The Syrian government has trapped hundreds of thousands of its own people in besieged areas, intentionally depriving them of food, medicine, electricity, and water, as a cruel tactic of war. Despite the inhumane conditions they have been living with for years now, the people of these areas have received little help from the international community.

The United Nations does not acknowledge the full extent of this crisis. The March 2015 Syrian American Medical Society (SAMS) report Slow Death: Life and Death in Syrian Communities Under Siege—the most comprehensive and systematic attempt to quantify these populations to date—shows that a minimum estimate for the number of people living under long-term siege in Syria is 640,200. This is three times the estimate from the official UN Office for the Coordination of Humanitarian Affairs (OCHA) at the time of the report’s release. The Slow Death study applied a conservative methodology to its population estimates and discarded low confidence estimates, so the 640,200 figure did not include population estimates for twenty besieged communities in Syria. The real number of people living under siege is probably closer to 1 million and the Syrian government is perpetrating the majority of these sieges.

The report also found that UN OCHA, which provides the population figures for the monthly UN Secretary-General reports to the Security Council, applies its “besieged” designation inconsistently across Syria and without any explanation or justification. Using UN OCHA’s own definition: “a ‘besieged area’ is an area surrounded by armed actors with the sustained effect that humanitarian assistance cannot regularly enter and civilians, the sick, and wounded cannot regularly exit the area,” SAMS’s study identified a total of forty-nine besieged communities, compared to just eleven that UN OCHA recognized at the time. The government of Syria is the perpetrator for all thirty-eight unrecognized areas under siege.

Just days after the Slow Death report release, the United Nations raised its besieged estimates up by around 200,000 people for the first time since mandated reporting began in March 2014. But this increase did not consider any of the additional areas identified in Slow Death, or raise the low population estimates for some of the eleven areas that it acknowledged as besieged. The 200,000 comes entirely from the addition of the western portion of Deir Ezzor city, a government-controlled area besieged by the Islamic State (ISIS or ISIL) since February 2015.

Including Deir Ezzor in its besieged figures is an unusual move for UN OCHA, since it has never recognized other shorter-term sieges in Deraa or in eastern Aleppo city. The siege of western Deir Ezzor city also differs from the other recognized (and unrecognized) sieges in an important way: this area receives regular supply shipments through the government-controlled military airport, which continues to function as a lifeline for the city. Air access has allowed the Syrian Red Crescent and the International Red Cross to bring in tons of food and medicine, and the UN is also preparing to airlift in humanitarian aid. Since the Syrian regime is the perpetrator of the majority of sieges against civilians in Syria, it has not allowed similar access to other areas.

In aiding the areas that Assad wants them to and abiding by the Syrian government’s refusal to assist others, UN agencies and international organizations inadvertently play a role in the success of the strategy using starvation of civilians as a tool of war – a war crime expressly forbidden under international law.

In addition to western Deir Ezzor city, the only other siege not being perpetrated by the Syrian government is in the towns of Nubl and Zahraa in northern Aleppo governorate. Nubl and Zahraa are pro-government towns that have been besieged by a collection of armed opposition groups since March 2013. Lacking the military capacity and air supremacy of the Syrian forces, armed opposition groups have not been able to enforce a complete siege and Nubl and Zahraa receive regular supplies from the Kurdish town of Afrin to the northwest. In Slow Death, 565 deaths were recorded in besieged areas across Syria from non-military causes (i.e. starvation, denial of medical care, etc). Despite being under siege for more than two years, not a single such siege-related casualty could be identified in Nubl or Zahraa, clear evidence of their ongoing resupply.

The point here is not to deny the need for aid to areas like Nubl and Zahraa or Deir Ezzor. The people of Deir Ezzor – isolated, long underserved by the government, and forced to contend with ISIS unaided since 2013 – have perhaps suffered more than most others throughout the course of this conflict. But the inconsistencies in UN OCHA’s designations of besieged areas are troubling, and greater transparency and accountability is needed in this regard. There has been no satisfactory explanation for the apparent dismissal out of hand of the Slow Death study and conclusions, despite the fact that SAMS and other humanitarian organizations have direct access to the besieged areas that the UN agencies lack.

With no feasible policy or military solutions in sight to bring relief to the besieged areas, these atrocities have become nearly invisible to the western world, barely making a ripple in our media or consciousness. The UN humanitarian agencies working out of their Damascus hub submit repeated requests to the Syrian government to transport life-saving supplies into these areas. Predictably, almost all requests are denied, and the UN must not be complacent that these efforts are sufficient. Having UN OCHA send continual requests to the Syrian government to allow aid shipments in to these areas is not an acceptable or effective solution.

Similarly, condemning the sieges in Security Council Resolutions is not enough if the UN does not enforce its words. Security Council Resolutions 2139 and 2165 both called for immediate access to these areas, but went unheeded on the ground and contained no enforcement mechanisms. The UN’s access to besieged areas actually slightly decreased from the passage of 2139 in early 2014 until the identification of Deir Ezzor as besieged in March 2015, with UN assistance aid reaching well below 1 percent of those in need most months. Passing resolutions without intent to enforce encourages impunity on the part of the perpetrators.

The underreporting of the number of people living under siege in Syria is not in and of itself the problem: 212,000 besieged civilians are far too many and should be more than enough to spur action. But it has not, and in order for stakeholders to even begin to address the issue appropriately, we must acknowledge the full extent of the problem. UN OCHA’s dramatic underrepresentation of the scope of the siege crisis only serves to deepen its obscurity and the lack of international urgency. For the Syrians still living under siege, acknowledgement is the least we can do.

Valerie Szybala is the author of Slow Death: Life and Death in Syrian Communities under Siege and has worked as a Syria analyst, researcher, and advocate with the Syrian American Medical Society (SAMS) and the Institute for the Study of War (ISW).

Image: Children carry containers as they queue to receive free meals from a soup kitchen in the besieged town of Deir al-Asafir in the Eastern Ghouta of Damascus May 19, 2015. (Reuters)