Beirut: In the Syrian city of Aleppo, children carrying groceries climb 15-foot mounds of rubble on their way home. Shoppers ignore vibrations from falling bombs. Buildings stand sliced in half, wires and beds and bathtubs exposed, with families still living inside. Most days, doctors have just seconds to decide which children to try to save and which to let die, as parents shriek and explosions shake the ground.
Three American doctors said such scenes were replaying in their minds after a recent visit to the insurgent-held section of Aleppo. The doctors provided a fresh perspective on life there, because their Syrian colleagues in Aleppo, after four years of bombardment by government forces, have grown tired of describing the horrors to the outside world and have, in some sense, stopped noticing.
“For them, that’s just their life,” said Dr. Samer Attar, one of the American doctors from the Syrian American Medical Society who volunteered for two weeks in rebel territory, then raced for the Turkish border just as pro-government forces cut off the last route out.
Their mission was to relieve, and honour, exhausted medical workers; bear witness to the ordeal of civilians in Aleppo; and press the world to help them. But now, the doctors said, the emergency has grown even more dire. Since July 28, eastern Aleppo has been completely encircled, bracing for a starve-or-surrender siege like the ones government forces have used to take back other rebellious areas, and intense bombing continues.
Attar, an orthopaedist from Chicago, recalled leaning over three children crowded onto a single gurney to perform cardiopulmonary resuscitation on a boy, about 10 years old, who was not breathing, one of his legs blown open.
“It was mass chaos, patients on the floor, a man with his foot on top of his belly,” Attar said. “The chief surgeon said, ‘I need you to focus on this man bleeding to death, because he’s still conscious, breathing, and has a better chance of making it.’”
As painful as that was, Attar said, he was awed by the doctor’s calm efficiency.
“These are everyday decisions for them,” he added. “These are not isolated attacks like the horrible things” — terrorist attacks in places like Bangladesh and Nice, France — “that are happening all over the world. In Aleppo, these bombings are happening every day.”
Speaking by telephone between surgical operations at Northwestern Memorial Hospital, where he works, Attar, 40, said he had flashbacks whenever he heard the wheels of a gurney.
“You feel like there’s a freight train running through your head,” he said of life in eastern Aleppo.
“I have no other way of conveying the fear and horror and dread and despair of living there.”
Aleppo is a crucial prize in the Syrian war. Once Syria’s largest city, with about 2 million people, it has been divided since 2012 between government-controlled territory in the west and rebel-held areas in the east.
On both sides, civilians have suffered for years from indiscriminate attacks. But only the government and its Russian allies have warplanes, making the bombardment of the east more devastating. Four hospitals were hit last weekend, and a strike Sunday on another in Daraa province killed six.
Medical organisations say the government has systematically singled out medical workers across Syria; the group Physicians for Human Rights has documented the deaths of more than 700, most killed by pro-government forces. Opposition groups say this violence is part of a scorched-earth policy to drive out residents by denying them basic services.
Syrian officials and their Russian allies deny that, saying that they are targeting terrorists and that civilians can leave eastern Aleppo through humanitarian corridors. On Saturday, the Syrian state media reported that dozens of families had started leaving rebel-held neighbourhoods for shelters in western Aleppo, a claim disputed by some opposition activists.
Each side accused the other of preventing civilians from leaving. Some residents said they feared that the government would throw them in jail.
The United Nations says nearly 300,000 people still live in the east, but estimates vary widely. There are several insurgent groups, some backed by the United States. There are also fighters from the Nusra Front, a group linked to al-Qaida that has changed its name to the Levant Conquest Front.
The Daesh group — whose attacks around the world have sucked attention away from the Syrian conflict, which helped spur its rise — does not have a major presence in the city, but it holds territory northeast of it.
Only three main hospitals are still open, and five are out of service, according to the medical society. All rely on the group or other aid agencies for money to pay employees and for supplies. All are surrounded by sandbags and other protective barriers.
Most of the hospitals have moved much of their work to basements and newly dug underground extensions. There are fewer than three dozen doctors; just one is a neurosurgeon, and he is still in training.
As the siege tightens, conditions will become worse. Medical supplies could run out within a month. Malnutrition could weaken people further. As the road to Turkey has come under regular fire, people have died because there are not enough doctors to treat them, vital equipment and supplies are missing, and the sick and injured cannot be evacuated safely.
“It’s very difficult to fathom how doctors in Aleppo take this, day after day, minute after minute,” said Dr. Zaher Sahloul, another visiting volunteer, who runs global aid programmes for the medical society.
Sahloul recalled treating a tailor with a head wound. The man had been rushing home from his shop, thinking he had heard an explosion from that direction, when another blast knocked him down.
Soon enough, his wife, Fatima, and their three children were carried in. Two of them, Abdo, 9, and Eilaf, 3, died. Fatima, 25, lost her unborn child, and was likely to die because the roads were too dangerous to evacuate her. Mahmoud, 7, survived.
Dr. Mohammad Al Ahmad, 50, a Syrian radiologist in Aleppo, has moved his family safely to Turkey. He said he had recently watched two boys and three girls being pulled from the rubble of a building; the boys lived, but the girls died. He watched their parents hugging their shrouded bodies.
“Sometimes, you can’t hold yourself from crying,” he said. “But if I look in front of me, there is no other way. God gave me this mission.”
Al Ahmad took comfort, he said, in knowing that the doctors from abroad had risked their lives to help Aleppo’s residents. He said Attar had told him, “My soul, my blood, is not more precious than yours.”
As the doctors drove in from Turkey, they said, the road stank of metal and rotting flesh. Smoke from recent air strikes could be seen in the distance on either side. Sahloul and Attar are of Syrian descent and know the country well. But Dr. John Kahler, a semi-retired paediatrician who works at a community health centre in Chicago, was making his first trip to Syria.
Kahler had expected something like his mission to Haiti after the 2010 earthquake, he said, but the destruction was “powers of 10 worse.”
