During a third day of intense aerial attacks, doctors at Aleppo's Children's Hospital worked around the clock with dwindling resources to treat children pulled from rubble and rushed to their emergency room.
"Medicines are running out. We are running out of fuel, we are working with very little electricity," pediatrician Tiem Shamy told The Globe and Mail from the hospital in the rebel-held eastern sector of the city. "Patients are lying on the floors, one child is hemorrhaging in the brain, there's no possibility for surgery."
Dr. Shamy is among the 250,000 civilians trapped in this area, facing intense bombardment as Syrian government and rebel forces battled for control on the third day of a Russian-backed offensive. Panicked and desperate, the residents are running out of food. Nearly two million people are also without water after air strikes late last week damaged the Bab al-Nayrab pumping station, the only facility that provides eastern Aleppo with potable water.
Dr. Shamy, who spoke by Whatsapp messenger service to a reporter in Toronto, said he had seen patients suffering from wounds caused by phosphorous bombs, barrel bombs and extremely powerful bunker-buster bombs. The reported use of advanced munitions that can cause widespread damage, such as bunker bombs, was condemned by the United Nations in a statement released Saturday.
During an emergency meeting in New York on Sunday, Staffan de Mistura, the United Nations envoy for Syria, pleaded with the Security Council for a 48-hour pause in fighting to let in humanitarian aid and evacuate the severely wounded. He described the "new heights of horror" reached, but failed to persuade the opposing sides of the war.
The U.S. accused Russia of "barbarism" while the Russian side firmly supported the Syrian regime, accusing its rivals of allowing terrorist groups to flourish in the Middle East.
Vitaly Churkin, the Russian ambassador to the UN, praised the Syrian government for showing "enviable restraint" and accused the U.S. of having no control over the rebel groups they backed.
The Syrian regime offensive came after months of diplomacy between the U.S. and Russia collapsed last week after a deadly attack on a UN aid convoy, and efforts to broker another ceasefire have so far failed.
"There's no hope in the people's eyes," said Ahmad Salem, a civilian inside eastern Aleppo who spoke with The Globe by Skype on Sunday. "We don't know if we will live another day."
"There isn't enough food," Fares al-Halby, an activist in the rebel-held east, said on Saturday. "We are getting bombed constantly everyday, [bombs] are falling like earthquakes.
"There is no safe place for civilians to go, all the roads are closed."
Harrowing images emerged from the city Sunday of children being pulled out alive from collapsed buildings. Save the Children estimated approximately half the casualties over the past three days were children. An ambulance crew with Shafak, a Syrian NGO, said more than 50 per cent of casualties they picked up in the past 48 hours were children.
Many were brought to Dr. Shamy, who struggled to care for patients missing limbs, suffering third-degree burns and experiencing difficulty breathing.
The hospital has access to a deep well and staff are using chlorine pills to decontaminate the ground water. Most water wells in the eastern sector of the city are not potable.
Some parents of patients in the children's hospital told staff they were in the marketplace rummaging for food when a missile flattened the walls around them.
"We are saddened, we are angry, but we have to trust in God," Dr. Shamy says. "We have to get back to work."
The unprecedented barrage of air strikes by the Syrian army continued Sunday, killing at least 26. By Sunday evening, the regime was gaining ground north of Aleppo, trying to cut off supply lines to rebel-held neighbourhoods by retaking the northern Handarat Palestinian refugee camp, a strategically important area overlooking the main supply route into the besieged city.
"This can't go on," Dr. Shamy said.