But although the United Nations is feeding more than 3.8 million people in Syria, those most in need are not being reached because of the complicated dynamics of the battlefield. Fighters loyal to the government of President Bashar al-Assad surround numerous rebel-held neighborhoods, notably in the suburbs of Damascus, and refuse to allow access to food or medical aid as part of what U.S. and other Western leaders have repeatedly described as a policy of deliberate obstruction.
U.N. officials say they are especially alarmed at the reports of a growing number of deaths emanating from Yarmouk, just a few miles from the heart of Damascus, the capital.
“There is profound civilian suffering in Yarmouk, with widespread incidence of malnutrition and the absence of medical care,” said Chris Gunness of the U.N. Relief and Works Agency, which is charged with helping displaced Palestinians across the region.
Most camp residents have long been eating little other than stale vegetables, powdered tomato paste and animal feed, he said.
Camp residents and activists on Tuesday reported the deaths of two more people from hunger, bringing to 48 the number who have died since November from illnesses related to the siege, according to Farouq al-Rifai, an activist in Yarmouk who uses a pseudonym to protect family members living in government-held areas.
At least five of those deaths were directly caused by malnutrition, he said, while others were attributable to a range of causes related to the lack of food and medicine, including anemia and diabetes. Some are dying of illnesses related to the poor quality of food, such as a family of five that killed and ate a cat and then succumbed to food poisoning, Rifai said. Some food is available, but at prices that few can afford; most people are subsisting on meager quantities of lentils, onions and, sometimes, boiled grass.
All of the victims have been children and the elderly, but “the hunger is inescapable for everyone,” Rifai said.
Gunness said the United Nations could not confirm deaths from starvation, but it has noted the reports with alarm.
“Yarmouk remains closed to humanitarian access and remains a place where extreme human suffering in primitively harsh conditions is the norm,” he said.
The deprivation brings more suffering for Palestinians who fled their homes after the creation of the state of Israel in 1948 and have since lived, with their descendants, as refugees in camps across the region, making them uniquely vulnerable to its many crises.
More than 160,000 Palestinians lived in Yarmouk on the eve of the uprising in Syria, which began in 2011, but most have since fled the fighting, reducing the population to about 18,000, according to the United Nations. The number may be higher, because thousands of displaced Syrians also have taken refuge at the camp.
Yarmouk residents accuse forces loyal to Assad of blocking access to relief convoys. The government blames “terrorists” inside the camp, including members of the radical Jabhat al-Nusra, which it claims has sought sanctuary there.
Gunness said an aid convoy on Monday was forced to turn back after a firefight erupted as the vehicles approached a loyalist checkpoint on the southern entrance to the camp. The government had denied access to a safer route through a northern checkpoint closer to the capital, he said.
Western leaders say the government is preventing aid from reaching Yarmouk and other besieged Damascus suburbs where conditions are reported to be dire, as well.
“The deliberate obstruction of humanitarian aid to the Syrian people is . . . utterly unacceptable,” British Foreign Secretary William Hague said Tuesday.
The issue of access to humanitarian relief is expected to feature on the agenda of U.N.-sponsored peace talks set to be held next week in Switzerland, where it is hoped that the Syrian opposition and the government will meet for the first time to discuss an end to the three-year-old conflict. The United Nations estimates that 9.3 million Syrians in the country and 2 million outside are in urgent need of aid.
In a video posted Monday on YouTube, a teenage boy living in the Yarmouk camp described the anguish of residents.
“We just want to eat and drink, and we have no money,” he said. “What have we done to be part of this?” he added, breaking into sobs. “It is nothing to do with us.”