Eastern Ghouta is running out of almost everything, but there is no shortage of ways to die.
It was an attack on eastern Ghouta, back in 2013, that put chemical weapons back into the modern world's lexicon of war. Now, days into a brutal campaign by Russian-backed Syrian government forces intent on clearing it of opposition forces, Ghouta is back in the world's gaze in a torrent of airstrikes, mortars, rockets and barrel bombs.
The death toll in two days is the highest since the 2013 chemical attack.
"We are talking about a catastrophic situation, a deteriorating humanitarian situation, a situation that cannot be described," says Siraj Mahmoud, a spokesman for the Syrian Civil Defence, also known as the White Helmets. "We are talking about extermination."
As the campaign has intensified, the immediate threat for the thousands of civilians in residential areas is violent death by military means. It is a menace that comes from the sky or might yet come in a rumoured impending ground assault, in a place designated a "de-escalation zone" by the parties half-heartedly trying to negotiate peace.
But it is the siege that has long had eastern Ghouta and many of its residents staggering to their demise.
A Syrian man runs between destroyed buildings that were attacked during airstrikes and shelling by Syrian government forces in Ghouta, a suburb of Damascus, Syria, on Thursday. (Ghouta Media Centre via Associated Press)
It is a siege that in the words of one UN official is "reminiscent of medieval times," a siege that has turned Ghouta — once described by Syrians as "heaven on earth" — into hell on earth.
"This didn't start just today, or yesterday, or 30 days, a month or two ago," said Abu Ahmad, a Syrian activist who lives in Douma, the city at the heart of the condemned suburb of Damascus.
It started more than four years ago, in a regime effort to quarantine and starve out opposition forces that have used the area to launch attacks, reportedly including rockets and mortars in recent days, against Damascus.
Shortages of food, clean water
What the siege has achieved is the imprisonment of some 400,000 civilians, denying them food, clean water, basic supplies and freedom of movement.
Now, families who were already facing severe food shortages and malnourishment long before all this, are being forced to shelter in basements to escape the relentless airstrikes with little to keep them alive.
Some have been without food, water or sun for nearly a week, says Abdel Razak Awad, who works with a Syrian humanitarian group called Banafsaji which has activists in Ghouta.
"These days, those who don't die in the bombing, will die of hunger," he said from Idlib.
A wounded Syrian man stands with his arm strapped to a piece of wood at a make-shift hospital in Douma following air strikes on the Syrian village of Mesraba on Monday. (Hamza al-Ajweh/AFP/Getty Images)
The UN Security Council was due to vote Friday on a resolution calling for a 30-day truce in the war. But if Russia once again exercises its veto power, nothing will change.
Sieges by all sides have been a regular feature of the Syrian war from the start. And it is cities that feature in this episode of 21st century warfare — in Syria, as in Yemen and Iraq.
So when sophisticated means of warfare meet the blunt instrument of sieges in urban environments, the results can only be catastrophic: "war crimes on an epic scale," Amnesty International calls it.
"Armed conflicts are waged with weapons designed for use on open battlefields, amplifying their destructive power in the crowded city," says a report by the International Committee of the Red Cross entitled "I saw my City Die."
In Douma, eastern Ghouta, that has meant damage to schools, medical facilities, roads. Medecins Sans Frontieres (Doctors Without Borders) says 13 hospitals and clinics it supports have been either damaged or destroyed.
'To the United Nations and all human rights organizations and the rights of the child: you are useless.' - Dr. Amani Ballour, resident of eastern Ghouta
And without a route in, what remains possible in terms of services, medical or otherwise, seems to repeatedly be forced back in time.
In videos gathered by activists in and around Douma, it is clear only rudimentary medical services are now available.
"We can continue as medical staff. We can work," resident Dr. Amani Ballour told CBC News. "But the children, and the women and other civilians, they can't continue like that."
On her Facebook page, she posts pictures of injured children.
"To the United Nations and all human rights organizations and the rights of the child: you are useless," she says.
'A human tragedy'
The international community appears unable or unwilling to stop the bombing, though a growing thicket of statements deals with the targeting of civilians as fact. The UN secretary general called it "a human tragedy that is unfolding in front of our eyes."
UNICEF issued a blank statement, unable to conjure up words.
Canada "strongly condemns the deliberate and increasing attacks against civilians in eastern Ghouta, including medical professionals, first responders and humanitarian workers," said a statement, calling the acts "reprehensible."
It also called for the Syrian regime to allow for full access for humanitarian assistance and to "respect basic human decency.''
Many of the calls have focused on a ceasefire that would allow the entry of supplies but also the evacuation of the hundreds who need urgent medical care.
"You can still save lives in eastern Ghouta, and elsewhere in Syria," Mark Lowcock, chief of humanitarian affairs for the UN, said in a briefing to the Security Council yesterday. "I urge you to do so."
Smoke rises after Syrian government airstrikes hit Ghouta, a suburb of Damascus, Syria, on Wednesday. (Ghouta Media Center via Associated Press)
Inside Ghouta, the mood is fatalistic.
"We are now speaking, but we don't know if we will, in a while, in a few moments or in a few hours, to give any further statements," said Mahmoud, as clearly audible jets flew overhead.
People are tired of calling on the world to act, says Awad.
A place that once inspired poets to write about its natural beauty, now smells like death, he says.
It is now mostly dying of neglect.
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