
Manal was boiling water on the stove in the besieged Syrian town of Hamouria, hoping to convince her four children that she is cooking, but she had no food.She puts the pot on the flame as a ruse, waiting for the children to fall asleep in the dilapidated house, before they will realize that there is nothing for dinner. In the Eastern Ghouta region where she lives, over 1,100 children are suffering from acute malnutrition, and hundreds more are at risk because of food shortages caused by the government siege.

Aid agencies are warning that the situation is worsening, despite an international agreement to implement a "de-escalation zone" in the area, which has decreased violence but led to no new access for food, medicine and humanitarian aid."They haven't eaten anything but bread for the last three days," Manal told me in tears."A neighbor gave us the flour."Eastern Ghouta, which lies outside the capital Damascus, was once a prime agricultural region.But the rebel stronghold has been under a tight government siege since 2013, causing shortages of food and medicine, and pushing up prices for what remains on the market, produced locally or smuggled in.

The region has been devastated by years of fighting, with government air strikes and shelling bringing down multi-story buildings and rendering whole streets uninhabitable.Basic services for the region, estimated by 400,000 residents, are virtually non-existent, with electricity produced only by generators and the water available often dirty and a vector for illness.

- Situation 'getting worse'Manal's husband Abu Azzam is unable to work because of a serious injury caused by a shelling attack in their old home elsewhere in Eastern Ghouta several years ago.The attack killed one of their children, and left another, Azzam, missing a foot and dependent on crutches to get around.

The family are desperately poor and have sold most of their furniture to afford food."In 24 hours, we have a single meal, which is not enough for the children," said Abu Azzam in despair. Ordinarily, the family is hoping for assistance from aid groups, but humanitarian access to Eastern Ghouta has been vanishingly rare throughout the conflict that began with anti-government protests in March 2011. Aid convoys can only enter with government permission, with only two teams accessing the region since August, carrying assistance for fewer than 100,000 people. In July, a "de-escalation zone" was implemented in Eastern Ghouta under a deal agreed by government allies Russia and Iran and rebel backer Turkey.The agreement was meant to improve humanitarian access, but Russian forces "did two distributions at a checkpoint and since

"All I want is to see my children with full bellies," said Abu Azzam."I hope the day will come when we'll be able to eat three meals a day." in the Eastern Ghouta town of Hamouria, on October 23, 2017.