ALEPPO (Syria) • With pools of blood and shredded bodies filling the streets, the rebel-held east of Aleppo has been reduced to an apocalyptic battlefront under a relentless regime and Russian bombardment.
Doctors at one of the last functioning hospitals in the city said they were being forced to carry out swift amputations in order to keep survivors alive.
“This morning alone, we had 60 wounded come in,” said Dr Ahmed, who asked not to be fully identified out of fear for his life and for the hospital that has come under persistent bombing and air strikes.
“We’re carrying out a large number of amputations just so patients survive because otherwise we don’t have the means to treat them,” he said, circled by men and children stretched out in pain on the floor. “Many of the wounded are dying before our eyes – we’re helpless.”
With supplies of blood and intravenous drips exhausted, he said their attempts to save lives were growing futile, especially where head injuries were involved.
On one bed, a little boy glanced in silence at his blood-soaked hands. The scene was reminiscent of four-year-old Omran, who sat dazed and confused at the back of an Aleppo ambulance last month in a haunting photo that made front pages around the world.
Battle for Aleppo
Russia's dispatch of troops and warplanes a year ago has worked to secure President Bashar al- Assad's grip on Damascus, the capital, and to reverse or halt rebel gains in the north and the south since fighting erupted in Syria more than five years ago.
Many communities that have held out against government forces have been gradually surrendering, most recently al-Waer, the last neighbourhood of the once-rebellious city of Homs.
Aleppo remains an exception - an important urban centre that the government was unable even to encircle until this month.
Before rebel fighters overran the eastern portion of the city around mid-2012, it was Syria's biggest metropolis, with a population of three million, and the epicentre of the country's industry and trade.
Diplomats say as long as the rebels have a presence in Aleppo, they can claim a stake in the future of Syria - but without it, their revolt against Mr Assad's rule becomes a rural insurgency contained within the country's border provinces.
Any battle for Aleppo is expected to be bloody and long.
An estimated 250,000 people are trapped there, far more than in any of the other communities, and the rebels have had four years to dig in and reinforce their positions.
It could become the next bargaining chip in any negotiations that may take place between Moscow and Washington.
A Western diplomat said on Friday that the only way for the government to take the area quickly would be to totally destroy it in "such a monstrous atrocity that it would resonate for generations".
WASHINGTON POST, REUTERS
The wounded boy on the hospital bed lost a baby brother when an air strike devastated their family’s apartment in the city’s Bab al-Nayrab district.
“We were home when a missile crashed into our road,” said their father Nizar, standing red-eyed and holding back tears outside what remained of their house. “Half of the building just caved in, and our baby was hit on the head. He died on the spot.”
“I’m waiting for relatives to finish digging his grave so I can bury him,” he said. His youngest child was lying wrapped in a blanket to conceal the head injuries from the mother.
In Bustan al-Qasr, another district under the barrage of bombs, at least seven people were killed in a strike as they queued to buy yogurt at a market.
The attack left a pool of blood, the grim odour of death and body parts in the front-line district, located between the government-held west and the rebel-held east of the city that was Syria’s economic hub before war overtook it in 2012.
In cataclysmic scenes, the streets in several parts of east Aleppo were filled with mountains of rubble, burnt-out cars and toppled electricity poles.
In Al-Kalasseh, a survivor dug desperately with his bare hands to try to find his uncle under the rubble. “Civil defence workers came to rescue him, but there was another strike that wounded six of their volunteers and they left,” he said.
Only three or four hospitals are still operational in government-besieged east Aleppo – far short of what is needed to cope with the hundreds of casualties flocking in from among the 250,000 people estimated to be trapped in rebel-held areas.
Nearly two million civilians have been left without water in Aleppo since bombardment damaged a pumping station and rebels shut down another in retaliation, according to the United Nations.
With no electricity or fuel for generators, the streets of Aleppo are pitch-black and hard to navigate at night. The fuel shortage has also made it tough to fill up vehicles.
The denial of access to food, water and medicine has been used repeatedly as a weapon by all sides in the five-year war, which has cost more than 300,000 lives and displaced over half the populace.
The United States and leading European powers said on Saturday that “the burden is on Russia... to salvage diplomatic efforts to restore a cessation of hostilities”.
A week-long ceasefire agreed on between the US and Russia ended last Monday, and efforts to revive the truce have failed.
That same day, an aid convoy was hit by an air strike that US officials have said was carried out by Russian planes. Moscow has denied responsibility.
AGENCE FRANCE-PRESSE, REUTERS