BEIRUT — The bombings at night are the worst. There is no electricity in the rebel-held portion of eastern Aleppo, and the warplanes flying overhead target any light piercing the blackness beneath.

So families huddle together in the dark, gathered in one room so that they don’t die alone, listening to the roar of the jets and waiting for the bombs to fall.

After they do, rescue workers venture out, navigating the rubble and craters left by earlier bombings, to dig out victims without headlights or lamps. They haul them to hospitals swamped with patients being treated on the floor by doctors who barely sleep, and must choose which lives to save and which to let go.

In the small hours of Wednesday morning, it was the turn of two hospitals to be hit in the dark. The hospitals, the two biggest in eastern Aleppo, were struck by bombs shortly after 3:30 a.m., killing two patients and rendering them out of use for the victims of more bombings later in the day.

Such is the tenor of life in rebel-held Aleppo, which had become accustomed to regular airstrikes in the four years since rebels seized control of the eastern portion of the city – but nothing like the intensity of the past week.

The collapse of a U.S.- and Russian-sponsored cease-fire on Sept. 19 was followed by the launch of a Syrian government offensive, backed by Russian airstrikes, to recapture the neighborhoods held by the rebels. The operation heralded what residents, doctors and medical workers describe as the most ferocious bombardments yet.



At least 1,700 bombs struck eastern Aleppo in the first week after the cease-fire’s collapse, according to the White Helmets civil defense group, a volunteer force funded by the United States and Europe that goes to the aid of people buried by buildings collapsed by bombs. Still, they keep raining down, with new bunker-buster bombs designed to be used against military installations blasting apartment buildings that house families.

Except that now there is no escape. The challenge of staying alive has been heightened by the complete siege imposed by government troops earlier this month, shortly before the cease-fire was announced.

Hundreds of thousands of people had already fled Aleppo, once a city of 3 million, to refugee camps further north, to Turkey and on boats to Europe. But the United Nations estimates 250,000 remain surrounded in eastern Aleppo, many of them the poorest of the poor, the families who couldn’t afford the cost of transportation out of the city.

Now they couldn’t leave if they wanted to. Food is scarce, prices are high and though no one really knows how much Aleppo has stockpiled over many months of fearing just such a siege, it will eventually run out. Doctors have already detected signs of malnutrition in some children, said Caroline Anning of the British charity Save the Children, which estimates that 35 to 40 percent of those trapped in Aleppo are children.



Critically wounded victims who would previously have been evacuated to Turkey must now be treated in makeshift hospitals barely equipped to handle life-threatening injuries. The bombing of the hospitals on Wednesday left just six hospitals functioning, and they are overwhelmed. Only 35 doctors remain, according to the World Health Organization, and 29 according to doctors in the city – down from 30 on Friday after a dentist died in an airstrike, said Adham Sahloul of the Syrian American Medical Society, which runs some of the hospitals.

Only seven of those doctors are surgeons capable of treating the catastrophic wounds inflicted by heavy bombs, the medical charity Doctors Without Borders said in a statement condemning Wednesday’s hospital attacks.

In the past week, the doctors have been handling hundreds of injuries a day. Photographs posted by medical workers show patients lying in pools of blood on hospital floors. Some have been left waiting for treatment on the sidewalks outside, according to Mohammed Tariq, a nurse at one of the hospitals.

“The doctors are exhausted. Many of them are working until 4 or 5 a.m., and then starting again at 9. They are also scared,” said Maher Saqqur, a surgeon who has been advising the doctors in Aleppo over Skype from his clinic in Canada.

“We have to triage patients, we have to judge whether their cases are hopeless. If they are, it is the hardest thing,” he said. Those with head injuries are being left to die. A man with both his legs blown off was judged too seriously injured to save. Five children died in one hospital on Sunday because there were insufficient resources to treat them.

“We try to make sure they suffer as little as possible, but even the supplies we need to do that are running out,” Saqqur said.

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