Aid groups have started medical evacuations of nearly 500 "critical cases" in a besieged rebel stronghold near Damascus. Aid workers have warned that the humanitarian situation there has again "reached a critical point."
"Tonight, the Syrian Red Crescent with the ICRC team started the evacuation of critical medical cases from Eastern Ghouta to Damascus," the relief group said in a tweet.
At least four people were evacuated on Wednesday, according to aid groups on the ground. The Syrian American Medical Society said the evacuations included "29 critical cases, approved for medical evacuation to Damascus."
According to the UN, nearly 500 people in the area need urgent access to health services. Although Eastern Ghouta is one of four "de-escalation" zones under an agreement between warring parties, the Syria government ramped up its bombardment of the suburb in November.
'Critical point'
Robert Mardini, Middle East Director for the ICRC, urged government forces and rebel groups to do more to provide crucial access to humanitarian aid and medical supplies to avert more suffering.
"The humanitarian situation in Eastern Ghouta has reached a critical point. As so often in Syria over the last six years, ordinary people are once again trapped in a situation where life slowly becomes impossible and where goods and aid are severely limited," said Mardini.
"The sick and injured must not be used as pawns in negotiations between the different parties involved in the fighting … No military or political gains could justify this amount of suffering, whether in Eastern Ghouta or elsewhere in Syria."
Considered one of the last rebel bastions in Syria, Eastern Ghouta has been under siege by government forces since 2013. The siege has caused severe shortages of food and medical supplies for its nearly 400,000 residents.
Who's fighting in the Syria conflict?
Syria's civil war erupted out of the Arab Spring protests that swept much of the Middle East and North Africa in 2011. The conflict has since drawn in multiple warring factions from around the world.
Image: Atta Kenare/AFP/Getty Images
War with no end
Syria has been engulfed in a devastating civil war since 2011 after Syrian President Bashar Assad lost control over large parts of the country to multiple revolutionary groups. The conflict has since drawn in foreign powers and brought misery and death to Syrians.
Image: picture alliance/abaca/A. Al-Bushy
The dictator
Syria's army, officially known as the Syrian Arab Army (SAA), is loyal to Syrian President Bashar al-Assad and is fighting to restore the president's rule over the entire country. The SAA has been fighting alongside a number of pro-Assad militias such as the National Defense Force and has cooperated with military advisors from Russia and Iran, which back Assad.
Turkey, which is also part of the US-led coalition against IS, has actively supported rebels opposed to Assad. It has a tense relationship with its American allies over US cooperation with Kurdish fighters, who Ankara says are linked to the Kurdistan Workers' Party (PKK) fighting in Turkey. Turkey has launched multiple military offensives targeting Kurdish militias.
Image: picture-alliance/AP Photo/L. Pitarakis
The eastern guardian
The Kremlin has proven to be a powerful friend to Assad. Russian air power and ground troops officially joined the fight in September 2015 after years of supplying the Syrian army. Moscow has come under fire from the international community for the high number of civilian casualties during its airstrikes. However, Russia's intervention turned the tide in war in favor of Assad.
Image: picture-alliance/dpa/Tass/M. Metzel
The western allies
A US-led coalition of more than 50 countries, including Germany, began targeting IS and other terrorist targets with airstrikes in late 2014. The anti-IS coalition has dealt major setbacks to the militant group. The US has more than a thousand special forces in the country backing the Syrian Democratic Forces.
Image: picture alliance/AP Photo/A.Brandon
The rebels
The Free Syrian Army grew out of protests against the Assad regime that eventually turned violent. Along with other non-jihadist rebel groups, it seeks the ouster of President Assad and democratic elections. After suffering a number of defeats, many of its members defected to hardline militant groups. It garnered some support from the US and Turkey, but its strength has been greatly diminished.
Image: Reuters
The resistance
Fighting between Syrian Kurds and Islamists has become its own conflict. The US-led coalition against the "Islamic State" has backed the Syrian Democratic Forces, an alliance of Kurdish and Arab militias. The Kurdish YPG militia is the main component of the SDF. The Kurds have had a tacit understanding with Assad.
Image: Getty Images/A. Sik
The new jihadists
"Islamic State" (IS) took advantage of regional chaos to capture vast swathes of territory in Iraq and Syria in 2014. Seeking to establish its own "caliphate," IS has become infamous for its fundamentalist brand of Islam and its mass atrocities. IS is on the brink of defeat after the US and Russia led separate military campaigns against the militant group.
Image: picture alliance/AP Photo
The old jihadists
IS is not the only terrorist group that has ravaged Syria. A number of jihadist militant groups are fighting in the conflict, warring against various rebel factions and the Assad regime. One of the main jihadist factions is Hay'at Tahrir al-Sham, which controls most of Idlib province and has ties with al-Qaeda.
Image: picture-alliance/AP Photo/Nusra Front on Twitter
The Persian shadow
Iran has supported Syria, its only Arab ally, for decades. Eager to maintain its ally, Tehran has provided Damascus with strategic assistance, military training and ground troops when the conflict emerged in 2011. The Iran-backed Lebanese Shiite militant group Hezbollah also supports the Assad regime, fighting alongside Iranian forces and paramilitary groups in the country.
Image: Atta Kenare/AFP/Getty Images
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No end in sight
More than 300,000 people have been killed since 2011, when government forces launched a draconian crackdown on protesters calling for the release of political prisoners and for President Bashar al-Assad to step down.
The government brutality triggered an armed conflict that has transformed into a multi-front war, pulling in global powers, neighboring countries and non-state actors, including the US, Russia and Iran.
From escalating violence in the Middle East and Africa to incoherent asylum policy at home - DW looks at how the EU has found itself in the midst of a refugee crisis.
Image: picture-alliance/dpa
Fleeing war and poverty
In late 2014, with the war in Syria approaching its fourth year and Islamic State making gains in the north of the country, the exodus of Syrians intensified. At the same time, others were fleeing violence and poverty in countries such as Iraq, Afghanistan, Eritrea, Somalia, Niger and Kosovo.
Image: picture-alliance/dpa
Seeking refuge over the border
Vast numbers of Syrian refugees had been gathering in border-town camps in neighboring Turkey, Lebanon and Jordan since 2011. By 2015, with the camps full to bursting and residents often unable to find work or educate their children, more and more people decided to seek asylum further afield.
Image: picture-alliance/dpa
A long journey on foot
In 2015 an estimated 1.5 million people made their way on foot from Greece towards western Europe via the "Balkan route". The Schengen Agreement, which allows passport-free travel within much of the EU, was called into question as refugees headed towards the wealthier European nations.
Image: Getty Images/M. Cardy
Desperate sea crossings
Tens of thousands of refugees were also attempting the perilous journey across the Mediterranean on overcrowded boats. In April 2015, 800 people of various nationalities drowned when a boat traveling from Libya capsized off the Italian coast. This was to be just one of many similar tragedies - by the end of the year, nearly 4,000 refugees were reported to have died attempting the crossing.
Image: Reuters/D. Zammit Lupi
Pressure on the borders
Countries along the EU's external border struggled to cope with the sheer number of arrivals. Fences were erected in Hungary, Slovenia, Macedonia and Austria. Asylum laws were tightened and several Schengen area countries introduced temporary border controls.
Image: picture-alliance/epa/B. Mohai
Closing the open door
Critics of German Chancellor Angela Merkel's "open-door" refugee policy claimed it had made the situation worse by encouraging more people to embark on the dangerous journey to Europe. By September 2016, Germany had also introduced temporary checks on its border with Austria.
Image: Reuters/F. Bensch
Striking a deal with Turkey
In early 2016, the EU and Turkey signed an agreement under which refugees arriving in Greece could be sent back to Turkey. The deal has been criticized by human rights groups and came under new strain following a vote by the European Parliament in November to freeze talks on Turkey's potential accession to the EU.
Image: Getty Images/AFP/A. Altan
No end in sight
With anti-immigration sentiment in Europe growing, governments are still struggling to reach a consensus on how to handle the continuing refugee crisis. Attempts to introduce quotas for the distribution of refugees among EU member states have largely failed. Conflicts in the Middle East and elsewhere show no signs coming to an end, and the death toll from refugee sea crossings is on the rise.