UN Says 400 Starving Syrians Need to Be Evacuated From Besieged Town of Madaya

A day after delivering desperately needed food and supplies to the besieged Syrian town of Madaya, the UN is pushing for the evacuation of some 400 residents it says could die without immediate medical care.

Speaking to reporters on Tuesday by telephone from Damascus, Yacoub El Hillo, the UN's humanitarian coordinator for Syria, said 44 trucks reached Madaya, located 15 miles northeast of Damascus, on Monday. At the same time, 21 trucks in separate convoys delivered food and supplies to the largely Shia towns of Foua and Kefraya in Idlib province.

Madaya's 40,000 residents have been under siege by government and allied forces since July of last year. According to Doctors Without Borders (MSF), at least 28 patients at an MSF-sponsored hospital in the town have died of starvation since December 1, 2015.

Related: 'Children Are Eating Leaves Off The Trees': The Nightmare of The Siege of Madaya, Syria

Activists accused Syrian President Bashar al-Assad and Hezbollah, the Lebanon-based Shia militant group that supports his regime, of cutting off access to humanitarian actors, and of using starvation as a tool of war and means of political leverage. Foua and Kefraya have remained under siege by forces that oppose the Assad regime, and the aid shipments to each area were part of a negotiated agreement.

"Medical staff, plus activists have been working all night," said Dr. Ammar Ghanem a board member of the Syrian American Medical Society working with doctors to dispense aid in Madaya. "The minute the sun arose, people come from each families, they are coming to take the family's share."

According to a video report published by Reuters, at least one resident speaking at a checkpoint on the outskirts of Madaya said that rebels kept some food for themselves, or sold it at exorbitant prices — though it was unclear if that was a reference to the aid shipment that arrived on Monday or previous incidents.

Reached on Tuesday, local medical workers claimed that government soldiers had spread rumors that residents could leave by that checkpoint. Mohammad Darwish, a dentist in Madaya affiliated with the Syrian American Medical Society, said that when people arrived at the checkpoint, "the regime started filming them and forced them to say that the fighters are depriving the civilians of food." In some of the footage, men in fatigues can be seen.

"Just as the insurgents are besieged/surrounded, and don't have any resources, neither food nor relief aid to store up," Darwish said in a WhatsApp message. "The only food resource in Madaya are the regime checkpoints, from which they sell the food for unimaginable rates, wherein a kilo of rice in Madaya that goes for an average of $250."

Related: Aid Convoy Finally Enters the Besieged Syrian Town of Madaya

El Hillo declined to discuss specific actors, and said that he didn't ask affiliations of fighters manning the checkpoints between Damascus and Madaya, only describing them as "military personnel." But he said the level suffering in Madaya was clear.

"We saw people that are severely malnourished, especially children, we saw people that are extremely thin, skeletons, that are barely moving," said El Hillo. "We saw a people that are desperate, a people that are cold, a people that are hungry."

Citing local medical staff, El Hillo estimated that around 400 people — and perhaps more — need urgent care, and should be evacuated. He said that one five-year-old girl had left for a hospital in Damascus on Tuesday, along with her mother. Should hundreds more in severe medical states be allowed to leave, they would also likely be taken to Damascus, he added.

The UN is expected to return to Madaya and neighboring Zabadani on Thursday, where it will finish delivering food supplies, including flour, which was not included in Monday's convoy. Though the UN estimates that the supplies will last Madaya's residents a full month, locals say it could be spent in as little as two weeks, leaving them once more in the hands of armed groups negotiating access.

The Security Council has demanded unimpeded humanitarian access in Syria, and there was some risk that the deal in Madaya, Foua, and Zefraya could set a precedent for using starvation tactics as a chip at the negotiating table.

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"As everyone said, this has to be just the start, it can't be just a one-off situation," said New Zealand's UN ambassador Gerard van Bohemen after the Security Council heard testimony Monday night on Madaya. "To allow humanitarian relief is an obligation under international humanitarian law. So we're calling on all concerned to facilitate humanitarian access throughout Syria, it is absolutely essential."

Across Syria, some 400,000 people live in besieged areas, including 200,000 surrounded by the Islamic State in the southeast city of Deir Az-Zor. "It is very clear fact that besiegement is being used by all parties to this conflict," said el Hillo.

Meanwhile, residents in Madaya are still worried about where their next meal will come from. "We need to break the siege," Loay, a 26-year-old student in Madaya told VICE News by phone. "That's the really important point."

Follow Samuel Oakford (@samueloakford) and Avi Asher-Schapiro (@AASchapiro) on Twitter