East Aleppo was one of 40 besieged towns. Now residents of towns under regime siege fear they might face a similar fate.

Beirut, Lebanon – Every night, Muhammad Darwish goes to sleep under four blankets. It is his only hope of keeping warm. Like everyone in the besieged Syrian mountain town of Madaya, the 26-year-old has few other choices if he is to avoid freezing to death.

There is no fuel to warm his home or cook hot food.

“The weather is so cold because we are in the mountains,” said Darwish, a dentistry student and one of the only medics left in Madaya. “The temperature is -5C at night. We are afraid of dying from the cold.”

Last year, the Syrian mountain resort of Madaya drew the world’s attention when medical workers published harrowing photos of its its malnourished residents showing wide-eyed babies without access to milk, and elderly men with cavernous rib cages.

Now after Aleppo’s fall, residents say they fear that their town, besieged by Syrian regime forces and its allies since July 2015, might face a similar fate.

“People are living in huge fear, because of the bombing, the heavy shelling and the snipers,” Darwish told Al Jazeera from inside Madaya. “People don’t know anything about their future.”

Children breaking wood for fuel in besieged Madaya [Houssam Mohammed/Al Jazeera]

Madaya is one of at least 39 communities under siege either by government forces and their allies or by rebel groups. According to a recent report by Siege Watch, a monitor managed by the US-based Syria Institute research group and PAX, a Netherlands-based peace research team, there are more than 1.3 million people besieged in Syria – although the United Nations only recognises a besieged population of around 970,000 in November.

People are living in huge fear, because of the bombing, the heavy shelling and the snipers. Mohammad Darwish, a Madaya resident

According to the report, the Syrian government and its allies remain “responsible for the majority of existing sieges”.

With eastern Aleppo city as well as Douma in rural Damascus and al-Waer in Homs, Madaya is one of the four communities cited in the report as in need of “immediate and unfettered international assistance to prevent looming humanitarian catastrophes”. Last winter, at least 65 of Madaya’s 40,000 residents starved to death because of insufficient food supplies.

This year, food supplies are still minimal with conventional gas and diesel supplies absent, people burn their possessions for fuel. “When we want to be warm or heat something or cook we break our furniture from our bedrooms and living rooms -anything made from wood, we break it and burn it to keep warm and to cook,” Darwish said.

In late November, an aid convoy that entered the town contained food, milk and medicines – but no petrol or diesel. A Syrian Arab Red Crescent spokesperson confirmed to Al Jazeera that the aid convoy did not carry any fuel but did not explain why.

“People have burned everything to heat their homes,” said Moussa al-Maleh, a Madaya resident who lost two children within a week last month. “They are doing everything to try to keep warm. When the snow comes heavily it will be a disaster.”

Siege specialists said that the recent aid convoy to Madaya failed to bring any kind of fuel because the Syrian government lays down what goods are permitted. “To my knowledge, fuel is not generally included in convoys,” said Valerie Szybala, of Siege Watch. “The type and amount of items allowed to enter in aid convoys is subject to approval by the Syrian government so there are almost always critical items excluded.”

Parents are wrapping their children in covers and blankets to keep warm, and those who have the materials are knitting hats, scarves and gloves. “People are dependent on just three or four kinds of food – rice, bulgur wheat, and chickpeas,” Darwish said.

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Residents say the town is coming under attack with surface-to-surface missiles. Last week, at least eight barrel bombs were hurled from aeroplanes, leaving up to 200 homes damaged or destroyed. The bombardments have so far left five people dead, including an 18-month-old girl named Nour. Other badly injured residents are in need of urgent medical evacuation.

“The violence was the worst Madaya has seen since it came under siege,” Darwish said.

Hezbollah-affiliated media channel al-Manar reported that its troops continued to besiege Madaya because rebels have prevented the delivery of food and aid to Kefraya and Fua, two small towns in Idlib besieged by Jaish al-Fatah coalition.

The latest apparent tit-for-tat exchange has seen violence exerted on towns besieged by both sides.

As missiles fell on Madaya, Ahrar al-Sham and Faylaq al-Sham, two factions within Jaish al-Fatah, posted a video and photos on social media of its fighters launching rockets against what it said were “sectarian militias” in Fua.

An Ahrar al-Sham source told Al Jazeera that it was targeting Assad regime’s “military positions and fortifications” in the towns. “This is a hundredth of what is being fired [by Assad forces] on Aleppo, Idlib, Madaya and other areas across Syria,” he said.

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The Siege Watch report said that the “deliberate starvation of civilians is a grave breach of the Fourth Geneva Convention, and therefore a war crime”.

The monitor also observed that a major development is how Assad forces have shifted siege tactics from “surrender or starve” to “surrender or die”.

The past three months have been characterised by the Syrian government’s “intensified efforts” to forcibly displace besieged communities, using “military escalation and coercion”, Siege Watch reports.

In short, Syrians who have been trapped and starved for months on end now risk being moved out of their homes. Evacuations from communities besieged by pro-regime forces took place in Daraya and Moadamiya, rural Damascus, in August and September respectively.

Syrian state media reported that the Daraya evacuation was carried out by an “agreement”.

But monitoring groups say the movements constituted a war crime by way of forced displacement. “Nothing about this evacuation is voluntary, and nothing about this evacuation is legal,” the New York-based group Physicians for Human Rights said at the time.

Local negotiating committees are coerced, according to the Siege Watch report, using “threats, lies, warnings and ever-changing terms, pushing besieged residents to new depths of despair”.

According to observers, it is difficult to fully assess whether evacuations constitute forced displacement, and therefore war crimes, while a conflict is ongoing. It is often necessary to wait until violence ends to see whether or not people are prevented from returning to their homes.

With a population weakened by the winter cold, bombing and a two-year-old siege, Madaya residents like Maleh believes that the Assad regime is employing the “surrender or die” tactic in Madaya.

Darwish is less sure. “I don’t know what the regime is thinking – whether they want us to leave or stay here.”

Houssam Mahmoud, another Madaya resident, said civilians feared for their safety after the fall of Aleppo. “With this continuing siege, people in Madaya have begun to fear a similar fate to Aleppo,” he told Al Jazeera.