The baby girls' skin crinkled like thin paper, as their tiny mouths opened in pain. Their bodies could no longer cope with Syria's war.

Abeeda Fawaidar and Sahar Devdeh both died this week after just a month of life - the latest victims of the Syrian regime-imposed siege on the Eastern Ghouta area of rural Damascus.

Yahia Abo Yehia, a doctor at the hospital in Eastern Ghouta that treated the two babies, said they died because of malnutrition and a lack of equipment to treat intestinal complications.

"There is no medical treatment for these cases," he told Al Jazeera. "There is a lack of specialist equipment for measuring electrolytes and blood composition or for scanning."

Aid supplies met only five percent of nutritional needs in the region, Abo Yehia said, and children were severely lacking in vital nutrients.

"As a paediatrician, I feel that the children of the world are my children. I suffer for their suffering," he said. "How do you feel if your child dies before your eyes and you cannot give him anything? It is something painful."

Four-year siege

Eastern Ghouta, once renowned for its fertile soils and rich agricultural production, has been surrounded by Syrian government forces for four years. Once-abundant food supplies have dwindled, and medical supplies are almost completely gone.

"We have many diseases to work on. There is no possibility of kidney dialysis, treating tuberculosis, liver inflammation, blood pressure disorders or diabetes," Abo Yehia told Al Jazeera.

"The facilities in the centres are very bad. There are no sterilisation devices. There is no fuel to run the appliances."

Eastern Ghouta was supposed to be one of the "de-escalation zones" brokered a year ago by Iran, Russia and Turkey. But civil defence workers in the area report almost daily artillery fire and air raids, often resulting in civilian fatalities. They estimate that 955 surface-to-surface missiles have been dropped on Eastern Ghouta since July and 126 people killed.

Siege conditions in Eastern Ghouta have continued to deteriorate, constricting food, medical and educational supplies to hundreds of thousands of people, observers say.

"In the past, food and necessities entered, at inflated prices, via intermediaries and dealers," local activist Abed al-Mayeen told Al Jazeera. "Three months ago, the siege tightened, and since then little food or medicine has entered the area. The situation is getting worse; there is a shortage of food, medical supplies, milk and food supplements. This is truly the worst the siege has ever been."

Rising frustration

A 42-truck aid convoy operated by the Syrian Arab Red Crescent, the International Committee of the Red Cross and the United Nations was allowed to enter some areas of Eastern Ghouta in late September. It delivered food, school supplies and children's clothing to 25,000 people in three besieged towns. But that is a small proportion of the estimated 400,000 people in the area.

Al Jazeera spoke with multiple residents in various areas of Eastern Ghouta about the prices for basic goods in their hometowns.

Aosus, a civil society organisation in the region, said a bag of bread cost 1,100 Syrian pounds ($2.10), a kilo of sugar 4,600 pounds, and a kilo of bulgur wheat 1,800. Eyad Swrewel, a media activist in Douma, one of the areas worst hit by the siege, cited even higher prices, putting the cost of a kilo of sugar at 6,000 Syrian pounds ($11.60).

Residents in Eastern Ghouta have grown increasingly frustrated with what they see as insufficient action by the international community.

"Siege and starvation have been used as a tactic of war by the Assad regime for the past six years," Jamal Malek, an aid worker in Eastern Ghouta working under a pseudonym, told Al Jazeera.

"I can't believe the United Nations and international community is unable to do anything to help us. I am a father, and I look at my 16-month-old girl and say to myself, this is her fate too [malnourishment] if the siege continues."

The Syria Institute, which co-produces quarterly reports on sieges in Syria with the Netherlands-based NGO, PAX, said the area risked becoming "the next eastern Aleppo" unless the international community, including the UN Security Council, "increased political pressure on besieging parties and their allies".

'We are crying'

Valerie Szybala, executive director of the Syria Institute, said the siege on Eastern Ghouta has tightened in the past few months, marking a particularly worrying case of a besieged community in Syria, where countrywide, more than 800,000 people live under blockade.

"Recently, the lack of basic needs has become more acute since the government cut off the limited commercial trade at al-Wafideen checkpoint around three months ago," Szybala told Al Jazeera.

On top of the government-imposed siege, the situation is complicated by internecine fighting between the rebels controlling Eastern Ghouta.

"Eastern Ghouta was plagued throughout the reporting period by fighting between armed opposition groups," said the latest siege report from the Syria Institute and PAX. "The outcry from civilians in the form of protests and mediation initiatives had little success in stemming the simmering tensions, which are likely to continue for the foreseeable future."

Talk of de-escalation zones and aid deliveries mean little to those not benefiting from them. Many in Eastern Ghouta are still watching month-old children waste away.

"We are crying now, but we can't do anything," al-Mayeen said. "There is no way of comprehending what it is like inside here."