Medical Evacuations Start in Syrian Rebel Enclave of Eastern Ghouta

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GENEVA — Medical evacuations have begun from the besieged Syrian rebel-held enclave of Eastern Ghouta, home to about 400,000 people, to Damascus, the International Committee of the Red Cross in Syria said on Wednesday.

The enclave has been targeted by forces loyal to President Bashar al-Assad, and the United Nations has pleaded for his government to allow for the evacuation of around 500 patients, including children with cancer.

The Syrian American Medical Society said four patients were taken to hospitals in Damascus, the first of 29 critical cases approved for medical evacuation, with the remainder to be evacuated over the coming days.

The medical society’s manager, Mohamad Katoub, said on Twitter that five had been approved for the first group of evacuations, part of a deal on an exchange of detainees between Assad’s government and rebel group Jaish al-Islam. It was not clear why only four of the five had left.

President Recep Tayyip Erdogan of Turkey said on Sunday that his country was working with Russia, a strong Syrian ally, to allow the evacuations to begin.

The United Nations has been waiting for months to gain approval from the Syrian authorities, and last week Jan Egeland, the organization’s humanitarian adviser for Syria, said the situation was getting worse, with 494 people on the priority list for medical evacuations; the medical society said more than 600 needed evacuation.

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“That number is going down, not because we are evacuating people but because they are dying,” he said. “We have tried now every single week for many months to get medical evacuations out, and food and other supplies in.”

Forces loyal to Mr. Assad have carried out air raids on Eastern Ghouta, while besieged rebels have fired mortars into neighboring Damascus. “That has nothing to do with the right of evacuating, and obligation to evacuate civilians,” Mr. Egeland said.

The evacuations came as a group of Syrian rebels, pinned down in a strategic area where the Israeli and Lebanese borders meet with Syria, said they had been given an ultimatum by government forces and their Iranian-backed militia allies: Surrender or face certain military defeat.

The Syrian Army, backed by local militias financed and equipped by Iran alongside Druze fighters from the area, have escalated their assault against Sunni rebels in an enclave in the foothills of Mount Hermon, close to both the Israeli and Lebanese borders.

The rebels have been encircled in Beit Jin, their main stronghold, after losing strategic areas in the hills and farms after over two months of near daily shelling and aerial strikes.

The Syrian Army was using a familiar approach, pushing opponents to rebel areas — in this case, Idlib Province — further from the Syrian capital after a twin tactic of siege and months of strikes on residential areas.

There were also more than 8,000 civilians who have been trapped in the remaining enclaves with their plight worsening, according to a rebel spokesman, Sohaib Alraheel.

Israel, which Syria has accused of helping the rebels, has expressed concern at the growing Iranian military influence in the Golan Heights and has stepped up its strikes against pro-Iranian targets inside Syria.