Adonis Diaries

Rana Obaid began her life less than two years ago in a comfortable house draped with roses, the daughter of a grocer locally famous for his rich homemade yogurt.

War and siege brought hunger so quickly to their town near Damascus that when she died in September, at 19 months, her arms and legs were as thin as broomsticks.

ANNE BARNARD Published this November 2, 2013 on nyt

In a nearby town, a woman with a son suffering from kidney failure makes her children take turns eating on alternate days.

In a village outside Aleppo in northern Syria, people say they are living mainly on wild greens.

Aid workers say that Syrian refugee children are arriving in northern Lebanon thin and stunted, and that suspected malnutrition cases are surfacing from rebel-held areas in northern Syria to government-held suburbs south of Damascus.

Across Syria, a country that long prided itself on providing affordable food to its people, international and domestic efforts to ensure basic sustenance amid the chaos of war appear to be failing.

Millions are going hungry to varying degrees, and there is growing evidence that acute malnutrition is contributing to relatively small but increasing numbers of deaths, especially among small children, the wounded and the sick, aid workers and nutrition experts say.

The experts warn that if the crisis continues into the winter, deaths from hunger and illness could begin to dwarf deaths from violence, which has already killed well over 100,000 people, and if the deprivation lasts longer, a generation of Syrians risks stunted development.

“I didn’t expect to see that in Syria,” said Dr. Annie Sparrow, an assistant professor and pediatrician at Mount Sinai Hospital in New York, who examined Syrian refugee children in Lebanon and was shocked to find many underweight for their height and age.

“It’s not accurate to say this is Somalia, but this is a critical situation,” she said. “We have a middle-income country that is transforming itself into something a lot more like Somalia.”

While the war has prevented a precise accounting of the number of people affected, evidence of hunger abounds.

The government is using siege and starvation as a tactic of war in many areas, according to numerous aid workers and residents, who say that soldiers at checkpoints confiscate food supplies as small as grocery bags, treating the feeding of people in strategic rebel-held areas as a crime. Rebel groups, too, are blockading some government-held areas and harassing food convoys.

But even for those living in more accessible areas, what aid workers call “food insecurity” is part of Syrians’ new baseline.

Inflation has made food unaffordable for many; fuel and flour shortages close some bakeries, while government airstrikes target others; agricultural production has been gutted.

Though the World Food Program says it is providing enough food for 3 million Syrians each month, its officials say they can track only what is delivered to central depots in various cities, not how widely or fairly it is distributed from there.

One aid worker — who, in a sign of the political challenges of delivering aid in Syria, asked that his organization not be identified — said he recently met Syrian health workers who reported a dozen cases of apparent malnutrition in a government-held Damascus suburb. He suspected that the situation could be far worse in rebel-held areas.

Lack of medical care and clean water exacerbates the problem.

So does the fact that Syrians have little experience diagnosing or treating malnutrition. Particularly troubling, aid workers say, are reports of mothers who stop breast feeding, unaware that it is the best way for even a malnourished mother to keep her child alive.

Some aid groups are trying to train Syrian doctors to use simple tools that measure upper arm circumference to assess malnutrition, as convincing data on its prevalence could help spur a stronger international response.

Aid workers caution against overblown claims that could discredit such efforts. Some government supporters even dismissed the images of bone-thin children from blockaded areas as propaganda after several thousand civilians were evacuated from the encircled Damascus suburb of Moadhamiya in recent weeks, looking exhausted, shellshocked and thin, but not on the verge of starving to death.