Urgent medical evacuations begin in besieged Eastern Ghouta region of Syria

Months of deadlock overmedical evacuations from Syria's biggest remaining siege brokelate on Tuesday when a deal between Damascus and a rebel factionallowed an aid agencyto evacuate a handful of critically illpatients.

Four patients were brought out ofEastern Ghouta, wherealmost 400,000 people have been under siege by President Basharal-Assad's forces since 2013, the Syrian American MedicalSociety (SAMS) said in a statement. The evacuees were taken tohospitals in Damascus.

The enclave, a densely populated pocket of satellite townsand farms, is the only major strongholdof anti-Assad forces near the capital Damascus. The military has steadily defeated pockets of armedrebellion in western Syria over the past year, with the help of Russian air power and Iranian-backed militias.

29 of the most critical cases

The Jaish al-Islam rebel group in Eastern Ghouta said it wasreleasing 29 detainees. In return, the government is allowing the evacuation of 29 of the most critical cases.

However, one person on the list, a six-month-old baby girl,died before she could be evacuated from the area, Dr. Mohamad Katoub, an advocacy manager for SAMS, wrote on Twitter.

• Doctor helping with the evacuation speaks withAs It Happens

"Now we have a list of 641 people who need to be treated outside of Ghouta," said Katoub, who is with the Syrian American Medical Society Association, which is helping to organize the evacuation.

In an interview with CBC Radio's As It Happens, Katoub said the list was prepared two months ago when the number of people who needed medical evacuation was much smaller.

"We submitted this list two months ago to the UN, but the UN couldn't get the approval from the Syrian government," he said.

Katoub said 18 people on the list have died awaiting evacuation.

The International Committee of the Red Cross (ICRC) said ithad facilitated the deal, which came two months after the UnitedNations asked Assad's government to allow the urgent evacuationof the 29 patients. The operation was still in an earlyphase, it said.

"Happy that our negotiations reached this important goal.This is a signal of hope for the future Syria," tweeted Francesco Rocca, presidentof the International Federation of the Red Cross.

A Syrian government spokesperson, Ahmed Mounir, said a deal wasstruck for a number of sick people to leave Eastern Ghouta inreturn for the release of what he called kidnapped people. Thenumber of people involved could increase, he said on television.

A Jaish al-Islam political official in Ghouta said theSyrian Arab Red Crescent (SARC) mediated between Damascus and the rebels for the swap.

"We worked to get them out through the Red Crescent, and weare working on evacuating the rest of the nearly 500 cases out,"said Yasser Delwan. But there was no indication of whether moreevacuations would be allowed, he added.

The United Nations has pleaded for the government to allow medical evacuation of around 500 patients, including children with cancer, and has said there was no excuse for not permittingtheevacuation to go ahead.

Although Eastern Ghouta is officially a "de-escalation zone"under Russian-led ceasefire deals for rebel territory, fighting there has continued. The population, including 130,000 children,is suffering the worst malnutrition seen in the almost seven-year war, the UNhas said.

Residents and aid workers said the government has tightenedthe siege in recent months in what they called a deliberate useof starvation as a weapon of war a charge the governmentdenies.

On Sunday, Turkish President Tayyip Erdogan said Turkey wasworking with Russia, Assad's ally, on the evacuations. Ankarahas backed some rebel factions in the Syrian war.

The UN has said. It has a priority list of 494 patients, while SAMS put thenumber of critical cases higher.

The remainder of the 29 patients included in the deal wouldbe evacuated over the coming days, said SAMS, a non-profit thatsupports hospitals mostly in opposition areas.

"The list includes 18 children and four women suffering fromheart disease, cancer, kidney failureand blood diseases, inaddition to cases requiring advanced surgery that are notavailable in the besieged area," it said.