Despite many claims the war in Syria is ebbing, one besieged pocket of rebel-aligned civilians near the Syrian capital is at a "critical point," says the International Committee of the Red Cross (ICRC).
They are experiencing the worst outbreak of child malnutrition yet in the savage six-year civil war, and in need of an emergency medical evacuation of more than 100 children, say UN officials.
An estimated 400,000 civilians in the suburban enclave of Eastern Ghouta have suffered from both a lengthy siege and continued bombardment. This has come amid a climate of peace talks and a victory declaration from Moscow in which Russian President Vladimir Putin said his military forces would begin to withdraw.
The ICRC's Middle East director, Robert Mardini, warned this week: "The humanitarian situation in Eastern Ghouta has reached a critical point. As so often in Syria over the last six years, ordinary people are once again trapped in a situation where life slowly becomes impossible and where goods and aid are severely limited."
"The sick and injured must not be used as pawns in negotiations between the different parties involved in the fighting," Mardini added.
'Starve or surrender'
Doctors and aid workers say it is children who are -- as has often been the case in this war -- suffering the hardest. In a grim, new superlative amid the sectarian war's brutality, the UN has declared the acute child malnutrition being experienced in Eastern Ghouta to be the worst the conflict has yet seen. An estimated 11.9% of children under five have acute malnutrition there -- up massively from a similar survey in January that recorded a rate of just 2.1%. A third of the children in Eastern Ghouta are said to have stunted growth as a result.
To blame is a four-year siege laid on the area by the regime, widely criticized for using food as a weapon of war. The tactic of "starve or surrender" -- in which rebel territories are starved into submission -- has caused several holdout rebel areas to eventually return to regime control.
It causes what little food there is to become unaffordable. The UN recorded bread prices recently as being 85 times higher in Eastern Ghouta than in central Damascus, less than 10 miles away. A cylinder of cooking gas, in the punishing winter, costs $300 in Eastern Ghouta compared to $44 in the capital, said the UN.
'Malnutrition is the biggest issue'
CNN has obtained video footage from the Syrian American Medical Society which shows the injuries and starvation affecting children there. It shows Ameera, age 1, yet underweight at only five kilos, and Noor, age 4 but only 10 kilos.
Dr Amani Balour, a pediatrician in Ghouta, told CNN: "Malnutrition is the biggest issue, but children are also suffering from communicable disease. We see many respiratory and intestinal problems ... due to lack of hygiene and unclean air from cooking smoke because there are no stoves available. Also much of the water is unclean because of the siege. We also see children with signs of mental illness, but we cannot offer them anything."
The footage emerges as the UN declares that 137 children need emergency evacuation for medical treatment. The footage shows tiny Qasim, part of whose face is heavily injured from bombardment on December 3, struggling to cling to life in intensive care. His mother died in the same bombardment.
While his suffering in a Ghouta hospital has mostly gone unseen, the head injuries of another young boy from Ghouta, 2-month-old Karim Abdel Rahman, have sparked a hashtag on social media. Karim lost an eye in an October airstrike, and diplomats and aid workers have posted pictures of themselves, covering one eye with their hand, in solidarity.