The New York Times

On Tuesday, 78 people were killed in the Syrian rebel enclave of Eastern Ghouta after heavy aerial bombardment by Syrian and Russian forces. The United Nations has called for a cease-fire for a month across Syria to be able to deliver humanitarian aid and evacuate the critically ill and wounded.

The siege of Eastern Ghouta has turned into one of the longest and most destructive sieges in recent wars — about a year longer than the nearly four-year siege of Sarajevo. Ghouta is an area of small towns and fertile countryside east of Damascus.

The regime of Bashar al-Assad has barred the residents from leaving and outsiders from visiting their relatives in the besieged area, according to Osama Nassar, an activist and journalist who has been living in the Douma district of the area since 2013.

The people of Eastern Ghouta joined the protests against the Assad regime in March 2011, in the very early days of the Syrian uprising, and government forces killed many young men there. I was there a few weeks after those protests and attended the funeral of eight people killed by the regime.

The killings militarized the uprising by the fall of 2011. By July 2012, the regime began attacking population centers with barrel bombs. Peaceful protests came to an end.
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In October and November 2012, the rebels drove out regime forces from Eastern Ghouta. In the beginning of 2013, the regime, supported by Iran and Hezbollah, regained the military initiative and imposed the siege.

I arrived in the Douma district in April 2013 and lived with a civil defense unit that came to be known as the White Helmets. Regime planes bombed the region daily. I saw the bodies of the dead being brought to the civil defense unit every day for registration. One day there were nine bodies. Another day, 26.

Yet people were still hopeful despite everyday life’s becoming increasingly difficult. On Aug. 21, 2013, the Assad regime attacked Eastern Ghouta with sarin gas and killed more than 1,400 civilians, including 426 children.

A deal between the United States and Russia forced the Assad regime to agree to surrendering its chemical weapons to United Nations investigators, but President Barack Obama decided not to enforce a no-fly zone over Syria. Mr. Assad concluded that he could use all other weapons, including barrel bombs and starvation, to crush the uprising.

A month after the chemical weapons deal, in October 2013, Mr. Assad’s forces intensified the siege of Eastern Ghouta. Even people who needed medical care were prevented from leaving or getting help from outside. Arbitrary daily bombings turned life precarious; people struggled even to retrieve corpses from the rubble of their houses.

Around that time, Jaish al-Islam, a Salafi militant group, came to dominate Douma and established a despotic system, arresting, kidnapping and assassinating people who did not comply with its dictates. Other rebel groups in the besieged areas include Faylaq al-Rahman, an affiliate of the Free Syrian Army, and Hayyat Tahrir al-Sham, which largely draws its membership from a Syrian al-Qaeda affiliate. And there are numerous smaller groups and brigades, which control and fight in smaller areas.

The civilians share an ambivalent relationship with the rebel groups. They offer them support for fighting against the Assad regime but criticize them for failing to overcome their factionalism and uniting against the regime. The civilians also protest and chafe at the rebels intervening in their daily life whether it is dealing harshly with them or arresting someone.

When I left Eastern Ghouta for Raqqa in the summer of 2013, the cost of everyday amenities had already increased significantly because of the war. Our only electric supply was a generator for four hours a day.

Samira al-Khalil, my wife, had joined me a few months earlier. We didn’t have enough to eat and began losing weight. We laughed that our friend Razan Zeitouna, a lawyer and writer documenting the atrocities, couldn’t lose weight because she was reed thin. The regime’s slogan was “Aljoo’ or Arrukoo’” (Starve or Surrender).

During the siege, Samira, who had been imprisoned for four years under the Hafez al-Assad regime for her activism, wrote in her diary, “Prison was just a joke when compared to siege, for all the people suffer from the latter: the children, the elderly.” She added: “ Under the siege there is nothing! No medicines, no bread, no water, no electricity, nothing. No! I forgot something important: death. It is available everywhere, in every family.”

By the fall of 2013, along with Eastern Ghouta, the rebel enclaves of Darayya, Mouaddamiyya, Nadaya and Zabadani, which are close to Damascus, were also under siege, being bombed and starved.

Eastern Ghouta showed great resilience and embraced innovative ways to survive. People continued growing food on their farms, and that partly helped keep hunger at bay. They found a way to breach the siege by digging a network of underground tunnels, some of which led to neighborhoods in Damascus and were used to smuggle in necessary commodities.

Numerous conversations with friends and acquaintances still living there give me a fuller sense of how they survived. People recycled plastic garbage and extracted fuel from it. They used this fuel for the generators that had been smuggled in through the tunnels. The electricity this generated became essential to connect with satellite internet and the outside world. They ground fodder and used it as flour to bake bread; they toasted oats and used it to make a beverage to replace coffee. They embraced wild herbs, which were untouched in peace, as a staple vegetable. They turned the basements of hospitals and schools into storage facilities in the face of the barrel bombs.

In a cruel twist, the regime sought to extract profit by doing some business with the besieged populace. Muhyi Eddin Manfoush, a businessman connected to the Syrian Republican Guard headed by Mr. Assad’s brother, Maher al-Assad, was allowed by the regime to sell flour, packaged food, butter, oil, tea and sugar, among other things, in the besieged area, according to several merchants in Eastern Ghouta.

The deal was that Mr. Manfoush would charge the besieged and impoverished buyers a tax beyond the usual price. For a kilogram of flour, sugar and rice he charged an extra 2,000 Syrian pounds, or about $4; for clothes, shoes and cleaning material he charged an extra 3,000 Syrian pounds, or about $6, according to multiple residents. But medicines, medical equipment, electronics and building equipment were strictly prohibited from entering the besieged area.

The people of Eastern Ghouta were left with few resources and a terribly depleted capacity to buy anything. The few sources of support were financial aid from a group of NGOs and some religious networks. By 2017, the fourth year of the siege, Mr. Assad’s forces had taken control of many neighborhoods from the rebels. In March, the regime took Barzeh and Qaboun, two neighborhoods in Damascus that were crucial for the survival of the besieged areas. The tunnels that the opposition had dug to bring in supplies led from Eastern Ghouta to Barzeh and Qaboun. Mr. Assad’s forces destroyed the tunnel network and blocked the supplies.

Within days of the fall of Barzeh and Qaboun, the price of diesel jumped to about $10 per liter from about 63 cents per liter. The season for harvesting crops and planting vegetables was days away. The farmers couldn’t afford the fuel for their agricultural tools — generators, water pumps, tractors. They simply couldn’t water their lands or even harvest the crops.

The failure to cultivate and harvest the local produce, the destruction of the tunnel system and the relentless siege pushed the cost of living punitively higher. In October, according to various residents and activists in Eastern Ghouta, a kilogram of sugar cost 2,400 Syrian pounds, or about $5; a kilo of rice was 2,900 Syrian pounds, or about $5; a kilo of lentils was 2,000 Syrian, or about $5; a liter of frying oil was 3,000 Syrian pounds, or about $6.

The besieged couldn’t afford it. Children were the first to starve and die. And that is when the images of the emaciated, undernourished children began coming out of Eastern Ghouta.

In late November, the businessmen connected to the regime brought in a new contingent of supplies at their usual extortionate rates. Few could afford it, and it barely lasted two weeks, according to Aous al-Mubarak, a dentist living there. Around 400 children suffered from extreme malnourishment, he said. The numbers have only risen.

Eastern Ghouta has been turned into a concentration camp by the Assad regime. Mr. Assad has perfected a system of political nihilism, which wipes out people who oppose it and enslaves those who acquiesce and submit. Even after five years of siege and bombardment, the residents are holding on to human dignity, mourning each death, not turning callous in the face of its familiarity.

Bara’a, a 15-year-old girl who was a friend of Mr. Nassar’s daughter, was killed in January after the regime planes bombed Douma. Mr. Nassar had thought five years of living under siege was familiarizing him with death. “I shudder every time I think of her mother,” he said.