In besieged areas of the Syrian city of Homs, even evergreen trees were stripped bare this winter.
Evacuees who fled in a United Nations-brokered ceasefire, which was extended for a further three days on Thursday, described being so desperate that they survived by eating leaves, plants, earthworms and cats.
The aid deal that has allowed civilians to flee into rebel-held neighbourhoods of Old Homs has provided a small glimmer of hope as a second round of peace talks in Geneva stay deadlocked.
But food supplies there have been scarce for more than a year.
And after sideline talks with the US and Russia on Thursday, United Nations envoy Lakhdar Brahimi admitted "failure is always staring at us in the face".
He described the deal in Homs, and the extension of the ceasefire, as a positive development, but said it would need a "miracle for our people to come out alive" - a reference to the deliberate targeting of aid convoys with mortar shells.
Abu Nizar, 72, fled with the first batch of evacuees a week ago. One of his group was shot in the stomach by a sniper as they crossed through open ground flanked by UN vehicles.
But Nizar was not deterred. He was desperate - and it was not his first attempt to leave.
Seven months ago, he tried to escape through a tunnel that had been smuggling precious supplies of food in and out of the area, but he said it was blown up by Syrian government forces and collapsed while he was inside.
After the tunnels were closed, the situation got worse, and for the last three months he had eaten no bread, wheat or rice. The opposition has accused President Bashar al-Assad of using starvation tactics as a weapon of war, and the UN estimates up to 200,000 civilians are living under siege in the country. "I ate worms," Nizar said. "It's disgusting, but we had to eat."
Another evacuee, Abu Jalal Tilawi, 64, said he been forced to kill and eat cats. "The bombs couldn't get us out, but the hunger won the game," he said. "People gathered grass. We were like herds of animals."
When the World Food Programme made its first deliveries this week, Matthew Hollingworth, the agency's Syria director, said he had never come across such destitution. "People were living in basements, crawling between them in tunnels, existing, not living," he said.
About half of the 2,500 civilians thought to be trapped in the Old City have been evacuated.
With living conditions so desperate, hundreds of men between 15 and 55 who, under the terms of the deal, must undergo questioning by Syrian security forces before leaving, have decided to take the risk.
Hollingworth said there was "extreme concern" for those that remained. But even those who have left fear the cycle will only repeat itself. On their exit, evacuees were able to choose where they will be taken. Many chose the neighbourhood of Al-Waer, partially under rebel control.
But Abu Jalal said food was scarce there, too, and when he tried to leave to buy groceries this week, he was turned back at a government checkpoint.
"I've told people to start raising cats and dogs because you never know when you'll need to eat them," he said. "Once the world has stopped watching, it will happen here too."