Warplanes roar overhead, bombs explode, and terrified residents shriek. But 7-year-old Maram Lahham struggles to hear the sounds of Syria's civil war.
Maram is going deaf, and a government siege of her home town of Darayya has prevented her from receiving medical care and enough food to eat. She has been unable to have anything resembling a normal life.
"You can't imagine how hard it is to watch this happen to your daughter and not be able to do anything about it," said Fatima Lahham, her mother.
Darayya is one of 18 areas of Syria besieged by government and rebel forces.
In recent weeks, diplomatic pressure appeared to force the Government to temporarily allow UN-supported aid convoys to bring limited supplies to Darayya.
But the blockade resumed almost immediately after the aid arrived, and forces loyal to President Bashar al-Assad have intensified attacks involving devastating barrel bombs, residents say.
The continuation of the siege underscores how the conflict shows few signs of ending anytime soon. That portends more suffering for Maram and hundreds of thousands of other blockaded Syrians.
Russia and the United States had pledged to organise air drops to blockaded Syrians if the Government did not loosen its grip around the encircled areas. Assad's forces are responsible for most of the sieges.
Moscow backs Syria's Government, and Washington has supported the opposition, but the two powers have enhanced diplomatic efforts to try to end the war. This has involved joint efforts to supply humanitarian relief.
The inability of the United Nations to force the Syrian leader to allow adequate aid into these areas is a major reason why peace talks between government and opposition figures in Geneva collapsed this year. Many criticise the United Nations for not pushing the Government harder to stop its sieges.
"It is astonishing that the international community has pumped billions of dollars of aid into Syria through Damascus, but they cannot persuade the Government to open the road to Darayya, only a few minutes from the capital," said James Sadri, director of the Syria Campaign, an advocacy group that is critical of the Syrian Government.
But UN officials say they must work with most sides of the complex conflict, including the government, in order to provide aid safely and effectively.
During the early days of the uprising against Assad, protesters in Darayya held vibrant, nonviolent rallies that attracted scores of people and inspired many.
1 Darayya is a Damascus suburb of about 8000 people
2 It has been blockaded since 2012, longer than any other area in Syria
3 The more than 500,000 people trapped in communities across Syria face shortages of food and medicine
4 Dozens have died from starvation and various medical conditions, according to UN officials, aid groups and activists
5 Like Maram, some suffer greatly from treatable ailments.
Government forces responded violently, arresting and killing protesters and compelling tens of thousands of people to leave as the death toll mounted. Other residents joined in what eventually escalated into an all-out revolt against the Syrian leader.
Darayya's continued refusal to submit to Assad has turned the place into a symbol of defiance for many in the opposition.
The Government says that Darayya's rebel fighters are terrorists and Islamist extremists. Residents say they are just local men defending their home turf. Because of its proximity to the capital and a key air base, the town holds strategic importance for Assad's forces.
Throughout the siege, the estimated 8000 residents have survived by harvesting their own crops, smuggling in medicine and other items, and melting plastic bottles to create makeshift fuel for power generators.
"There is so much misery here, but people still somehow continue to live, to go on," said Mohammed Shihadeh, who works at the Darayya local council.
Even so, the prolonged deprivation has taken a toll on people such as Maram, whose family spoke to the Washington Post over Skype. During the interview, she struggled to hear questions.
Maram is underweight. Along with her six siblings, she generally eats a meal or two a day consisting of soup made of homegrown parsley and boiled grass, her mother said.
They last ate meat two months ago, Fatima said, after government shelling killed two sheep in the area. The animals were divvied up among dozens of residents, leaving them with little more than scraps.
She still wakes up happy sometimes. She says, 'I just saw Daddy in my dreams'
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Lately, she has grown alarmed by Maram's worsening deafness. Most doctors in Darayya fled long ago, including specialist physicians.
When they hear the sound of government warplanes, the family runs for shelter, Fatima said. But Maram "just can't hear them coming," she said.
Two years ago, a bomb destroyed part of their house, forcing them to move to an abandoned apartment. That happened shortly before a sniper killed Fatima's son-in-law, Alaa.
In late 2014, another sniper shot dead her husband and Maram's father, Bashar, while he was helping rebel fighters build a wall to shield people from gunfire, Fatima said. Maram was especially close to her father.
"She still wakes up happy sometimes," said Fatima. "She says, 'I just saw Daddy in my dreams.' "
Maram attends classes that are held in a basement because government forces routinely target schools. She has fallen behind the other students, Fatima said.
Maram received hearing aids donated from Darayya's sole medical facility, an ill-equipped field clinic, but the special batteries that power them are difficult to obtain. She spent months wearing the hearing devices even though the batteries had long run out of power, Fatima said.
"She refuses to take them off, even before she goes to bed," she said. "She says, 'No, they might make me hear!' "
A recent aid convoy brought Maram spare batteries, which will power the hearing aids for several weeks. Receiving replacements depends on whether more aid convoys will be allowed into Darayya, an uncertainty that does not instill Fatima with hope.
For now, she does her best to provide her daughter with a sense of normality. She encourages Maram to draw.
Recently, Fatima said, the child's illustrations have taken a dark turn.
"She draws pictures of a family fleeing bombs, but as they run away, there's a little girl who isn't running away because she can't hear," she said.
"It's hard not to cry when you see those."