The United Nations reported last November that nearly one million Syrians now live under siege, a figure that is up from 393,000 Syrians at the same time the year before.

“Horror is now usual,” UN Emergency Relief coordinator Stephen O'Brien said in a November statement before the UN Security Council in New York. “It is a level of violence and destruction that the world appears to consider normal for Syria and normal for the Syrian people.”

One area of particular focus in the UN report is Madaya, a former summer resort town 26km northwest of the capital and home to 40,000 residents. Regime and allied Hezbollah forces have surrounded the town since July 2015 with an airtight encirclement reinforced by thousands of landmines. The result? Mass starvation, with residents surviving on foliage and scraps.

A complex and frequently criticized truce agreement dictates whether humanitarian aid can enter Madaya or whether emergency medical cases can be evacuated from the town.

Mohammad Darwish overlooking Madaya. Photo courtesy of Mohammad Darwish.

In September 2015, residents of Madaya and Zabadani, two regime-encircled towns in Outer Damascus, and al-Fuaa and Kafariya, two rebel-encircled towns in Idlib province, signed on to the “Four Towns Agreement,” which stipulates that all aid deliveries and medical evacuations occur simultaneously across the four towns.

Medical evacuations, whether due to injuries from sniper fire or life-threatening illness, would not take place unless a similar evacuation occured on the other side.

Because the towns are linked, attacks on al-Fuaa and Kafariya by rebels can lead to increased shelling and sniper fire in Madaya, and vice versa.

Inside Madaya, Dr. Mohammad Darwish is one of three remaining medical professionals: two dental students and a veterinarian. Since the first days of the Madaya encirclement, he has been Syria Direct’s main source on the ground, documenting meningitis outbreaks, sniper wounds and kidney failure.

Though a former dental student, Darwish has helped lead all medical operations for the town amidst near-daily bombings and constant medical shortages.

But now, he is tired.

“Under siege in Madaya, it’s as if every part of my life has ground to a halt,” Darwish tells Syria Direct’s Alaa Nassar in this dispatch from Madaya. “You can’t feel, you can’t think and you can’t grow…My mind is rotting.”

“We’re ready for this suffering to finally end, and we’re prepared to do so by any means necessary.”

Living in Madaya, I feel like I’m in a black hole trapped outside time and space. We’re so far removed from the rest of the world. No one can feel what we've felt. No one can suffer like we've suffered. Those who are outside Madaya don’t believe us when we say that people are dying of hunger here. Every single day, you’ll see people—young and old—sifting through the garbage just to find nylon bags, cardboard or trash that they can burn to stay warm. People are breaking down their own furniture just to have something to feed a fire in order to cook and stay warm.

Under siege in Madaya, it’s as if every part of my life has ground to a halt. I feel like an inanimate object. You can’t feel, you can’t think and you can’t grow. It’s purgatory. My mind is rotting, atrophying. I’m forgetting everything that ever learned. It would take 10 lifetimes to make up for what I’ve lost here.

We’ve reached the point where we’ve begun asking the regime and Hezbollah to kick us out of our land, and even that hasn’t gotten a response.

We’re ready for this suffering to finally end, and we’re prepared to do so by any means necessary. For so long, we’ve lived under encirclement. There’s been no food, no medicine, diseases spreading every single day and so many injuries from sniper fire. What matters most to the people of Madaya is that this suffering ends. This is all that matters.

Recently, there was a proposal drawn up for us to leave. This wasn’t like any previous reconciliation deal where those wanted by the regime would leave and anyone prepared to accept amnesty could stay. No, this was something new. Here, the regime guaranteed that every last person would leave Madaya for Idlib, and, in exchange, everyone from al-Fuaa and Kafariya would come here. But there was never a response from the Victory Army.

The only obstacle that we face right now is negotiating our departure in coordination with the Four Towns Agreement. If you were to poll the streets right now, you’d see that 100 percent of people are in favor of leaving Madaya and finally ending this ordeal. I’m one of those people. [Ed.: Syria Direct interviewed five Madaya residents regarding their respective willingness to leave the town. Each expressed a somewhat varying opinion, ranging from reluctant acceptance of leaving to firm opposition]

They’ve bombed us for a year and four months, and they’ve done so whenever they please. If there’s some issue between a husband and a wife in Idlib or in Binnish and they decide that these two feel like shooting up al-Fuaa and Kafariya, we’re the ones that have to pay the price for their mistake. We’re left bearing the full weight of bombs because of the stupidity of a few, and that’s on all sides: the Victory Army, the regime and Hezbollah.

Once the bombing starts, there’s nothing you can do to respond. If we do try to respond with some gunfire, we’re met by an incomparable barrage of bombs and bullets.

Three years ago, I was supposed to graduate from dental school and live a normal life. I would have opened up a clinic just like any ordinary dentist. But, instead, I’ve been thrust into an inexplicably difficult position. There are no trained doctors here in Madaya, and so the lives of so many people are in my hands. It’s an immense responsibility where truly any small mistake could mean the difference between life and death. This is only exacerbated by the fact that we lack so much of what is necessary to keep people alive. This eats at me, constantly, and my conscience is racked with guilt, but I recognize that there’s just nothing else that we can do.