Hala, a 2-year-old girl, suffers from the lack of medical care and adequate nourishment at her home in the rebel-held town of Saqba in Eastern Ghouta, Syria, on Oct. 25. Aid agencies warn the situation is worsening, despite an international agreement to implement a “de-escalation zone” in the area, which has decreased violence but led to no new access for food, medicine and humanitarian aid. (Abdulmonam Eassa/AFP/Getty Images)

In the final days of Sahar Devdeh's life, her parents feared their hugs might break her. She barely moved. She was too weak to cry. At times, her doctor thought, she looked more like a skeleton than a month-old baby. 

When she died last week at 34 days old, Sahar became a stark casualty of a growing food crisis in a pocket of the Syrian capital. Aid groups warn more deaths will follow.

The story of how a child dies of hunger is not a simple one. In the besieged suburb of Eastern Ghouta, food supplies did not dry up overnight. Even after years of violence, families still managed to cope, spending savings on food sold at inflated prices and finding creative solutions when the fuel ran out.

Slowly, after years of a government blockade, warlord profiteering and international paralysis over the appropriate humanitarian response, residents of this suburb once known as the breadbasket of Damascus have reached a breaking point. 

"What we saw with baby Sahar was just the start of a tragedy," said Hamza Hasan, a representative of the Syrian American Medical Society in Eastern Ghouta. "If things continue as they are, there will be many, many more."

Forces loyal to Syrian President Bashar al-Assad have long besieged rebel-held areas to push them to surrender. Six years into the war, government forces have recaptured most opposition areas, with only a handful still dominated by fighting.

Just east of Damascus, Eastern Ghouta is one of the most strategically significant of the disputed ­areas. About 385,000 residents still live in the suburb, once home to fertile farmlands that supplied the capital with food.

When the blockade of Eastern Ghouta began in mid-2013, business executives on both sides of the political divide smuggled food, fuel and clothing through a lucrative network of tunnels.

Late last year, the Syrian government recaptured nearby districts and sealed those routes for good. Then on Oct. 3, it closed the only entry point accessible to commercial and humanitarian convoys.


A mother holds her 6-month-old twins Safa and Marwa, who suffer from malnutrition, in the Hazzeh area, in the eastern Damascus suburb of Ghouta, Syria, on Oct. 25. (Bassam Khabieh/Reuters)

Figures provided by UNICEF, the U.N. children's agency, suggest that about 1,100 children in Eastern Ghouta are suffering from some form of malnutrition. Chronic shortages of medicine have compounded the problem. Doctors who worked on Sahar's case said she died of intestinal complications that medics were unable to treat. At least two other young children died of hunger-related issues last month.

The Washington Post interviewed nine residents of Eastern Ghouta by phone, each of whom described the toll of the siege on their lives.

For Umm Sayyah, 28, the siege's strangling grip has meant worrying as her 2-year-old daughter, Hala, wastes into a bundle of bones.


Two-and-a-half year-old Hala al-Nufi is held by her uncle in the Saqba area in the eastern Damascus suburb of Ghouta, Syria, on Oct. 25. Hala suffers from a metabolic disorder that is worsening because of the siege and food shortages in the eastern Ghouta. (Bassam Khabieh/Reuters)

When Hala fell ill at 7 months old, the family paid smugglers to take them through the tunnels and out to the children's hospital in Damascus. "She put on weight, she was eating. She recovered there," Umm Sayyah said. "We could give her pieces of apple, pieces of banana, all of the things she couldn't get back in Ghouta."

When Hala became sick a second time, there was no way out.

A series of photos show her decline from a round-faced, smiling infant to one so thin she's unrecognizable. Ribs protrude through shrunken skin. Doctors said the toddler now weighs just over nine pounds.

"We can only give her water, and it goes right through her," Umm Sayyah said. "She sleeps for 15 minutes, and then she starts screaming again. I'm so tired."

Under the terms of a cease-fire agreement brokered by Turkey, Russia and Iran, Eastern Ghouta was supposed to receive aid from the United Nations. On Monday, the first humanitarian convoy in more than a month arrived in the suburb, delivering supplies to tens of thousands of residents but leaving most empty-handed.

Government bombing has ­resumed, targeting militant groups, but also the marketplaces in which goods are sold. Dozens of civilians have been killed.

Speaking recently in New York, the U.N. special envoy for Syria, Staffan de Mistura, described the trend as "re-escalation rather than de-escalation."

De Mistura said violence could intensify in coming months as Syrian government forces shift their attention from the country's remaining pockets of Islamic State-held territory and toward the final rebel holdouts.

"The desired improvement on humanitarian access therefore continues to elude us," he said.

In Eastern Ghouta, women no longer come to the community center Layla Bikri runs.

Many are too frail to travel far.

Bikri, 26, who works with the Syrian nonprofit Women Now for Development, described watching children walk past the few shops that still sell sweets, which are far too expensive for their parents to afford.


A bowl of starch cooks on the stove in a house where a Syrian family is taking shelter on Oct. 25, in Haza, a town in the rebel-held eastern Ghouta area that has been under government siege since 2013. (Abdulmonam Eassa/AFP/Getty Images)

"When you see them, they look so sad. Back in the days that we had dessert, I used to promise my daughter a piece at the end if she was good. Now when she asks, I give her pieces of corn. A piece of corn each time," she said.

Tamara Kummer, a UNICEF spokeswoman, said the pictures from Eastern Ghouta served as a grim reminder of the toll on the youngest Syrians.

"The psychological impact will be huge. They can't eat when they are hungry, they don't even have access to the most basic goods or infrastructure," she said. "If you're in that situation, you don't have a childhood anymore."

According to UNICEF, about 80 percent of Syria's children have been affected by the war, either living amid violence at home or as refugees abroad.

With winter fast approaching, chronic shortages of fuel in Eastern Ghouta are expected to make the situation worse. Aid officials and local humanitarian workers said substitutes — wooden benches, plastic bags — have mostly been used up.

Bikri said her job is getting harder. "I'm trying to give women and children hope that I just do not have," she said. "I'm describing to you how we live here, but you just can't imagine it. It feels hopeless here."

Zakaria reported from Istanbul.