The Syrian American Medical Society (SAMS) said four patients have been taken to hospitals in Damascus, the first of 29 critical cases approved for medical evacuation, and that the remainder would be evacuated over the coming days.
Medical evacuations have begun from the Syrian rebel-held enclave of Eastern Ghouta to Damascus, the International Committee of the Red Cross (ICRC) in Syria said early on Wednesday.
Almost 400,000 people in Eastern Ghouta are besieged by Syrian regime forces, and the United Nations has pleaded for evacuation of around 500 patients, including children with cancer.
The Syrian American Medical Society (SAMS) said four patients were taken to hospitals in Damascus, the first of 29 critical cases approved for medical evacuation, and the remainder would be evacuated over the coming days.
TRT World's Ahmed al Burai reports from Hatay, Turkey, near the Syrian border.
SAMS advocacy manager Mohamad Katoub said in a tweet that five had been approved for the first group of evacuations, part of a deal on an exchange of detainees between the Syrian regime and rebel group Jaish al Islam. It was not clear why only four of the five had left.
4 from 5 patients who were approved for today evacuation from besieged #Ghouta are evacuated. The patients are from a list of 29 set by medical staff over 2 months ago and submitted to UN. The evacuation is under a deal of detainees exchange between the regime and Jaish Alislam— Mohamad Katoub (@MhdKatoub) December 26, 2017
The Syrian Red Crescent said the evacuations were the result of "long negotiations".
An ICRC spokeswoman declined to give more details, citing the sensitivity of the operation.
On Sunday, Turkish President Recep Tayyip Erdogan said Turkey was working with Russia, a regime ally, on the evacuations.
Last week Jan Egeland, the UN humanitarian adviser for Syria, said 494 people were on the priority list for medical evacuations.
"That number is going down, not because we are evacuating people but because they are dying," he said.
"We have tried now every single week for many months to get medical evacuations out, and food and other supplies in."
The United Nations has been waiting for months for the Syrian authorities to provide "facilitation letters" to allow the aid operation to get under way.
Forces loyal to Syrian regime leader Bashar al Assad have carried out air raids on Eastern Ghouta, while besieged rebels have fired mortars into neighbouring Damascus.
"That has nothing to do with the right of evacuating, and obligation to evacuate civilians (and) wounded," Egeland said.
Eastern Ghouta is one of four de-escalation zones Turkey, Russia and Iran agreed to at Syria talks in the Kazakh capital Astana.