BEIRUT — The Syrian army has been using starvation as a “weapon of war” in its siege of the Yarmouk Palestinian refugee camp on the outskirts of Damascus, Amnesty International said Monday.

In a report on the plight of Palestinian and Syrian civilians in Yarmouk, the rights watchdog said nearly 200 people have died since an army siege was tightened in July 2013 and access to food and medicine cut.

The document, entitled “Squeezing the life out of Yarmouk: War crimes against besieged civilians,” said 128 of the deaths were caused by starvation.

“Life in Yarmouk has grown increasingly unbearable for desperate civilians who find themselves starving and trapped in a downward cycle of suffering with no means of escape,” Amnesty’s Philip Luther said in a statement.

Amnesty said the siege of Yarmouk was “the deadliest of a series of armed blockades of other civilian areas, imposed by Syrian armed forces or armed opposition groups on a quarter of a million people across the country.”

Syrian troops have laid siege to the camp as near-daily battles rage between rebels and pro-regime fighters in the sprawling southern Damascus suburb.

The violence has prompted the exodus of tens of thousands of Yarmouk’s 170,000 residents. Some 20,000 are still trapped inside the camp, facing hardship and hunger, according to the UN refugee agency UNRWA.

‘Repeated attacks on civilians’

Amnesty also charged that government forces and their allies have repeatedly launched attacks, including air raids and shelling with heavy weapons, on civilian buildings in the camp.

“Launching indiscriminate attacks on civilian areas, leading to deaths and injuries, is a war crime,” it said.

“To repeatedly strike a heavily populated area, where the civilians have no means of escape, demonstrates a ruthless attitude and a callous disregard for the most basic principles of international humanitarian law,” Luther said.

Amnesty also said at least 60 percent of those who have remained in Yarmouk are said to be suffering from malnutrition, with residents not having eaten fruit or vegetables for months.

“Syrian forces are committing war crimes by using starvation of civilians as a weapon of war,” Luther said.

“The harrowing accounts of families having to resort to eating cats and dogs, and civilians attacked by snipers as they forage for food, have become all too familiar details of the horror story that has materialised in Yarmouk.”

It said aid delivered to the camp was “woefully inadequate to meet basic needs.”

Children and the elderly had suffered the most, according to the report. “Eighteen children including babies have died. Complications have also arisen from residents eating inedible or poisonous plants and dog meat.”

It said hospitals have run out of basic medical supplies, while residents had told Amnesty armed opposition groups had looted supplies and stolen ambulances.

Once a buzzing commercial and cultural hub, Yarmouk has suffered massive destruction because of frequent clashes, shelling and air raids.

Syria is officially home to nearly 500,000 Palestinian refugees. Half of them have been displaced by the conflict in Syria since it broke out in March 2011.