A trail of fresh blood leads up the steps of the public building that serves as a hospital in this war-scorched, rebel-held town. In the entrance hall, a young fighter lies dead on a stretcher — his mouth ripped open, his face, hair and beard grey with dust from the blast that killed him, a pool of crimson seeping on to the marble floor from the hole in the back of his skull.
Onlookers shout “Allahu akbar” and “Where is the UN? Where is the world?” They remove cigarettes, a mobile phone and other belongings from the dead man’s pockets. A woman and young girl sob as the men tear up a sheet for a shroud and then carry his corpse away.
But the real charnel house, the true face of Syria’s interminable conflict, is downstairs in the basement emergency room. There, a dozen doctors and nurses are treating horrific injuries on every operating table.
One man’s ankle has been shattered by a shell. Another is having his scalp sewn together while his body shakes uncontrollably. The thigh of a third has been sliced open from top to bottom like meat in a butcher’s shop. Others cry with pain as jagged shards of shrapnel are pulled from their backs, legs and buttocks. Blood-sodden clothes and discarded boots are strewn across the floor.
Amid the bedlam a fresh commotion erupts. Another casualty is rushed into the room on a stretcher — a young man with a deathly pale face and wide open, unseeing eyes. He is laid on the floor for want of a table or trolley.
The doctors rip open his shirt to reveal a neat wound near his heart. They stick a needle into his arm and pump air into his chest in a frantic attempt to revive him. They labour for 15 minutes before a doctor in a bright blue shirt pronounces him dead. The room falls briefly silent. All deaths are painful, but this one particularly so. Farid Abas Gandi, 25, was a colleague hit by a sniper as he sought to rescue injured fighters.
The blue-shirted doctor asks to be identified only as “Dr B”. Before his native Syria was convulsed by revolution he worked at an NHS hospital in England. A year ago he quit to work full time for Hand in Hand for Syria (HHS), a small private charity based in Nottingham that sends out medicine, medical equipment and ambulances to 33 clinics and field hospitals in rebel-held Syria.
“I needed to stop crying in front of the television and do something,” says Dr B, 39, who has left his pregnant wife and two-year-old son in Britain while he strives to relieve his homeland’s suffering by delivering that aid to some of the most dangerous parts of Syria.
Towns such as Ma’arat al-Nu’aman in southern Idlib province are desperate for such help. The Free Syrian Army captured it last October — a huge strategic prize because it controls the all-important highway from Damascus to Aleppo.
Since then the regime has shelled it daily from military bases south and east of the town. It has pounded it from the air with barrel bombs, cluster bombs and at least three Scud missiles, according to rebel commanders. Heavy fighting continues on the town’s southern edge. Days are punctuated by the booms of incoming shells and bursts of gunfire.
Most of the town’s 100,000 people fled north to relative safety long ago. It is as well they did. The sheer scale of the destruction is astounding.
More than half the buildings of Ma’arat al-Nu’aman have been wrecked. Walls have been ripped from houses, leaving ceiling fans or pictures hanging in full view as poignant reminders of vanished domesticity. The concrete floors of apartment blocks lie pancaked on top of each other. Mosques have been smashed and their minarets toppled.
The old souk has been utterly destroyed. Cratered streets are strewn with charred vehicles, overturned carts, crumpled shop shutters, broken signs, fallen trees, snapped telegraph poles and satellite dishes holed like colanders by shrapnel and bullets.
A lone fruit seller still hawks his wares in the town’s ancient heart — his apples, oranges and bananas providing a vivid flash of colour against the monochrome grey of the ruins all around.
“I’m trying to provide for the people still living here,” he explains, and — incredibly — there are a few. Here and there men and boys scavenge in the rubble of their homes. Three women clad all in black have returned to inspect their properties, but found them gone. From behind a shuttered window comes the unexpected cry of a baby.
The town’s general hospital was among the buildings destroyed. We were asked not to publish the location of its makeshift replacement, but the regime seems to know where it is because shells regularly land close by. Mazen al-Soud, the doctor in charge, says that it is often attacked soon after another part of the town has been shelled, in an evident attempt to hit it at its most busy.
In truth, it is always busy. Only five of the town’s 50 or 60 doctors remain, along with nine nurses. They sleep at the hospital in the odd hours when they are not working. Last month they treated more than 2,600 patients — roughly half of them fighters and the rest civilians.
They try to bind up war wounds well enough to speed the injured north to Turkey. They treat the diseases that flourish when there is no water, fuel or sanitation — diarrhoea, bronchitis, hepatitis A. They perform Caesarean sections.
Dr al-Soud says that more than 800 people have died since October despite his team’s best efforts. Many others have had limbs amputated. He shows us an 11-month-old baby girl, Fahid, whose right leg was amputated below the knee last week after a tank shell hit her house. Her ten-year-old sister was killed. Her mother lost her left arm and suffered a fractured skull.
“I used to cry through my eyes, but now my heart is crying,” says Ahmed, an exhausted doctor.
Dr al-Soud, 52, who has refused the entreaties of his brother, a Manchester cardiologist, to leave the country, says that he also cries at times. “I never thought I’d be doing work like this. We do everything we can for the medical care of our patients but I feel I do nothing. It’s never enough. We have too much work and not enough staff or medicine or equipment ... Why is the world silent?”
Without the support of HHS, matters would be worse still. It has shipped out the hospital’s ambulances, operating tables, anaesthetic machines, stretchers and much of its medicine and surgical instruments from Britain, but that is small consolation for Dr B.
“We saved about 12 people’s lives today, but still we lost five,” he says. “You have to keep working all the time. These people have no one else. If I had more equipment I could make much more of a difference.”