“Damascus a city in paradox | Jobar in dark & regime-held neighborhoods in the distance #Syria (via @lensdimashqi)” – via Majd Arar

This article, now modified to reflect more recent developments, was originally published on October 27, 2013, in Italian, in the newspaper Il Foglio.

Names and minor details have been altered to protect the identity of sources.

“Now starts the evening symphony: bom bom, smatter smatter.” The shelling could go on for hours, a throaty baritone emanating from Bashar al Assad’s artillery bases that ring Damascus. Many people across Syria’s capital city report the same thing. This time, the woman describing this fury to me is not the recipient of this rage. Many of her patients, however, are not as lucky.

Catherine (a pseudonym) works in a charity day clinic which provides medical attention to those who could not otherwise afford it, especially mothers, and children. But what she is seeing now is a horrifying new reality in Damascus. Surrounded by war and shut off from the suburbs because of government checkpoints, many of the clinic’s patients are refugees who fled into the capital to stay with family before the worst of the violence started. She learns about the conditions just a few kilometers away from those who still have family there, “and from the newly arrived. Workers families mostly live in the outskirts of town and in small villages. I made field trips to check families.” Now, however, Catherine and others can’t reach outside of the city.

The situation just outside of the center of Damascus is dire. In Moadamiyah, just a few kilometers west of where Syria’s President sleeps, the town is sealed off from the outside world by artillery fire, snipers, bombing runs, and government checkpoints. Unable to flee the violence, and unable to get food into the city, there have now been four documented cases of children starving to death (and rising). During the shelling, water pipelines have been destroyed, turning even drinking water into a commodity. In recent days, the regime and the rebels have tried to broker a peace in order to evacuate civilians. Those efforts have met with mixed results. The New York Times documented more chaos on last week, as civilians trying to flee the suburb were killed by incoming artillery fire. But as journalist Michael Weiss reports in his thorough examination of the situation in Moadamiyah, even when civilians escape, their suffering does not end there:

[Last week], locals were able to get around 600 women, children and seniors out of Moadamiyah after a cease-fire was brokered with the regime. They were taken to Qusaya, a Damascus town completely controlled by Assadist forces where the inevitable happened, according to Zakarya [a rebel spokesman in the town]: 10 children were kidnapped by intelligence agents and beaten into confessing information about the whereabouts of FSA fighters and activists inside Moadamiyah. “Four of these kids were released after 10 hours and told us the story,” Zakarya said. “Another six are still missing.” Power outages mean communicating with those outside the town is difficult. Zakarya said that to fuel his cellphone, which he was using to talk to me, car and scooter batteries were rigged up as homemade generators.

On October 29th, 1800 civilians were “evacuated” from Moadamiyah, a humanitarian effort orchestrated by the Catholic nun, Mother Agnes Mariam. However, this nun, an apologist for the Assad regime, once again betrayed the trust of those who cooperated with her. According to a new report, several hundred of those who fled starvation were not taken to receive medical treatment, but were brought to the Mezzeh airforce base, where they will be interrogated. As the starvation worsens inside Moadamiyah, the situation that its refugees face may be just as brutal.

Moadamiyah has received significant press attention, and this past Friday opposition protesters in the northern Syrian town of Kafranbel held up protest banners to call attention to the starvation there. One banner read, in English, “Should anyone have to eat cats and dogs to survive?” Another mimicked the famous photograph that Kevin Carter took in Sudan, showing a vulture waiting to feast on a starving child. Things are so bad there that Moadamiyah has become a rallying cry for the opposition, and a symbol of the world’s indifference.

But the area affected is now much wider than Moadamiyah. Children are starving to death across a ring that nearly encircles the capital. There have been confirmed starvation deaths in the south of the capital as well, in Hajira al Balad and Hajar al Aswad, and even in Douma to the northeast. All of the documented fatalities, so far, are children. Other children are shown in desperate pleas posted on Youtube, skinny, dirty, and without hope that their situations will improve any time soon.

And it’s not just the suburbs of Damascus that are affected any more. Many of those whom Catherine treats in the clinic are now living like refugees inside the perimeter of Assad’s control. The lucky ones are living with relatives, but there aren’t enough jobs to go around, food prices have exploded, and day clinics like the one Catherine works in cannot take patients overnight to ensure that they have what they need to survive.

“They’re now living inside the city with relatives, if they have any, in rented flats with 4-5 families per flat. Some live in parks under a tree…most have run out of money but have nowhere to return to.” Lice, eczema, diarrhea and pneumonia are now common because of the poverty, and the malnutrition. Most have dirty clothes because they cannot afford laundry detergent, and because access to running water is limited. Winter is approaching, but heating oil has become extremely expensive, and even if the refugees could afford it, it wouldn’t help many of them. “This winter will be horrible for most. You cannot stay warm in a tent.”

“Baby milk used to cost 250 Syrian Pounds (SP). Now it costs 1250 SP,” a five-fold increase. Lentils have doubled or tripled their price, from 80 SP to 190-235 SP. “But most of the clinic’s patients don’t have any work, so they couldn’t buy the food anyway.”

Catherine is well aware that there are people starving in the suburbs. But even inside the capital things are now desperate. Women send their babies to the clinic for treatment because they cannot provide for their own. She says that some mothers weigh only 33 kgs (about 73 pounds). Realizing that her patients cannot stay there, the clinic provides food packages, lentils, baby food, etc., and sends the patients on their way. But the food meets “sticky fingers.” Catherine says that sometimes her patients are living within city limits, and sometimes they are allowed to pass through government checkpoints “from all the places you hear about in the news,” but that their food and supplies are confiscated by Assad’s soldiers when the patients attempt to return.

In the clinic, there is also the sense that the walls are closing in. On several occasions, rebel mortar shells have landed near enough to the clinic to create intense air pressure, blowing smoke and debris through the doors and sending already-feeble patients flying. Increasingly, car bombings nearby in the city have everyone on edge. But the overwhelming feeling expressed by many these days is a resignation that things will only get worse.

“You do what you can,” Catherine writes. “You get used to everything. You cannot do anything about it anyway. Your country (The United States) was supposed to do something… Lame, don’t care, it seems.”

No matter how hard clinic volunteers work, however, Catherine is right. They are only providing bandages for Syria’s gushing and ever-widening wounds. The war on Damascus’s horizons shows no sign of abating, and until it does the number of lifeless and emaciated children will grow, and populate an ever-growing number of dots on Syria’s map.