“I am deeply alarmed by the extreme escalation in hostilities in east Ghouta,” Panos Moumtzis, UN Regional Humanitarian Coordinator for the Syria Crisis, said in a statement issued following clashes that killed over 40 civilians and injured more than 150 injuries in the besieged enclave.

Hundreds of civilians, many of them women and children, have lost their lives or been injured in airstrikes and shelling since November. There have been daily reports about civilians being killed and others being severely wounded, in addition to warehouses, hospitals and schools being damaged or destroyed.

The recent escalation of violence compounds an already precarious humanitarian situation for the 393,000 residents of east Ghouta, many of them internally displaced, and which account for 94 per cent of all Syrians living under besiegement today.

“The humanitarian situation of civilians in east Ghouta is spiraling out of control,” Moumtzis warned, noting that the lack of access to besieged areas has led to severe food shortages and a sharp rise in food prices, malnutrition rates have now reached unprecedented levels, and the number of people requiring medical evacuations continues to surge.

“We continue to call for unconditional, unimpeded and sustained access to close to 3 million people in besieged and hard-to-reach locations across Syria, including east Ghouta, and urge all parties to the conflict to strictly adhere to their obligations under international humanitarian law to take all feasible measures to protect civilians from harm,” he said.