An aid convoy entered the town of Madaya, besieged by government forces, where thousands had been trapped for months without supplies and people had been reported to have died of starvation.
Yacoub El Hillo, the UN resident and humanitarian coordinator in Syria who was in Madaya overseeing the operation to distribute food to over 40,000 people, said he had also received reports, which could not be confirmed, that at least 40 people had died of starvation.
"We have seen with our own eyes severely malnourished children. I am sure there also malnourished older people and it is true they are malnourished, and so there is starvation," he told Reuters by phone from Madaya.
He said aid workers had also seen cases of starvation in al Foua and Kefraya.
They are two mostly Shi'ite villages, besieged by rebels, with about 20,000 residents. They also received deliveries from Monday's convoy. Aid delivery both to Madaya and to Foua and Kefraya in the northwestern province of Idlib, 300 km (200 miles) away, involved 65 trucks loaded with medical supplies and food.
Another large-scale operation to deliver wheat, flour, medical supplies and non-food items to those areas will be completed on Thursday, El Hillo said.
Dozens are said to have died from starvation or lack of medical care in rebel-held Madaya and activists have said some inhabitants have been reduced to eating leaves. Images said to be of emaciated residents have appeared widely on social media.
The government of President Bashar al-Assad has denied blockading the town. It accuses insurgents of hoarding food and blames them for the plight of civilians.
'Sieges are a terrible thing'
El Hillo said relief workers in rebel-held Madaya would be handling the food distribution operation in an acceptable way, although the United Nations would not be on the ground.
"There is fairly organized way of registering families and the community itself will play a very important role in making sure that the food gets to the right people," he said.
The operation agreed on by the warring sides, and undertaken jointly by the United Nations, the International Committee of the Red Cross and the Syrian Red Crescent, to provide enough food for one month was only a first step, El Hillo said.
"For people who have been starving, this is going to finish very quickly, so we must be able to continue delivering humanitarian assistance to people in these besieged communities on a continuous basis," he said.
El Hillo said there were at least 400,000 Syrians living in besieged areas, half of whom are in Islamic State-controlled areas in the northern province of Deir Zor and the rest mainly in rebel-held areas in southern suburbs of the capital, Damascus.
"We must get access to all Syrians in all parts of Syria in order to help mitigate the impact of the crisis on people," the Damascus-based UN official said, blaming the warring parties for the various sieges across the country.
A UN commission of inquiry has said siege warfare has been used "in a ruthlessly coordinated and planned manner" in Syria, with the aim of forcing a population, collectively, to surrender or suffer starvation.
"Sieges are a terrible thing and that should not happen and when it happens people suffer and this is what we are seeing now with our own eyes. This is not social media circulating it, we are seeing it," El Hillo said.
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