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and medicines.
Distribution will continue through the night to 40,000 people who have been trapped for six months
by a government blockade and without aid since October.
The UN says it has received credible reports of people dying of starvation.
Simultaneously, aid lorries entered two villages besieged by rebel forces in the northern province of
Idlib under a deal between the warring parties.
The situation in Foah and Kefraya is also said to be extremely dire, with an estimated 20,000 people
trapped there since March.
The arrival of the aid was delayed until both sets of lorries were ready to enter.
"Some are smiling and waving at us but many are just simply too weak, with a very bleak expression,
too tired."
One resident, Hiba Abdel Rahman, 17, told Agence France-Presse: "For 15 days we have been eating
only soup.
"I saw a young man killing cats and presenting the meat to members of his family as rabbit. Some
people went through garbage bins, others ate grass. We sought food from the fighters but they refused
to give it to us."
In total, some 44 lorries operated by the UN, the ICRC, the Syrian Red Crescent and the World Food
Programme reached Madaya from the capital, Damascus.
Image copyrightReutersImage captionA few people have been given permission to leave Madaya
Another 21 entered Foah and Kefraya.
They were carrying basic food items - including rice, vegetable oil, flour, sugar and salt - as well as
water, infant formula, blankets, medicines and surgical supplies.
Marianne Gasser, head of the ICRC's Syria delegation, said the deliveries should not be one-offs.
She said: "To relieve the suffering of these tens of thousands of people, there has to be regular access
to these areas."
A few residents were given permission to leave and could be seen with belongings awaiting
evacuation.
Madaya, which is about 25km (15 miles) north-west of Damascus and 11km from the border with
Lebanon, been besieged since early July by government forces and their allies in Lebanon's Shia
Islamist Hezbollah movement.
Brice de la Vigne from the medical charity Medecins Sans Frontieres (MSF) described the situation in
the town as "quite horrific".
Mr de la Vigne, whose organisation supports a health centre in Madaya, told the BBC that more than
250 people there had "acute malnutrition".
MSF said on Sunday that a total of 28 people - including six children less than one year old - had died
of starvation in Madaya since 1 December.
However, Hezbollah has denied that there have been any deaths in the town, and accused rebel leaders
of preventing people from leaving.
Blockades have been a feature of Syria's civil war. Up to 4.5 million people live in hard-to-reach
areas, including nearly 400,000 people in 15 besieged locations who do not have access to life-saving
aid.
In a separate development on Monday, activists said at least 12 children had been killed in an air strike
on a school in the rebel-held town of Ain Jara, in Aleppo province.