Abu Abdul Rahman has not eaten in four days.

Hungry and weakened, Rahman and his family have been trying to limit their movements inside their house in the Syrian town of Madaya, fearing that any activity would drain the little energy left in their bodies.

"There are no more cats or dogs alive in the town. Even tree leaves that we have been eating have become scarce," he tells Al Jazeera's Ali Saad over the phone.

Residents of Madaya, about 25 kilometres north-west of Damascus, are suffering from severe malnutrition and have little access to fuel and medical supplies due to the siege imposed by President Bashar al-Assad's troops since July.

The Red Cross says that people in the town are heating plastic to keep themselves warm.

And as days pass by, Rahman says he has little hope he and his family can stay alive.

"Describing the situation as tragic is merely airbrushing reality on the ground," he tells in a subdued voice.

The Syrian Observatory for Human Rights on Wednesday said that at least 23 people, including children, had died in rebel-held Madaya because of the siege and mines laid around the town by Assad's forces, who are backed by fighters from the Lebanese Shia group Hezbollah.

At least 300 children in Madaya are suffering from malnutrition, the UK-based monitoring group said.

Local activists said an estimated 40,000 people in Madaya have little access to food and medicines.

Pawel Krzysiek, a spokesman for the Red Cross in Damascus, said the situation in Madaya was "very difficult."

"People are hungry and it is very cold out there with no electricity or fuel," he told the DPA news agency.

Medical professionals in Madaya said that people "were eating grass to stay alive."

"We cannot provide milk for infants," Dr Khaled Mohammed told DPA on Wednesday. "Today, a 10-year-old child died of malnutrition."

The opposition Syrian National Coalition warned of a "humanitarian catastrophe" in Madaya.

The nearby town of Zabadani is also under siege, despite a deal last month that saw Sunni rebel fighters given free passage out of the town in exchange for the evacuation of Shia families from the northern towns of Kefraya and Fua.

The UN's Syria mediator aims to convene peace talks in Geneva on January 25 in the latest effort to end nearly five years of conflict in which more than 250,000 people have died.

Al Jazeera