Russia and Syria are preventing essential humanitarian aid from reaching starving, sick civilians in east Aleppo, according to the United Nations.

Around 200,000 people desperate for food and medical equipment remain trapped by fierce fighting in the rebel-held district of Syria's second city where surgeons are reported to be operating in basements without anaesthetic.

Image: Some 30,000 civilians are estimated to have fled the besieged city in four days

UN envoy Staffan de Mistura said the Russian and Syrian governments have declined requests for a ceasefire to allow aid to get through and to allow for the emergency evacuation of 400 people desperate for medical treatment.

President Bashar al Assad and Moscow have instead offered to discuss the opening of four safe corridors through which civilians and surrendering rebels could escape and the UN has urged Al Nusra militants to leave to help broker a ceasefire.

Image: Many have fled to safer ground in areas under government or Kurdish control

Since Saturday it is estimated 30,000 people have used unauthorised escape routes to flee eastern districts of Aleppo which have been under siege for four months as Syrian and Russian forces continue their push to retake the city.


Regime forces captured another six rebel-held eastern districts over the weekend.

Aleppo at risk of becoming 'giant graveyard'

Government forces have overrun the northern area and, while southern areas are still under rebel control, civilians there are cut off and caught in the crossfire.

Many have reportedly fled to safer ground in areas under government control or a Kurdish-controlled enclave between the city's two sectors.

Image: Children sheltering in the town of Jibreen some 10km (six miles) north of Aleppo

The UN, the Syrian Red Crescent and Russia have been administering aid to those who have made it to west Aleppo.

Fawwaz al Ashaari stayed on in the Sakhur neighbourhood of east Aleppo through the loss of his eldest son and his home.

As the fighting got closer his family joined a mass exodus to government territory across the front lines.

Image: Hundreds of refugees are currently sheltering in three concrete blocks that make up a reception centre in the town

They are among hundreds of refugees sheltered in three concrete blocks that make up a reception centre in the government-held town of JIbreen about 10km (six miles) north of the city.

"I can't lose any more," he said while recovering in a temporary shelter, his back propped up against his battered black suitcase, adding he now had a single wish.

Image: A Syrian boy evacuated from eastern Aleppo eats bread in the government controlled Jibreen

"The rest of my children only want to live in safety. They have seen death several times. I want them to know life."

Aleppo is seen as a vital strategic prize for the Syrian government as it is the last city still holding out against the Assad regime and it controls trade and military supply routes to Turkey.