Constant bombing attacks, the destruction of hospitals and schools, and the severing of supply chains have left Aleppo and its estimated 320,000 remaining citizens in dire straits.
"The boy didn't know what happened. He only knew he was going to school, and, then waking up with a lost leg. That's a lot of shit for a seven-year-old child," said Dr. Hamza Kataeb, 29, in a voice message sent to me via Facebook. Dr. Kataeb is the manager of a 32-bed field hospital in Eastern Aleppo, and he was covering for another doctor; he was on the 72nd hour of his shift. In the voice message, his courteous voice sometimes broke from exhaustion as he described a recent victim of Russian airstrikes. He had 20 hours left to go.
Kataeb is part of a rare group. Ninety-five percent of Aleppo's doctors have left, fled, or been detained since the start of the war, according to the nonprofit Physicians for Human Rights. Kataeb himself has suffered from this persecution: After participating in anti-government demonstrations, he told me, he landed himself on a wanted list, and he had to abandon his medical residency. According to a recent UN report, airstrikes have destroyed the vast majority of the 33 hospitals in Aleppo, leaving field units like Kataeb's as some of the last providers of health care left in rebel-held parts of the city. Kataeb, who treats both chronic conditions and traumatic injury, says that once the Russian airstrikes started, he began treating the seriously injured in far higher numbers.
In January, these Russian airstrikes sent over 30,000 Syrians fleeing to the mostly-closed Turkish border. Camped out with little to no food, shelter, or sanitation, these refugees live in squalid conditions that aid groups struggle to address. From the other side of the border, international media document their plight.
But conditions in Aleppo and the surrounding countryside are even more dire.
Since the regime and its allied militias cut the main supply road from Turkey to Aleppo, prices of essential goods have spiraled upwards. "All food and fuel supply routes were cut except from one hardly-accessible and very dangerous road," said Amr Yagan, a Dubai-based activist and lawyer from Aleppo who works as a liaison with local aid organizations. "This caused the prices to jump up extraordinarily amid shortages of life's necessities." When the Russian intervention began, organizations Yagan worked with stocked up on fuel, wood, and basic foodstuffs. But with the road cut, Yagan said, it became difficult to bring in everything from diapers to heating to the vehicles used by the city's civil defense. Fuel has grown scarce, and according to one cab driver I interviewed through a translator on Facebook, the diesel that powers most cars and generators had nearly tripled in price.
The partial blockade has been coupled with steady bombardment of civilian infrastructure—bombings that target not just Aleppo but most rebel-held parts of Syria. Earlier this month, after airstrikes hit a pair of hospital's in Syria's north, including one in supported by Médecins sans Frontiers, the organization said the attacks "can only be considered deliberate, probably carried out by Syrian-government-led coalition that is predominantly active in the region." Fearing more strikes, MSF now refuses to share the GPS coordinates of its facilities with the Syrian government.
Bombs fall on schools as well as hospitals. On January 11, Al Jazeera reported that 15 people, 12 of them children, had died after a Russian missile hit a school in Ain Jara, fewer than ten miles north of Aleppo. On February 14, Russian warplanes reportedly bombed a school in Orem Al Kubra, a town in Aleppo's countryside, leaving five children wounded. Over Facebook Messenger, Ismaeel Barakat, an Aleppo activist who witnessed the aftermath, told me, "The children's blood was mixed with pens, ink, books, and papers."
"There's a state of panic and psychological pressure," said Amr Yagan, the activist. "Our schools are functioning with major difficulties because of the bombing and the students' fear of going to school gravely affects their education."
Every day more bombs fall on the eastern part of Aleppo, the world's oldest continuously inhabited city, gradually turning neighborhoods into graveyards of rubble and dust. Recently, a member of the Aleppo's civil defense (also known as the "White Helmets") told me that airstrikes have targeted the city at least six times a day, concentrating on civil and residential neighborhoods. After bombing runs, he said, planes wait for first responders to gather, then bomb again. This is the notorious "double-tap" strategy that allegedly killed Canadian photojournalist Ali Moustafa and that was used in December against an MSF hospital in Homs.
Describing the challenges of his job, the first responder recalled one morning when he and other civil defense employees watched the government helicopters buzzing like insects in Aleppo's sky. One dropped a barrel bomb on a group of civilian cars. The White Helmets ran over. "I saw a horrific scene when I went to search inside one of the cars, a mother pressing her child to her chest because of the strong explosion and fear. Both bodies were charred," he said.
When asked about the toll of their airstrikes, the Syrian and Russian governments respond as governments always do. They deny killing civilians. According to them, their bombs kill only terrorists—and since 9/11, the Muslim terrorist has become a folk devil in the international imagination, whose existence justifies any torture, military aggression, or crime.
As Russian airstrikes displaced tens of thousands of Syrians in mid-February, the Russian Ministry of Defense tweeted: "Near #Aleppo, terrorists are evacuating their families to the north of the province, to the Turkish border due to complicated situation." Even fleeing women and children become terrorists when seen through the funhouse mirror of military PR.
Attacks on civilians are heinous but link civilians to terrorists, and to many people, such actions suddenly become palpable. It's not just the Russian government that engages in this kind of calculus, either. In December, Republican presidential candidate Ted Cruz said of ISIS, "We will carpet-bomb them into oblivion. I don't know if sand can glow in the dark, but we're going to find out." Not to be outdone, GOP frontrunner Donald Trump has floated the idea that he would fight terrorists by "tak[ing] out their families." The US is no stranger to attacks on civilian infrastructure in Syria: In February, the British-based Syrian Observatory for Human Rights reported that US airstrikes killed 15 when it hit a bakery in an ISIS-occupied town near the Iraqi border. Nor does the US necessarily spare hospitals. In October, a US gunship razed an MSF hospital in Kunduz, Afghanistan, killing 30 staff and patients.
On midnight Saturday, a limited cessation of hostilities came into effect in Syria after negotiations between the US and Russia. But the agreement does not cover strikes on groups considered "terrorists," including ISIS or the al Qaeda affiliate Jabhat al-Nusra.
Because of this, many opposition supporters treat the "ceasefire" with bitter skepticism. When asked his thoughts, activist Ismaeel Barakat called it "a dirty game the Americans and Russians are playing to eliminate the revolution under the pretext of fighting terrorism."
On Saturday, the White Helmets reported via Twitter that things were "very quiet" compared to the last several years, but there have been numerous violations of the agreement throughout the country, with Russia trading accusations with Turkey and rebel groups about who was responsible for which attacks.
Despite bombings and a potential siege, an estimated 320,000 people remain in Aleppo. Some are too old, sick, or poor to join the flood of refugees. Others have established businesses, or built homes, that they are unwilling to abandon for a precarious life in Turkey.
Others stay out of a deep sense of commitment. No matter what happens, Dr. Hamza Kataeb and his colleagues aren't going anywhere.
"We are not only medical professionals; we are also activists," he told me. "We will stay here until the end. Until the regime is completely over. Until the end of the revolution, so that everyone who killed innocent people should get the outcome of his doing. That has to be in a courthouse."