A top U.N. official says he fears Syrian President Bashar al-Assad is "using children as bargaining chips" in a deal to evacuate critically ill patients, mainly children, from a besieged opposition-held town on the outskirts of the capital, Damascus.
Jan Egeland, the special adviser to the U.N.'s special envoy to Syria, expressed frustration about the emergence of a reciprocal deal that is seeing Assad officials agreeing to the evacuation of ill children in exchange for the release of Syrian government workers being detained by rebels.
"Let's hope that the agreements are good when they come," Egeland told the BBC.
"There can also be bad agreements," he added. "It is not a good agreement if they exchange sick children for detainees; that means children become bargaining chips in some tug of war. That shouldn't happen. They have a right to the evacuation and we have an obligation to evacuate them."
Since Tuesday, 32 patients have been evacuated from the Damascus area, half of them coming from the Eastern Ghouta suburb. The International Red Cross said the other half were urgent cases.
Eastern Ghouta, one of the last rebel strongholds, has been besieged by Syrian regime forces and Shi'ite allies for more than five years and targeted daily by government warplanes as well as artillery. The enclave is a mixture of towns and farming villages. The government has refused to lift a near-total blockade of the area for the past eight months.
Eastern Ghouta was targeted in an alleged sarin gas attack by Assad's forces in 2013.
Aid convoys have been allowed into the battered enclave only rarely. Its estimated population of 400,000 suffers severe shortages of food, fuel and medicines. The suburb has been designated one of the "de-escalation zones."
Russia and Iran, both allies of the Syrian government, along with Turkey, agreed on them earlier this year, but in recent weeks hostilities have broken out between regime forces and rebels.
The dominant rebel group in Eastern Ghouta, Jaish al-Islam, confirmed Wednesday that the Assad regime had agreed to evacuations in exchange for the release of 29 detained workers.
"We have agreed to the release of a number of prisoners … in exchange for the evacuation of the most urgent humanitarian cases," the rebel faction said in a statement.
In November, the U.N. submitted a priority list that contained the names of nearly 500 critically ill people, urging that they be allowed to be evacuated. The U.N. has tried to convince world powers to help arrange the medical evacuation.
Many on that list have already died, according to U.N. officials; but, with little in the way of medical facilities, others are becoming seriously ill. As in other parts of rebel-held territory, aid workers and rebels say the government purposely targets clinics and hospitals.
"The Syrian war has been a war against the medical profession in many ways," Egeland said. "Too many hospitals have been bombed, have been hit on both sides; hundreds of doctors and nurses have been killed or wounded, so what is left in Eastern Ghouta for the 400,000 civilians is not that much."
Valerie Petitpierre of the International Committee of the Red Cross (ICRC) said the organization is hoping more evacuees will be allowed out of the besieged town. She said the ICRC continues to insist that humanitarian action should not be used as a bargaining chip.
Syria's state-run Ikhbariya television reported Thursday that 35 medical cases had been evacuated by the Syrian Arab Red Crescent (SARC), while the insurgents had freed 34 detainees. But those numbers were disputed by aid workers.
Yasser Delwan, a Jaish al-Islam political official in Ghouta, told reporters Wednesday SARC had mediated between Damascus and the rebels for swaps, but that the fate of hundreds of others with life-threatening conditions remains unresolved and several of the most urgent cases slated for evacuation had died.
Those evacuated this week include 18 children and four women. The patients suffered from a variety of illnesses, including heart disease, cancer, kidney failure and blood disorders.
Fayez Arabi, a spokesman for the opposition-held Rural Damascus Health Directorate, said, "The number of people awaiting evacuation due to inadequate medicine and medical supplies has now surpassed 600."