Under Siege in Yarmouk

"I remember the first person to starve to death," recalls Ram Heramic, a 24-year-old from Yarmouk, the Syrian refugee camp 6 miles from Damascus center that ISIS fighters overran in early April. Yarmouk has been under siege for more than two years. "He was a 6-year-old boy called Abd Alhay Yousif. It's ironic—his name means 'one who worships immortal gods.'"

She adds, "The immortal gods did not protect him. He never grew up."

Heramic and others from Yarmouk compile what they call the Starvation Death List. It has 177 names of people who have died of hunger since 2013, during the period of siege when hardly any goods have been able to reach the camp. Conditions for the estimated 18,000 people left in Yarmouk have deteriorated even further since early April, when ISIS militants took over parts of the camp. Now they face frequent bombing from Syrian government forces, as well as fighting between rival armed groups.

U.N. Secretary General Ban Ki-moon has described Yarmouk as "the deepest circle of hell" in the four-year Syrian war. "What is unfolding in Yarmouk is unacceptable," Ban said. "We simply cannot stand by and watch a massacre unfold."

Yarmouk and the humanitarian crisis facing millions of other Syrians will be high on the agenda this week as the U.N. envoy to Syria, Staffan de Mistura, launches a new round of ambassadorial-level talks in Geneva to try to end the civil war.

Yarmouk, officially a city in the Damascus governorate, was established in 1957, largely for the Palestinian diaspora who had fled what they call the Nakbah (catastrophe) following the 1948 war in which they lost their territory to Israel. Before 2011, there were nearly half a million Palestinians living in Syria, including around 150,000 in Yarmouk. Though generally referred to as a refugee camp, Yarmouk is not a camp of tents, but rather an established community. Loubia Street, one of its markets, was renowned throughout Damascus. Residents included many doctors, pharmacists, teachers and lawyers, and there were Palestinian cultural centers and arts programs.

"Yarmouk was a busy suburb where Palestinians had built their homes brick by brick from 1957," says Nikol Jafra, from the Jafra Foundation, a Palestinian organization providing relief and youth development. A few weeks after the ISIS invasion, the group's water coordinator was gunned down by militants, and it is now too dangerous for its staff to operate there.

While the Palestinians were not technically Syrian citizens, they enjoyed the same rights, were protected by the same labor laws and were not ostracized by society.

"It was our homeland," says Heramic, who managed to leave Yarmouk with some of her family and now lives in Damascus. Two of her brothers escaped and made the perilous journey by boat from Egypt to Italy (spending 11 days at sea), and a sister made it to Sweden.

The U.N. Relief and Works Agency (UNRWA) for Palestinian refugees says around 18,000 people remain in and around the Yarmouk area, including 3,500 children.

Many more than that fled since December 16, 2012, when rebels from the Free Syrian Army marched into the camp from the south. Within 30 minutes, the Syrian government responded, sending an MiG warplane to attack two shelters inside the camp—one a school and the other a mosque. At least 200 civilians died that day, according to Jafra. "Time in Yarmouk was separated into before the MiG and after the MiG," he says.

Since then, the government has imposed a Sarajevo-type blockade and around 1,000 people have been killed by bombing and violence, according to Jafra.

Heramic says for those who stayed, the only way to survive was to stay indoors and hide in the bathrooms, which felt safest. "There was constant shelling and sniping," she says. "But what was worse was the hunger. That's when we started making the starvation death lists."

"We started to starve after people consumed all their canned goods," she says. "Then they broke into closed shops and took anything that might help to cook a meal. They ate leaves from trees. After a couple of months, nothing was left at all."

Since July 2013, no people, food or medical supplies have been allowed entrance into the camp except for intermittent aid deliveries that fall far short of what is necessary. According to the Action Group for Palestinians of Syria (AGPS), there has been no running water in Yarmouk for at least 232 days. The electricity is cut, and a lucky few get generator power (if they can find fuel to run them) a few hours a day. Some residents say they are eating a soup they make from boiled water, plants and spices.

"They're facing the double hardship of living in an active conflict zone and struggling to meet even their most basic needs after two years of living under siege," says Joe Stork, deputy Middle East director at Human Rights Watch.

At the start of April, conditions got even worse when Islamic State (ISIS) militants advanced into parts of the camp. Sources in Yarmouk say ISIS "cooperated" with Jabhat al-Nusra (the Al-Qaeda franchise in Syria), using its checkpoints established throughout Yarmouk to pass through freely. ISIS forces entered from Hajar al-Aswad, an area just southwest of Yarmouk.

There are a range of other militant groups in and around the camp, including the Palestinian group Aknaf Beit al-Maqdis, known to be pro-Hamas, as well as fighters from the Free Syrian Army, the Army of Islam (another jihadi group) and other anti-government militias.

Syrian government barrel bombing intensified on April 4 and has continued ever since, in an effort to flush ISIS out of the camp. Barrel bombs have hit the Palestine Red Crescent hospital, the only functioning hospital in the camp, which was already severely lacking in medicine and staff.

"Even before April 1, Yarmouk was a community where women were dying in childbirth from lack of medicine and children were reportedly dying of malnutrition," says Chris Gunness, spokesman for UNRWA.

Gunness says UNRWA medical personnel detected acute malnutrition in three out of 19 children under the age of 5 they examined, a rate of 16 percent.

Syrian regime officials insist there are few civilians inside Yarmouk and their bombing campaign is focused on ISIS.

Toward the end of April, children in Yarmouk took part in a demonstration in response to a comment by Syria's representative to the U.N., Bashar Jaafari, on April 25 that "fewer than 1,000 civilians were left inside."

"Dozens of children came on the street to say, 'We are here, we are children and we are still in Yarmouk,'" says Faris Shin, a 22-year-old Syrian activist from Yarmouk. "We describe what is happening in Yarmouk as a starvation massacre."

Shin says, "I just heard a story of one little boy who wanted something sweet to eat…so he ate the [sugar] that is used by women to remove hair from their bodies.... It caused diarrhea. Because there is no treatment for something as simple as diarrhea, he died. So imagine what it is like being seriously injured in Yarmouk. Imagine being shot and no treatment. Imagine needing medicine to stay alive."