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Relief groups on Monday began a major humanitarian aid delivery to tens of thousands of besieged people in an opposition-held central Syrian town.

The aid convoy to the town of Rastan, in Homs province, included 35 trucks carrying food, medicine, diapers, delivery kits for pregnant women and anti-lice shampoo, spokesman Pawel Krzysiek said.

The town has been under siege since January. It received its first batch of humanitarian aid in over a year on Thursday.

The population of Rastan had doubled to 120,000 because of the influx of people fleeing nearby fighting in the Hama province.

Last Thursday, aid groups sent 65 trucks into the town in the largest aid delivery yet in Syria.

More than four million people live in besieged or hard-to-reach areas with little or no access to food or medicines.

Rebel groups took control of Rastan and the vast agricultural land around it in 2012.

Residents had since received so little aid that they found it hard to believe there would be a second delivery so soon.

"We told them we would be back in the coming days and one of them said, 'Yeah, yeah, that's what people said last time... If you manage to enter again, we'll have a party,'" Krzysiek told AFP.

The ICRC had noted several cases of malnutrition, but the situation was not as "intense" as other besieged towns like Madaya, near Damascus.

Madaya became infamous in late 2015 after dozens died of starvation in the town, which is besieged by pro-government forces.

"The irrigation areas and farmlands are really the front lines" in Rastan, Krzysiek said.

"It's too dangerous to do large-scale cultivation and even if you manage, you cannot sell it."

Syria's conflict started in March 2011 as anti-government protests but has spiralled into a complex, multi-front war.

Both government forces and armed rebel groups are accused of war crimes, including laying siege to civilians.

The UN has criticised regime forces for denying access for aid groups to enter besieged areas.

Agencies contributed to this report.