Residents of a rebel-held town near Damascus are suffering from severe malnutrition and have little access to fuel and medical supplies because of a siege by the Syrian military.

The town of Madaya, about 25 kilometres north-west of Damascus, has been under siege since July by President Bashar al-Assad's soldiers and fighters from the Lebanese Hezbollah movement.

Local activists say an estimated 40,000 people have little access to food and medicines.

"Food is rare. We cannot provide milk for infants," Khaled Mohammed, a doctor at a field hospital, said on Wednesday. "Today, a 10-year-old chid died of malnutrition. People are eating grass to stay alive."

The doctor told dpa that "most of the people in Madaya suffer from severe malnutrition to the extent that they started about 10 days ago to slaughter dogs and cats and eat their flesh."

"The situation in Madaya is very difficult," spokesman for the Red Cross in Damascus, Pawel Krzysiek, said.

"People are hungry and it is very cold out there with no electricity or fuel," Krzysiek told dpa, adding that locals were heating plastic to keep themselves warm.

The opposition Syrian National Coalition warned of a "humanitarian catastrophe" in Madaya.

"There must be an immediate move to save lives of the civilians and end siege on Madaya and other areas in Syria," the alliance said in a statement.

The Syrian Observatory for Human Rights said Monday that at least 23 people, including children, had died in Madaya because of the siege and mines laid by al-Assad's forces around the town.

At least 300 children in Madaya are also suffering from malnutrition, the Britain-based monitoring group reported.

More than 250,000 people are estimated to have been killed in Syria's conflict since it started in 2011.

Nine people were killed and more than 30 wounded in shelling Wednesday on government-held central Damascus, the Observatory and state media reported.

Rocket shells hit Abid Street, which runs between the parliament building and the central bank, as well as other areas of the city centre, the watchdog said.

Central Damascus is regularly hit by mortar and rocket shells fired from rebel-held areas on the outskirts of the capital, which have themselves been devastated by three years of artillery shelling and airstrikes.

State news agency SANA blamed the shelling on the Army of Islam, a powerful rebel group which controls most of the eastern suburbs. A spokesman for the group told dpa it was not responsible.

The Army of Islam's commander, Zahran Alloush, was killed in an airstrike in late December, two weeks after the group participated in an opposition summit in Saudi Arabia aimed at putting together a negotiating team for planned peace talks later this month.

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