At the Dar al Shifaa hospital in Aleppo, an endangered safe haven on the rebel side of the ancient city, soldiers loitered around the dim building on Wednesday afternoon. Doctors scrambled to keep up with the wounded: Bystanders picked off by government snipers while crossing the street were among those rushed into the overcrowded, poorly equipped emergency room.
And in a split second, a Syrian government airstrike eviscerated the building.
An ambulance had just pulled up outside with more injured at around 3:45 when the sound of an incoming air attack sent hospital workers, nearby civilians and several rebel fighters scrambling for cover.
With a deafening boom, boulders of concrete were sent hurtling through the air, and the inside of the hospital, where for months, doctors have been working around-the-clock to treat a steady stream of casualties, descended into pitch-black confusion, as moans and panicked cries could be heard through a suffocating, thick cloud of dust.
After the explosion, dozens of injured were rushed immediately to a secret location where the beds were overflowing and wounded were being treated shoulder-to-shoulder on the hallway floor as doctors, still covered in blood and dust, stepped around limbs, scrambling to treat the patients. Meanwhile, ambulances, medical workers and volunteers were trying to remove the patients – many of them grievously injured – who were inside the hospital when it was struck.
Two bulldozers searching through a mountain of rubble found several buried survivors, and the voices of others could be heard as the search continued late into the night. At least one body was pulled from the rubble and a nurse working at the hospital was reported missing.
In the four months since the hospital, located in the Shaar district, started treating wounded opposition fighters, government attacks have demolished its upper floors. Facing badly damaged equipment, sparse supplies and frequent power cuts, hospital staff compressed an emergency ward into the main floor and basement, where they had continued to operate amid the constant sound of gunfire and mortars.
Daily fighting between the rebels and the forces loyal to President Bashar al-Assad has transformed parts of Aleppo into a deadly labyrinth of snipers, checkpoints and daily aerial bombardments. With the front line now almost cleaving the city in two, the hospital was the best choice for injured civilians cut off from the regime side of the city.
Minutes before the airstrike on Wednesday, doctors were telling me about the long hours and difficult conditions they have faced to keep the hospital operating. "Sometimes I have to do X-rays with my hands because the equipment doesn't work," Abdala Alma, an orthopedic specialist, said.
Like many of the workers there, he was risking his life just to work at the hospital after leaving his job at a government clinic. "I'm afraid of the regime," Dr. Alma said. "If they catch me, they will kill me immediately."
Many of civilians who sought treatment here live on the rebel-held side of the city and would similarly likely face arrest, or worse, if they attempted to seek treatment at other facilities.
Though a dozen or more rebel soldiers were treated while I was at the hospital on Wednesday, in the hours leading up to the attack, a middle-aged woman was brought to the hospital after being shot in the leg by a sniper. A civilian man was also rushed from a taxi to the entrance of the hospital after being shot in the arm. An elderly man who was shot by a sniper was similarly rushed into the emergency room, but later transferred to the morgue. And earlier, the lifeless body of a young girl shot in the head by a sniper was brought, against all hope, to the hospital as well.
Many others, including children, received treatment for mild ailments and injuries in the crowded front room of the hospital, before being discharged to make room for the next car that, dripping blood from the door, screeched to a halt out front.
It is unclear where the survivors will go now.
The hospital's chief doctor had to be led away from the debris in tears.