“The shocking images of what appear to be severely malnourished children that have emerged in recent days are a frightening indication of the plight of people in Eastern Ghouta, who are now facing a humanitarian emergency,” said UN High Commissioner for Human Rights Zeid Ra'ad Al Hussein in a news release from his office (OHCHR).

Eastern Ghouta, on the outskirts of the nation's capital, is being considered one of the “de-escalation areas” brokered in May by Iran, Russia and Turkey under the Astana process. However, residential areas, including those areas previously spared attack, are now being hit on an almost daily basis by ground-based strikes by Government forces and their allies.

The UN human rights office has also received reports of armed opposition groups conducting ground-based strikes on Damascus.

Various armed groups controlling the area have restricted the work of humanitarian organisations, and clashes between these groups have for months limited civilians' freedom of movement within the region.

The UN last reached Eastern Ghouta on 23 September. Between January and September, the Government only accepted 26 per cent of requests to deliver assistance to besieged and hard-to-reach areas.

“I remind all parties that the deliberate starvation of civilians as a method of warfare constitutes a clear violation of international humanitarian law, and may amount to a crime against humanity and/or a war crime,” said Zeid.

Unidentified attackers reportedly stormed and looted a food warehouse in the Eastern Ghouta town of Hamourya on 19 October. The following day several hundred people allegedly looted a second warehouse in the town – a possible sign of growing desperation.

“If parties to a conflict cannot meet the needs of the population under their control, they must allow and facilitate efforts by impartial humanitarian agencies to provide aid, including by granting them the right of free passage,” he stressed.