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Madaya, along with neighboring Zabadani, is besieged by pro-government forces including the Lebanese militia group Hezbollah. The aid shipment there was being coordinated with a similar delivery to the northern Syrian towns of Fouaa and Kfarya in Idlib Province, which are surrounded by Syrian insurgent groups.

For months, aid to both areas has been the subject of delicate negotiations toward an agreement known as the four-towns pact. Under the agreement, some aid was delivered in October, and last month, several hundred wounded fighters and their families were evacuated from both sides.

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Lebanese protesters at the border with Syria held a sign reading “We swear we are hungry” with images of starving children from Madaya, a town under siege in Syria.Starving Syrians in Madaya Are Denied Aid Amid Political JockeyingJAN. 10, 2016
Since then, plans for more aid and evacuations have stalled, and malnutrition has worsened in Madaya, where, according to interviews with a dozen residents as well as with humanitarian workers assisting a clinic there, people have been collapsing of hunger as they try to subsist on things like grass soup.