Typhoid has broken out among residents of the Yarmouk Palestinian refugee camp in Syria, the United Nations said yesterday, warning of further disease outbreaks unless aid reached the camp because of the appalling conditions there.

Eleven cases of typhoid were confirmed by the UN agency for Palestinian refugees (UNRWA), which gained access to residents from the Yarmouk camp for the first time since June in nearby Yalda, where it carried out more than 200 medical consultations.

Typhoid is contracted by drinking or eating contaminated matter and symptoms include nausea, fever, and abdominal pain. Untreated, the disease can lead to complications in the gut and head which can kill.

“Our concern is that these typhoid cases only represent the tip of the iceberg, because the erosion of health services and appalling public health standards create a massive, massive risk of diseases breaking out,” said UNWRA spokesman Chris Gunness.

Children are reduced to eating grass

“The situation is desperate, and suffering may be far more widespread and intense inside the camp,” Gunness told the Thomson Reuters Foundation by phone. The camp, set up close to Damascus has become a symbol of the desperate plight of people in rebel-held territory since the Syrian government laid siege to it in 2013.

Islamic State fighters attacked the camp in April but withdrew soon afterwards having largely defeated their rival, Aknaf al Maqdis, leaving the al Qaeda-affiliated Nusra as the biggest force in the camp.

Fighting in and around the camp has left some 18,000 refugees, including 3,500 children, without food, water and medical supplies and prompted aid agencies to urge the warring parties to allow access for aid and evacuations.

“Women are dying in childbirth due to a lack of medicine, children are reduced to eating grass because there is no food, and the water supply hasn’t been functional since September,” Gunness said.