Gaunt, ragged figures fill the streets for as far as the eye can see in the besieged Palestinian refugee camp of Yarmouk outside Damascus, where some 40,000 are said to be slowly starving to death.
The UN distributed shocking images this week of thousands of people, their faces emaciated, desperately flocking to receive food aid that only a few were lucky enough to collect.
“We live in a big prison,” said Rami al-Sayed, a Syrian activist living in Yarmouk. “But at least, in a prison, you have food. Here, there’s nothing. We are slowly dying.”
“Sometimes, crowds of children stop me on the streets, begging me: ‘For the love of God, we want to eat, give us food.’ But of course, I have no food to give them,” Sayed said.
Residents have spoken of eating grass, cats, and dogs in a bid to stay alive. At least 86 people are known to have starved to death.
After months of shelling and fierce fighting in and around Yarmouk between rebels and president Bashar al-Assad’s troops, the camp’s population has shrunk from more than 150,000 to 40,000.
Among them are 18,000 Palestinians.
Since last summer, the area has been under choking army siege, creating inhumane conditions for its inhabitants.
“We’ve been living off herbs, but these herbs are bitter. Even animals won’t eat them,” said Sayed.
“And if you go to the orchards to pick herbs from there, to use them to cook soup, you’ll get sniped.
“The situation is really tragic. On the streets, all you see are emaciated people, their faces drained of any life. Sadness is everywhere,” said Sayed.
Even the UN Relief and Works Agency (UNRWA) for Palestinians was overwhelmed by the crisis.
Since January, the agency has only been able to carry out limited, intermittent food distribution in the camp.
“Gaunt, ragged figures of all ages fill the streets of the devastated camp for as far as the eye can see,” UNRWA said, adding that such scenes were the agency’s “daily reality”.
“Humanitarian need has reached profound levels of desperation. Hunger and anxiety are etched on the faces of the waiting multitudes.”
Since January, UNRWA has distributed only 7,500 food parcels in Yarmouk, describing that as “a drop in the ocean compared with the rising tide of need”.
One parcel feeds a family of between five and eight for 10 days.
“This week only 10% of people here received assistance,” said Sayed.
Ali Zoya, a Palestinian living in Yarmouk, said “the aid will only last a few days”.
Much of the camp has been reduced to rubble by shelling, fighting and occasional aerial bombardment.
The distribution only began after rebels from outside the camp agreed to withdraw, following a deal reached with Palestinian factions.
The lack of food in Yarmouk is compounded by medical shortages.
“In the hospitals, there are wounded people who cannot be treated because there are no doctors or medicines,” said Sayed.
“I saw a young man with a shrapnel wound to his leg. He won’t get better until he is able to leave the camp,” which is still under siege even though the rebels have withdrawn.
Since October, more than 100 people have died from food and medical shortages, says the Syrian Observatory for Human Rights.
After a visit this week, UNRWA chief Filippo Grandi described the “shocking” conditions of life he witnessed in Yarmouk.
He compared the people flocking to the distribution point as “the appearance of ghosts”.
Their despair echoes that of families who were trapped in rebel-held areas of the central city of Homs for more than 18 months, also under a tight army siege imposed to turn people against Syria’s nearly three-year revolt.
“People here are completely exhausted,” said Sayed.
“They feel tortured. They say: ‘Let us out, or let us die.’
“[They] have been trapped in there not only without food, medicines, clean water — all the basics — but also probably completely subjected to fear because there was fierce fighting.
“The devastation is unbelievable. There is not one single building that I have seen that is not an empty shell by now.”
But he said the condition of the camp’s remaining residents “is more shocking even”.
“They can hardly speak,” he said.
“I tried to speak to many of them, and they all tell the same stories of complete deprivation.”
Yarmouk is one of several parts of Syria where civilians are trapped under regime or opposition sieges which prevent freedom of movement and the entry of food and medicines.
More than 140,000 people have died in Syria since the conflict erupted in March 2011.
When the uprising against Assad erupted in March 2011, most Palestinians stayed on the sidelines. As the revolt turned into a civil war that reached Yarmouk in December 2012, most residents backed the rebels and some even took up arms to fight Assad’s troops and pro-government Palestinian fighters.
People in Yarmouk are so desperate for food that many eat stray animals, and some women have resorted to prostitution, according to residents reached via the internet.
“Many here have slaughtered and eaten cats and dogs, and even a donkey,” said Yarmouk resident Ali, who was a university student when Syria’s revolt erupted in 2011.
“One man who killed a dog couldn’t find any meat to eat on its body, because even the dogs are starving,” he said via Skype.
“What was unimaginable a few months ago is normal now.”
Ali said: “The situation is so desperate that women are selling their bodies to men who stocked up food before the siege was imposed, for just a cup of rice or bulgur (wholegrain food),” Ali said.
“Imagine the feeling of a father unable to feed his children, as they wail from hunger,” he added.