In the dim and crowded surroundings, aid workers who went there recently met a woman whose daughter spent four days without eating. This, the mother told them, was because the girl's body no longer tolerated rice.
Residents, under siege since June 2015, said rice had been the only food available there for months.
Some children could no longer walk straight, the workers heard, because they lacked vitamins. Others had stopped growing. Elderly people looked fragile and much older than their years.
The 40,000 residents of Madaya, in the mountains 15 miles (25km) north-west of Damascus, are surrounded by the Syrian army and allied fighters from Lebanon's Hezbollah movement.
Most of their food provision is dependant on infrequent humanitarian deliveries.
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