- Associated Press - Friday, March 14, 2014

KAB ELIAS, Lebanon (AP) - Trapped in her northern Syrian village by fighting, Mervat watched her newborn baby progressively shrink. Her daughter’s dark eyes seemed to grow bigger as her face grew more skeletal. Finally, Mervat escaped to neighboring Lebanon, and a nurse told her the girl was starving.

The news devastated her. “They had to hold me when they told me. I wept,” the 31-year-old mother said, speaking in the rickety, informal tent camp where she now lives with her husband in the eastern Lebanese town of Kab Elias.

Her daughter Shurouk has been undergoing treatment the past three months and remains a wispy thing. The 9-month-old weighs 7 pounds (3.2 kilos) - though she’s become more smiley and gregarious. Mervat spoke on condition she be identified only by her first name, fearing problems for her family in Syria.

Her case underscored how dramatically Syrian society has unraveled from a conflict that this weekend enters its fourth year. Such stark starvation was once rare in Syria, where President Bashar Assad’s autocratic state ran a health system that provided nearly free care.

That system, along with most other state institutions, has been shattered in many parts of the country where the fighting between Assad’s forces and the rebels trying to overthrow him is raging hardest. The war has killed more than 140,000 people and has driven nearly a third of the population of 23 million from their homes - including 4.2 million who remain inside Syria and 2.5 million who have fled into neighboring countries. Nearly half those displaced by the war are children.

Now aid workers believe starvation cases are increasing in besieged areas of Syria and malnutrition is spreading among the poorest Syrian refugees.

Before the conflict, doctors inside Syria would see fewer than one case a month of a child with life-threatening malnutrition, now they tell UNICEF they encounter 10 or more a week, said Juliette Touma, a Middle East regional spokesperson for the U.N. children’s agency.

In Lebanon, malnutrition grew from 4.4 percent in 2012 to 5.9 percent of Syrian refugee children, according to a recent UNICEF-led survey. In all, an estimated 10,000 Syrian children in Lebanon are likely suffering malnutrition, said Dima Ousta of the International Orthodox Christian Charities, an NGO leading efforts to deal with the issue in Lebanon. UNICEF said nearly 2,000 were at risk of dying because of acute malnutrition if they weren’t immediately treated.

A survey in Jordan found that 4 percent of Syrian refugee children under five needed treatment for moderate or acute malnutrition, the World Food Programme said on Monday.

Touma said UNICEF had not yet finished surveys for refugees in Turkey or inside Syria itself.

Malnutrition is the product of a series of ever-widening and interconnected problems.

Within Syria, fighting in the worst hit areas can limit access to food supplies and health care for children. There and among refugees, children are vulnerable to diarrhea and other illnesses from drinking dirty water or being exposed to sewage. Those conditions can exacerbate malnutrition and, in turn, malnourished children are less resistant to disease.

Social factors also play in. Rural Syrian women tend to marry as teenagers and rely on their mothers or other relatives to help in child-rearing. But as refugees, many lose that support network and without guidance don’t know how to properly breastfeed their children - bringing a risk of malnutrition. As refugees run out of money and struggle to find work, many mothers don’t have enough to buy supplementary food.

The poverty and poor hygienic living conditions at the root of the problem are likely only to worsen as Syria’s war drags on.

“Malnutrition is not an issue related to food. It’s a health issue,” said Zeroual Azzeddine of UNICEF.

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