A/HRC/37/72 unanswered. Between 26 and 28 December, 29 patients were evacuated to Damascus in exchange for a number of civilians held by armed groups in Douma (see A/HRC/36/55, paras. 46–48). V. Conclusion 32. Entering its fifth year, the siege of eastern Ghutah has been marked by increasingly cynical means and methods of warfare, which have led to the worst documented cases of malnutrition over the course of the Syrian conflict. Characterised by pervasive war crimes, including the use of prohibited weapons, attacks against civilian and protected objects, starvation leading to severe acute malnutrition, and the routine denial of medical evacuations, the siege of eastern Ghutah continues to primarily affect the hundreds of thousands of civilians subsisting in the besieged enclave. The Commission has thoroughly documented how all parties to the conflict use siege warfare in order to erode the viability of life under the control of opposing sides, in an attempt to compel surrender (see A/HRC/36/55, para. 18). On the part of armed groups operating in eastern Ghutah, concerted, indiscriminate attacks using unguided mortars continue to kill and injure dozens of civilians in Government-held Damascus city. 26