BEIRUT — The United Nations expressed alarm on Thursday at widespread reports of starvation in a besieged town west of the Syrian capital of Damascus, welcoming a promise from Syria's government to allow aid to reach the hungry people there soon.
No food has reached the rural town of Madaya since October, and desperate residents say they have been eating cats and grass to stay alive. Photographs posted on the Internet have shown images of frail, skeletal people amid reports that there have been several deaths from malnutrition.
Hassan Abu Shadi, a rescue worker in Madaya contacted by telephone, said one or two people had been dying of hunger daily since snow fell on the mountain town late last month, for a total of 20 deaths so far.
"We were eating leaves and grass, but these days there are no more leaves because of the snow," he said. "There is nothing left but salt and water."
The United Nations said in a statement that it had received "credible reports of people dying from starvation and being killed while trying to leave" the town, an opposition stronghold that has been under siege by pro-government forces since July.
"Almost 42,000 people remaining in Madaya are at risk of further hunger and starvation," the statement said.
Fighting over the town, which fell into rebel hands in 2012, ended this summer under a cease-fire deal that also encompassed two rebel-surrounded towns in northern Syria. According to the terms of the cease-fire, rebel fighters from Madaya and nearby Zabadani were escorted by the United Nations to Turkey, and government loyalists from the towns of Foua and Kefraya were permitted to leave for government-held areas of Syria.
The deal also stipulated that food aid and other supplies should be allowed to reach civilians inside the towns. But only one delivery was made to Madaya, on Oct. 16, and residents have almost entirely run out of food.
The U.N. pointed out that it requires Syrian government permission to send food aid to the estimated 400,000 needy people living in various areas around Syria that are under siege by government forces, but that in the past year only 10 percent of those requests have been granted.
People are going hungry in many of those locations, but Madaya appears to be the worst afflicted. The Britain-based Syrian Observatory for Human Rights put the number of deaths from starvation at 10 people. One of them was apparently a 53-year-old man, Jamil Aloush, whose bony corpse was photographed and distributed by activists on Twitter on Tuesday.
The Syrian government has long used siege tactics to compel towns that fell under rebel control during the uprising against President Bashar Assad to surrender. At the entrance to the town, said Abu Shadi, the fighters besieging it have hung a sign proclaiming "kneel or starve," a slogan intended to capture the stark choice confronting rebels in the besieged communities.
He said most of the fighters surrounding the town belong to the Lebanese Shiite movement Hezbollah, which has been leading the battle to recapture Syrian towns in the vicinity of the nearby Lebanese border.
Though the reports of starvation deaths can't be independently confirmed, videos and photographs posted on social media cumulatively suggest that conditions are dire. In one, a mother is shown feeding her gaunt, 16-month-old daughter sips of jam diluted with water, because, she says, there is no milk. Another video shows more images of emaciated people.
The U.N. said the Syrian government promised to allow aid to be delivered to Madaya, as well as the two other towns under siege by rebels, "in the coming days." In the past, such promises have taken weeks or months to fulfill.