With the threat of using chemical weapons now off the table, the Syrian regime has apparently turned to even more punitive actions to force rebellious citizens into submission: blockade-induced starvation. For months now the government of President Bashar Assad has encircled the rebel-aligned suburbs south and east of the capital Damascus, cutting off road access, telephone connections, water and electricity. But in the wake of the Aug. 21 chemical-weapon attack on the area, which rebels and the West blame on the regime, the government tightened the blockade even further, increasing fears that mass starvation might lead to even more deaths than the estimated 400 to 1,400 victims of the chemical attacks. Already six have died from malnutrition, according to activists, and as winter approaches, conditions are likely to worsen. One rebel brigade has dedicated its forces to breaking the siege in Moadhamiya, a town about 10 km from Damascus that has been under siege for more than six months.

“The situation is bad in Moadhamiya; it’s a real disaster,” Oraba Idriss, commander of the 1,200-strong Maghaweer Brigade tells TIME via Skype. “People lack for everything. They didn’t even have bread to eat until we were able to bring them some wheat and flour.” According to the Moadhamiya Media Center, an activist group that works with Idriss, six people have died of starvation in the past month, including four children. Another dozen children are in medical clinics, suffering from acute malnutrition. One video, released by the media center and posted on YouTube and Twitter, shows the emaciated body of an 18-month-old girl they claim succumbed to starvation on Sept. 23. Whatever power there is comes from generators running off limited supplies of fuel that are smuggled in. Transporting something as simple as flour or fuel across enemy lines requires days of strategic planning and a large degree of luck. “Every mission to Moadhamiya is like a suicide mission for us,” says Idriss. “We have to go around tens of checkpoints, and if they discover us, death is inevitable.” In the past month he has lost four men. Still, he says, the sacrifice is worthwhile. “Hundreds, if not thousands, of civilians are starving in Damascus, and if we don’t risk our lives for them, they will simply die.”