AMMAN: Amidst the largest assault by loyalist forces against the rebel-held neighborhoods of Aleppo city in more than five years of war, hundreds of casualties are overwhelming doctors, rescuers and hospital workers and prompting international calls for medical evacuations.

In the past nine days, aerial and ground bombardment has killed an estimated 400 people and injured 1,300 others in rebel-held east Aleppo, according to the Aleppo Civil Defense.

“That’s only the number of people we were able to pull out of the rubble,” Ammar Selmou, the head of the Aleppo Civil Defense told Syria Direct on Wednesday. “The ones still under there haven’t been counted. The actual figure may be far higher.”

Airstrikes by Syrian regime warplanes and their Russian allies began on September 19, after the former announced the end of a ceasefire brokered by Washington and Moscow. The bombardment intensified this past Friday after the regime officially announced an offensive against east Aleppo.

Scores of wounded people have overwhelmed the rebel-held east’s already-struggling medical and rescue infrastructure in recent days.

Approximately 30 medical professionals are currently serving an estimated quarter million people blockaded in Aleppo’s eastern neighborhoods. But only roughly half of them graduated from medical school, hospital employees and a rescue worker told Syria Direct. The rest are nurses or medical students who were not able to complete their studies because of the war, and are now serving as doctors in understaffed hospitals.

“There are 12 doctors, including surgeons, specialists and general practitioners,” Muhammad Zain, who works with all the city’s hospitals as an administrator in the Aleppo Medical Council, told Syria Direct on Wednesday. “This has rendered us helpless, stunned before the huge numbers of the wounded and the round-the-clock massacres.”

The pace of the bombing has significantly slowed from its frantic pace earlier this week—when an estimated 250 people were killed in three days—but loyalist aerial and ground bombardment continues on Wednesday, sending new casualties to the already-bursting hospitals.

 
An East Aleppo medical facility on Sunday. Photo courtesy of Aleppo Civil Defense.

Opposition media reported airstrikes in at least seven neighborhoods as of late afternoon on Wednesday. In one of the bombings, a reported Russian airstrike killed six people waiting to buy bread on Wednesday morning in east Aleppo’s al-Maadi district. The day before, a bombing in the a-Shaar neighborhood killed 24 civilians, according to the Aleppo Civil Defense.

“There are many wounded who urgently need to be evacuated,” Jumaa Arab, who heads an east Aleppo ambulance crew told Syria Direct. “They need specialized treatment and devices that we don’t have.”

World Health Organization (WHO) spokesperson Fadila Shayib called for the “immediate establishment of humanitarian routes to evacuate sick and wounded” from east Aleppo, speaking at a press conference in Geneva on Tuesday. Remaining health facilities are “on the verge of complete destruction,” she added.

Shayib stated there are seven hospitals remaining in Aleppo out of 25 total medical facilities. Multiple rescuers and doctors Syria Direct spoke with on Wednesday said there are currently five functioning hospitals, after a sixth was partially destroyed and shut down by a bombing earlier this week.

On Wednesday, predawn airstrikes by Russian or regime warplanes reportedly damaged the M10 field hospital, the largest trauma facility in east Aleppo, knocking it out of service.

A second hospital, M2, was struck by artillery and mortar fire originating from the nearby regime-held Aleppo citadel around the same time, Hussein Dabak, the hospital’s accountant told Syria Direct.

The bombardment caused “material damages to ambulances, generators and the emergency department,” he said, adding the hospital was closed for repairs on Wednesday.

 
After an airstrike in east Aleppo’s a-Shaar neighborhood on Tuesday. Photo courtesy of Aleppo Media Center.

Syrian and Russian state media have not reported Wednesday’s hospital bombings. Syrian regime forces and their allied militias launched a ground attack on Tuesday and reportedly captured the al-Farafrah neighborhood from rebels.

Russian state-run TASS agency reported that nine districts of regime-held west Aleppo were under shelling by rebels in the east on Tuesday, with “dozens of injured people taken to hospital every day.”

‘With everything we have’

In blockaded east Aleppo, “we don’t have the space to do anything,” said Muhammad Zain, who works with the medical council responsible for all hospitals in the rebel-held neighborhoods. “The hospitals are bursting, people are lying on the ground, waiting their turn. We’re helpless, watching them die, one after the other.”

In pictures and videos posted by media sources inside the city, east Aleppo’s emergency rooms resemble abattoirs. The wounded, waiting to be seen, lie there—some stone-faced and silent, others groaning—as blue-clad medics pick their way through the carnage.

“If there is a bone injury, we amputate immediately,” said Zain. “If there were a specialist, we could have kept these limbs.”

With limited resources, doctors make impossible choices, he said, giving east Aleppo’s sole Intensive Care Unit as an example. “We’re forced to take one patient on the respirator off and put in his place another who has a better chance of surviving,” said Zain, “leaving the first to die.”                                                                                       

Specialists rotate from hospital to hospital, depending on need. Rescuers coordinate with hospitals so they don’t add extra pressure to struggling emergency rooms. Diesel-run generators power one department at a time to conserve precious fuel.

“We’re doing what we can, with everything we have,” said Zain. “If we’re bombed in the morning, we work at night. If a generator is hit, we use another. We work madly, defiantly, steadfastly.”

“It’s something like a miracle from God that we are still standing.”