By Stephanie Nebehay and Tom Miles

GENEVA (Reuters) – Aid workers in eastern Aleppo were distributing the last available food rations on Thursday as the quarter of a million people besieged in the Syrian city entered what is expected to be a cruel winter, U.N. humanitarian adviser Jan Egeland said.

Speaking in Geneva, Egeland said he was hopeful of a deal on a four-part humanitarian plan the United Nations sent to all parties to the conflict several days ago. The plan covers delivery of food and medical supplies, medical evacuations and access for health workers.

“I do believe we will be able to avert mass hunger this winter,” Egeland told reporters in Geneva, noting that east Aleppo last received relief supplies in early July.

“I don’t think anybody wants a quarter of a million people to be starving in east Aleppo,” he said.

Some families in the rebel-held area have not had food distributions for several weeks and food prices are skyrocketing, he said. Around 300 sick and wounded require medical evacuation, he added.

Syria’s government rejected a U.N. request to send aid to east Aleppo during November, but Egeland said he was confident that Damascus would give its permission if the new U.N. humanitarian initiative was accepted by all sides. He said he also had the clear impression that Russia would continue its pause in air strikes over the northern city.

Russia’s military will continue arranging ceasefires, or so-called “humanitarian pauses” in Syria, Interfax news agency quoted Deputy Foreign Minister Sergei Ryabkov as saying on Thursday.

The U.N. refugee agency UNHCR said a survey based on nearly 400 interviews in eastern Aleppo between Oct 24 and Oct 26 found 44 percent of respondents wanted to leave if a secure exit route was available, while 40 percent wanted to stay.

“Those who wish to stay either didn’t know of any safe place to go, wanted to remain with family members, couldn’t afford the cost of moving, or feared they would not be able to return to their homes,” UNHCR said in a report.

Egeland, asked about expectations from the administration of U.S. President-elect Donald Trump, said: “Syria is the worst war, the worst humanitarian crisis, the worst displacement crisis, the worst refugee crisis in a generation. So we expect there to be continued, uninterrupted U.S. help and engagement in the coming months.”

(Reporting by Stephanie Nebehay and Tom Miles; Editing by Raissa Kasolowsky)