Sick children dying as lifesaving medicine waits at checkpoints, youngsters forced to survive on animal feed and leaves, and families burning their mattresses just to find something to keep them warm.

Schools moving underground for shelter from barrel bombs, the crude, explosive-filled and indiscriminate crates that fall from the sky and are so inaccurate that some observers have said their use is a de facto war crime.



The wounded left to die for lack of medical supplies, anaesthetics, painkillers and chronic medicine; children dying of malnutrition and even rabies due to the absence of vaccines, while landmines and snipers await anyone trying to escape.



The scenes are not from second world war death camps or Soviet gulags. They are the reality of life for more than a million Syrians living in besieged areas across the war-torn nation, according to a report by Save the Children.



Tanya Steele, the charity’s chief executive, said: “Children are dying from lack of food and medicines in parts of Syria just a few kilometres from warehouses that are piled high with aid. They are paying the price for the world’s inaction.”



At least a quarter of a million children are living in besieged areas across Syria, Save the Children estimates, in conditions that the charity describes as living in an open-air prison.



The report is based on a series of extensive interviews and discussions with parents, children, doctors and aid workers on the ground in besieged zones.



It illustrates with startling clarity the brutality with which the conflict in Syria is being conducted, five years into a revolution-turned-civil-war that has displaced half the country and killed more than 400,000 people.



The suffering of people in besieged areas in Syria is also an indictment of the failure of the international community to bring an end to the crisis. Less than 1% of them were given food assistance in 2015 and less than 3% received healthcare.



Rihab, a woman living in eastern Ghouta near Damascus, which has been besieged by Bashar al-Assad’s regime, was quoted as saying: “Fear has taken control. Children now wait for their turn to be killed. Even adults live only to wait for their turn to die.”

A truce negotiated last month by major powers was supposed to bring relief and aid into the besieged areas, but humanitarian workers and activists say the Assad government, which is conducting the vast majority of siege warfare in the country, has repeatedly delayed access, potentially in violation of the truce agreement.



The halting ceasefire has therefore brought scarce relief to what agencies including Médecins Sans Frontières estimate are 1.9 million people living in besieged and hard to reach areas.

Nearly all those surveyed by Save the Children reported that children had died in their communities due to a lack of medication caused by the siege. Many had cut down their meals and some did not have enough for even one meal a day, while 25% reported that local children had died from a lack of food.



The report documents other tragedies of life under siege: an increase in sexual violence, child labour, petty crime, violence and school closures as a consequence of airstrikes and material shortages.



Ahmed, a boy living in the besieged Damascus suburb of Douma, told interviewers: “When I hear the sound of a shell or a plane then I get very afraid and I hurry to escape and hide under my bed.”



Rihab said: “Here there are no children any more. Only small adults.”

