An intense siege led by government forces on a rebel-held town near Damascus is taking its toll on thousands of trapped locals. Humanitarian aid is on its way in a race against the clock to save the town's already starving residents.

When wintery weather brought snowfall to the Syrian town of Madaya, pleas for food aid became all the more urgent.

“The snow has covered most of the vegetation such as grass and tree leaves, which people eat to survive,” Mazhen Burhan, an activist and resident in the rebel-held town, told dpa via Skype.

Now time is running out to save the thousands of people in Madaya, as a siege led by government forces continues to strangle the flow of food and other resources to the town.

"The situation is getting worse every day. We cannot wait any more. Aid has to enter as soon as possible or there will be a catastrophe," he said.

The United Nations said Thursday that it was preparing to deliver humanitarian assistance in the coming days to Madaya, located around 25 kilometres north-west of the Syrian capital Damascus.

Since July, the Sunni Muslim town has been caught in the middle of intense fighting between Syrian President Bashar al-Assad's forces, backed up by the allied Lebanese Shiite movement, and rebel fighters who have claimed the town.

The blockade imposed by government forces was tightened in October when rebels refused to cooperate in a deal to hand over the town.

Burhan, who is a civil engineer and a member of a humanitarian committee inside Madaya, said he had lost more than 30 kilos of his weight as a result of the siege. 

"Enough. People are desperate. We cannot look into their eyes anymore,” he said.

"There are no more animals to kill in the area or anything to eat," Abu Mohammed, a father of six, said via Skype.

"Today I was lucky. I got three biscuits from the humanitarian committee in the town and I found few yellow tree leaves near my house," he said while crying.

Fatima, who is a single mother of four children, said she and her children have been living on water, salt and pepper for three days now.

"I could not find anything for my children today. I came to the committee and begged for some salt so that my children will have something to stay alive," she told dpa, referring to the local aid group to which Buhran belongs.

There are currently around 25,000 people, among them women and children, living inside Madaya, according to Burhan.

"We have advised people to limit their movement and the movement of their children so that they will not drain their energy, especially as it is getting very cold and we do not have more supplies for them," he said.

The medical charity group, Doctors without Borders, also known by its French acronym MSF, reported that 23 people have died of starvation in Madaya since December 1.

Among the deaths were six infants aged less than one and five people over 60, according to the report. But many of the reported cases were also adults.

"The situation is affecting all age groups and both sexes and makes MSF extremely alarmed for the patients currently under treatment," said the group, which supports a clinic inside Madaya.

"Madaya is now effectively an open air prison," the statement said. "There is no way in or out, leaving the people to die.”

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