More than one million Syrians are trapped in besieged areas, a new report says in a challenge to the United Nations, which estimates just half that amount and has been accused by some aid groups of underplaying a crisis.
The fate of Syria's besieged is at the heart of peace talks that quickly fell apart last week, in Geneva, and are set to resume by February 25. Negotiators for the Opposition had insisted the Syrian government stop besieging civilians before talks could truly begin.
The new Siege Watch report, issued on Tuesday by the Netherlands-based aid group PAX and the Washington-based Syria Institute, comes a month after images, posted online of emaciated children and adults, led to an international outcry and rare convoys of aid to a handful of Syrian communities.
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The town featured in the images, Madaya, was not listed by the UN as a besieged community at the time. Aid workers who entered last month reported seeing skeletal people and parents who gave their children sleeping pills to calm their hunger.
The Siege Watch report says 1.09 million people are living in 46 besieged communities in Syria, far more than the 18 listed by the UN. It says most are besieged by the Syrian government in the suburbs of Damascus and Homs.
In the eastern city of Deir el-Zour, about 200,000 people are besieged by both the Islamic State group and the Syrian government. The report lists two communities besieged by armed opposition groups.
"Electricity and running water are usually cut off, and there is limited (if any) access to food, fuel, and medical care," the report says. Deaths have been reported from malnutrition, disease, hypothermia and poisoning while scavenging for food.
Some communities have been besieged for months or years.
The estimates are based largely on information provided by local contacts in the communities, including local councils, medical workers and citizen journalists.
With the spotlight on the besieged, the UN last month raised its estimate by almost 100,000, saying that 486,700 people are affected. That's still less than some aid groups' and others' estimate. They argue that the world body's numbers set the tone for humanitarian response efforts and that more urgency is needed.
"Many remain unaware of the extent of crisis, and the international response has been muted as a result," the Siege Watch report says.