A/HRC/31/68 health items to Madaya, Fu’ah and Kafraya. Supplies in Madaya were exhausted within 20 days. By December, residents were eating grass, leaves and cats. 124. Shortages of food, water and medicine in Madaya have led to moderate or acute malnutrition and deaths in vulnerable groups, including children and the elderly. A local veterinarian and anaesthetic technician perform surgeries on parturient mothers. With no electricity or fuel, residents burn garbage for cooking. 125. Amid international outrage, additional convoys organized by the United Nations, ICRC and the Syrian Arab Red Crescent were granted access to deliver humanitarian assistance to Madaya and Bqine, and Fu’ah and Kafraya, on 11, 14 and 18 January. 126. Government forces continue to besiege eastern Ghutah and parts of southern Damascus countryside. In Duma, soldiers at checkpoints have impeded the delivery of lifesaving humanitarian aid. Residents rely on an elaborate network of tunnels to smuggle in food and medicine, while soldiers demand bribes to grant entry of the most basic commodities. Government forces cut the city’s access to water two and a half years ago, while inhabitants continue to incinerate plastic in order to generate electricity. Largely inadequate medical care caused by years of siege had fatal consequences for those wounded in intense aerial bombardments in August and September 2015. No individuals were allowed to evacuate to hospital in government-held areas. 127. ISIS encircled the government-held neighbourhoods of Dayr az-Zawr city in June 2014. As ISIS continues to deny all commercial and humanitarian access to the city, the primary source of aid and supplies is through the main airport, which remains under government control. More than 200,000 residents living in the densely populated districts of Dayr az-Zawr city face increasing hardship, as the Government has been unable to provide enough aid to sustain all residents. In January, the Government of the Russian Federation announced that its air force had dropped 50 tons of relief by air into the city. 128. In addition to the siege imposed by ISIS, government forces have prevented residents in Dayr az-Zawr city from travelling outside areas under government control. In September, government forces began requiring residents to submit applications to leave, which would be granted only if they contained a medical imperative. Residents often pay bribes to officials to facilitate their exit. Once they enter areas controlled by ISIS, they are forcibly subjected to istitaba (“repentance-seeking”) lessons. Women traveling alone face insurmountable challenges, given that ISIS forbids women from travelling without a close male relative. 129. The use of starvation as a method of warfare is prohibited, as is denying civilians safe passage from besieged areas. The rights to adequate food, to health and to to life, as well as the special duty of care owed to the well-being of children, continue to be breached countrywide. Such acts violate core human rights and humanitarian law obligations. D. Dismantling of the economy 130. Since 2011, countrywide insecurity, the imposition of sieges, economic sanctions and warfare have seriously impaired the ability of Syrian civilians to earn a living. The protracted nature of the war has produced a devastating wave of unemployment, with many – especially those internally displaced – struggling to survive in dire conditions of poverty. 131. Years of hostilities have given rise to a host of parallel economies rooted in opportunism, comprising acts of violence, extortion and an abject denial of fundamental human rights. Throughout besieged areas, a surge in the price of basic commodities and restrictions on freedoms of movement, which prevent the access of residents to their places of work, have a devastating impact on confined populations. 18