S. and its allies want to see replaced. While Russia and the U.S. have edged closer on some issues, they have yet to agree on what a transitional government might look like.