When the last remaining hospital in besieged eastern Aleppo crumbled under a wave of artillery strikes on Nov. 18, one of the casualties was 25-year-old nurse Kefah.
"The last time he called me was one night before he was killed," says Dr. A.M. — an intensive care specialist based in Detroit who, for the past four years, has been providing training and support via Skype and WhatsApp to medical staff in Aleppo. He asked that we only use his initials because the Syrian government has persecuted doctors — and their families — for treating rebels.
"He was such a good kid," he says. "Now Kefah is gone. You know, he has a 9-day-old baby. And his wife, she is very badly injured. His father, a security guard at one of the hospitals, just recently he lost his other son."
A few days before he died, Kefah wrote — as an encouraging mantra — an Arabic folk saying on a wall of his hospital: "Frivolously you try, but a revolutionary does not die."
Now that wall is rubble.
The fall of Omar Bin Abdul Aziz — the last standing hospital in eastern Aleppo — means as many as 300,000 civilians in the area, living under a siege imposed by the regime of President Bashar Assad, have nowhere to seek treatment for injuries or illness.
Three other hospitals were put out of service that day as Aleppo was targeted by aerial bombardment. The attacks came as Russia and the Assad regime have continued a devastating military offensive on eastern Aleppo and other rebel-held areas that began when a shaky cease-fire ended on Nov. 15.
Warplanes have been specifically targeting hospitals in Aleppo for years, according to humanitarian groups. Since March 2011, the international aid group UOSSM — also known as the Union of Medical Care and Relief — has documented 545 attacks on 250 medical facilities throughout Syria.
Most facilities have moved underground, to basement clinics, where they are safer from aerial bombings — but the severity of the recent attacks, and the potency of the explosives used, were able to take out even these fortified facilities.
UOSSM and other aid groups have been waiting outside Aleppo's borders with trucks full of supplies and medical aid, but the groups say that Assad's forces are blocking all access.
"There is no way we can get any medical aid to them, or even evacuate patients to get them medical care," says Dr. Khaula Sawah, CEO of UOSSM USA. "There's nothing we can do until there's a political resolution."
Dr. M. says he now has no way to help his friends in Aleppo — his medical advice is useless because the doctors and nurses there have no way to implement it.
"For patients on life support, there's not enough oxygen tanks — there's not even enough diesel to run electricity and oxygen tanks," he says.
"I don't know what is going to happen," he adds. "I am afraid this is the end of the story for Aleppo."
His last phone call with the medical staff displaced by the recent airstrikes — on Wednesday — was interrupted by yet another bombing.
"When I talk to them now, it is like a sick joke," Dr. M. says. "I ask, 'How are you?' and they say, 'I am still alive.' They feel that they are just waiting for their time to come."
One doctor in Aleppo that I've been in touch with sent me a voice message through WhatsApp, saying he was sorry he hadn't been able to call. "We are facing difficult circumstances due to the shelling and the huge number of injuries," he said.
Trauma surgeon Abdul Aziz says the situation has left him "heartbroken." After working in Aleppo for several years, Aziz went to Harvard three months ago to research solutions to the medical crisis in Syria.
"Now, to be honest, I'm feeling guilty," he says. When he was working in Aleppo, "There was no way to sleep — if you sleep, people die. We were always exhausted. Still, I'd prefer to be there rather than here — at least I could stay with my people."
Aziz can't go back until the siege is broken. From abroad, he says, there is "nothing to do other than shout to the international community — 'please do something.' "
"Why are people silent? This silence should not be," Aziz continues. "If this was happening in London, Paris, Berlin or any city in the U.S., would the world be silent? This is a black spot in the history of the world."
Those left in Syria "just have to keep going," says Ahmad, another doctor. He asked that we only use his first name out of fear that the government would come after his family members still in Aleppo. The Pittsburgh-based doctor, who left Syria before the conflict began to pursue a medical degree in the U.S., has been coordinating telephone support to Syrian doctors and clinicians through the Syrian American Medical Association.
Over the past few days, Ahmad has been brainstorming with a couple of surgeons and a few nurses left in Aleppo about how — given the lack of supplies and facilities — they can still try to provide care for the remaining residents.
Survivors are digging through the rubble to salvage any medical equipment that survived the airstrike on Omar Bin Abdul Aziz hospital, Ahmad says.
"That's the plan for now — moving whatever is left, from beds to oxygen tanks, to another basement and start again," he says — and if that new location gets bombed, "you move to another place — that is the attitude of the people there."