DAMASCUS: Struck by sarin gas in the notorious dawn attack last month, the people of Moadamiyeh have a second reason for being among the most hapless victims of Syria’s war. They are under siege, cut off from all outside help, gradually being starved and with no means of escape.

Almost everywhere else in the country, Syrians who have been bombed or intimidated out of their homes or live in communities where food and water are running short have the option to flee.

Millions of families have taken it, spilling out across Syria’s borders into overcrowded refugee camps or staying in Syria and looking for shelter somewhere that seems a bit safer.

Moadamiyeh is one of a number of towns and villages in Syria in which people are, in effect, prisoners. There is no moral difference between their jailers. In some places it is government forces who are putting a rebel-held area under siege; in others, the rebels are tightening the noose on a government-held area.

“When you come down to it, it’s war. All this layer of civilisation comes to nothing at ground level. If they want people to starve, they will let them,” says Khaled Erksoussi, head of the disaster response unit at the Damascus branch of the Syrian Arab Red Crescent (Sarc).

With 10,000 volunteers in 80 sub-branches around Syria, Sarc is the main distributor for the United Nations agencies’ assistance, whether food, blankets or medicine. Every day they risk their lives in crossing front lines. Twenty-two volunteers have died since the conflict began two years ago.

Erksoussi escaped death in April last year when the white Sarc ambulance he was driving, clearly marked with the organisation’s red crescent, was negotiating access to the rebel-held Damascus suburb of Douma.

“My colleague in the passenger seat was on the phone to the rebel commander when a bullet came from the front, hit the dashboard and by pure chance decided to go left, not right. He was killed instantly. The rebels later apologised but I don’t know if that counts for much,” he says.

Erksoussi was a senior manager at the mobile phone company, Syriatel, before he joined Sarc as a volunteer. The company continued to pay his salary while he devoted hours to Sarc’s work. Last week they sacked him. In three earlier visits to Damascus since the war began I never saw him as angry. It is not his sacking that upsets him, but the wanton cruelty of the gunmen on both sides.

“It’s five months since we’ve been able to get into Moadamiyeh. We estimated there were 15-20,000 trapped there at that time. People are crying out for aid. It is not a farming area, so there’s little food that grows there,” he says.

Government shells can be heard and seen falling regularly on the community, which is barely 10 minutes’ drive from central Damascus and close to the main highway to Beirut.

Road access is controlled by men of the recently-formed National Defence Force, an expanding set of local volunteers who support the official Syrian army.

In Nubel and Zahra, two Shia villages north of Aleppo, it is rebel forces who are besieging pro-government civilians. “We haven’t been able to get in there for a year. Around 60,000 are without help. The army was able to deliver some food by helicopter late last year but they were shot at and have stopped,” Erksoussi says.

In Hamidiya in Homs’s Old City, one of the few remaining parts of the town held by rebels, the government is the besieger. But rebels of the Free Syrian Army are conducting a siege within a siege.

“There are between 250 and 300 trapped families, mainly Christians. We tried to negotiate their exit. The International Committee of the Red Cross was with us, but the opposition told us we could only take the wounded and elderly. Just 12 people came out,” says Erksoussi. “Why do they need to keep the others?” he asks, leaving it clear from his gestures that they have become human shields.

The biggest group of siege victims is in western Aleppo, the only part of Syria’s commercial capital that the rebels have not yet captured. Tens of thousands, perhaps a hundred thousand civilians are surrounded. “For a month now we haven’t been able to run any convoy to Aleppo,” Erksoussi says. “At the end of the day we are trying to help civilians. Which civilians get it is not the issue. They are all Syrian, and they are all in need.”

By arrangement with the Guardian