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BEIRUT, Lebanon — In a photo of the girl taken a few months before she died, her light brown hair is matted, her face and clothes smudged with dirt. She holds a chain in her tiny hands — a glimpse of the hardships of her all-too-short life.
Six-year-old Nahla al-Othman spent her final years living in a crowded tent with her father and siblings in an impoverished camp for Syrians displaced by a decade of war and largely forgotten by the world. To keep her from wandering around the camp, the family said, her father often shackled her and locked her in a cage he fashioned out of her crib.
Her father “used to chain her hands or her feet to prevent her from walking outside the camp,” said the camp supervisor, Hisham Ali Omar. “We asked him more than once to unchain her, not to put her in a cage, but he constantly refused.”
This month, the crises that twisted Nahla’s life came to a tragic head when she choked to death while desperately hungry and eating too quickly. Images of her in chains and the cage spread quickly on social media after her death, and the outrage over them spurred the local authorities to detain her father.
The case drew rare attention to the suffering of millions of children forced from their homes during the war and living in camps dotted across Syria’s north. Displaced by violence, stalked by hunger and lacking access to education, medical care and sanitation, they face a daily struggle to survive.
“We are talking about children who are born in tents, which become a hazard after the first rain,” said Ahmad Bayram, a spokesman for the aid group Save the Children. “We are talking about children who don’t know if their bed will be dry when they go to sleep.”
“They have forgotten what a normal life is like,” he said.
Nahla lived with her family in the Farjallah camp in a rebel-held pocket of northwestern Syria. More than half of the area’s 4.2 million people have fled there during the war, and many of them live in makeshift shelters. They lack protection from heat, cold and disease, and live in fear that Syria’s government and its Russian allies could resume attacks at any time aimed at seizing the area.
Aid groups say that conditions in the camps are becoming increasingly dire, especially for children. Many work to help support their families, and malnutrition rates are growing.
Suicides among children and teenagers in northwestern Syria are also on the rise, according to Save the Children.
“We have seen instances of children aged 11 or younger who have given up on life,” Mr. Bayram said.
The Farjallah camp is home to about 350 families in Idlib Province, near the border with Turkey. The camp supervisor said it had been months since the tented settlement had garbage collection or enough water for people to drink, cook and bathe.
Nahla’s uncle, Adnan al-Aloush, said the family had been driven from their home in another part of Idlib Province three years ago when government forces seized the area. Her parents separated, and her mother went to live as a refugee in Turkey.
The father, Issam al-Othman, kept the children, and they lived together in a cramped tent. Relatives and other camp residents said Nahla’s father struggled to support the family.
An older sister, Heba al-Othman, said that other children taunted Nahla because she had a skin infection, and that they had sometimes poured water on her because they knew it scared her.
“They used to call my sister ‘mother of germs,’” said Ms. al-Othman, 22. “My father couldn’t handle all this pressure.”
Mr. Omar, the camp supervisor, said the dire conditions in the camps left many parents struggling to care for their children.
“We live in tents — no doors, no locks — and the girl kept wandering around,” he said. “The only solution was to shackle her.”
At other times, Nahla’s father confined her in her crib, using a metal grate as a lid to turn it into a cage.
Mr. Omar said that some people in the camp felt sorry for Nahla and gave her food. It was widely known that her father chained her, but people didn’t intervene, either because they were caught up in their own struggles or they empathized with his troubles, he said.
“Living in camps is not easy,” he said. “People here are jobless — they have to deal with daily life challenges and problems. I saw parents sending their children to look for food in the trash.”
There was no indication that any residents reported Nahla’s father to the local authorities, possibly because many have known one another since before the war and felt that such issues should be handled privately.
“We all came from the same village, so it’s better to keep the story among us,” Mr. Omar said.
Nevertheless, there were indications that Nahla was mistreated well before she died.
Ahmad Rahal, an activist who documents the war in rebel-held areas, visited the Farjallah camp several months ago and took a video of the young girl, which he shared with The New York Times. He said she appeared to be smart but neglected.
In the video, Mr. Rahal asked her name and what she was looking for. A sandwich, she said, stretching out a hand dotted with sores. She told him that her father beat her.
Mr. Rahal said that he had reported the suspected abuse to the local authorities, but that they had taken no action.
On May 4, camp residents found Nahla choking and rushed her to a hospital in the nearby village of Killi. Mahmoud al-Mustafa, a pediatrician there, said the sister who had brought her in said she had been extremely hungry and was eating so quickly that she had choked.
A medical report on the cause of death confirmed that she had choked and was malnourished.
Dr. al-Mustafa said his hospital lacked the supplies to treat her.
“If the hospital were better equipped, we could have saved Nahla,” he said. “If we had a ventilator or children’s ward, we could have done something.”
The local authorities detained Nahla’s father for several weeks on suspicion of neglect, but he was released without charge this past week.
Some relatives and camp residents insisted that he had done what he could for his family under impossible circumstances.
After his release from detention, the father said he had committed no crime.
“I can’t believe I’m accused of being a tough father,” he said. “Nahla is an innocent angel. I would never harm my daughter.”
He did acknowledge that he had sometimes chained her, however.
“Yes, sometimes I used to shackle her — I had to,” he said, adding that she used to go out undressed and wander the camp, and that his neighbors had complained about her.
“She used to leave the tent morning and night,” he added. “We live like we are in a forest here. I tried to reach many aid organizations for medical help, but couldn’t find any treatment for her.”
Ben Hubbard, Megan Specia and Asmaa al-Omar contributed reporting.
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