IDLIB, Syria (Reuters) - At a maternity hospital in northwest Syria, an alarm flashes at the main entrance to alert staff. It’s not patients en route to the hospital. It’s warplanes.
Doctors at the hospital face a daily struggle to care for expectant mothers amid a Syrian government assault that has driven deep into Idlib province in an attempt to snuff out the last stronghold of rebels battling President Bashar al-Assad. Medical staff said there had been a marked rise in miscarriages and premature births in the last two months. Some expectant mothers arrive in shock after leaving home in terror at the bombardment, and every day four or five babies are found to have died in the womb, one doctor told Reuters.
“For me, the latest stage has been the toughest of all,” said the doctor, 37-year old Ikram who is eight months pregnant.
Speaking Thursday in a small ward filled with a dozen tiny babies in incubators, she said the last hospital she worked in had been hit in an air strike. She said so too had her father-in-law’s house and that a rocket had landed unexploded next to the kindergarten her two young children – aged 3 and 4 - usually attend.
Minutes after she spoke the hospital’s alarm went off. An amber light flashed warning of an aircraft approaching and a red light signaled danger of a direct strike.
While the maternity center was spared, an intensification of air strikes and shelling in northwest Syria has caused the biggest single displacement of Syrians of the 9-year conflict, in which hundreds of thousands of Syrians have been killed.
Nearly a million people – more than half of those children – have been uprooted since December as they have fled the destruction of their towns and villages, resulting in what the United Nations has said could be the worst humanitarian crisis of the conflict. Traumatized by war and with many uprooted several times already by fighting, they are now crowded into a shrinking pocket of land between Syrian government forces advancing from the south and east and the walled-off Turkish border to the north.
The Russian-backed Syrian government has been trying in recent months to retake Idlib province, a region that stretches around 100km (60 miles) into Syria from its northernmost point on the Turkish border. It says it is fighting to clear terrorist groups including al Qaeda from its land and has pledged to retake “every inch” of Syria. Turkey, which has said it can’t cope with the number of people fleeing the war, is supporting rebel forces fighting against Syrian President Bashar al-Assad.
More than 130 civilians, including at least 44 children were, were killed during February alone, with dozens of hospitals and schools among facilities affected by the strikes, according to the United Nations.
Fighting has escalated sharply in recent days, bringing Turkey – a member of the North Atlantic Treaty Organization – and Russia closer to direct confrontation in Syria. Turkey launched a counter offensive against Russian-backed Syrian government forces in the region after 33 Turkish troops were killed in Syrian air strikes in Idlib last week.
Turkish President Tayyip Erdogan says he hopes to achieve a ceasefire in Syria’s Idlib in talks with Russian President Vladimir Putin this week. On the battlefield, however, both sides have doubled down.
Ikram, who requested her last name not be published due to security concerns, qualified ten years ago just before the uprising started in 2011. She decided to stay in Syria, even as other doctors left. She worked in the town of Maarat al Numan, where there had been a shortage of doctors, and then moved to a hospital in her hometown of Idlib city. “I wanted to do what I can,” said Ikram, becoming visibly emotional.
The maternity hospital she currently works at has been open about five years, she said, adding she’s is one of only three doctors left working there.
At Idlib city’s central hospital, a missile smashed into the road outside last week, leaving a large crater. The strike – which wounded four medical staff and damaged hospital rooms and employee living quarters– was the third near miss in recent months, said surgeon Mohammad Abrash, speaking Friday in a room overlooking still-visible crater outside.
He said medical staff were at the front lines of treating people but that they were overloaded, and medication and medical equipment were in short supply and there were no replacements.
“It’s so difficult for us to work under these conditions,” added 58-year old Abrash, from the nearby town of Saraqeb, before rushing to a basement operating theater to treat an injured man bleeding from wounds to his abdomen.
For the roughly 3 million Syrians packed into Idlib province, crossing the Turkish border to safety is a distant dream.
Hundreds of thousands are sheltered in camps within sight of the concrete border wall which marks the frontier, battling freezing temperatures in recent weeks during which up to ten children died, according to the United Nations.
Along the 30 km (20 mile) road from the border to Idlib city, more settlements are pitched across olive groves and ochre mud fields or perched on rocky outcrops. Some date back to the early years of the war and are now small towns of solid breeze-block dwellings. But others have sprung up in the last two months.
In one camp established in January to absorb the most recently displaced, there are communal tents housing 20 to 40 families each as well as smaller tents, according to camp administrators.
“We came to this camp to shelter from the winter,” said 55-year-old Mamdouh al Darfil, seated outside a 3 meter by 3 meter tent he and some of his family members share at the site, near the town of Maarat Misrin, north of Idlib city. He said he and his nine children had been displaced six times in the course of the conflict.
They first moved into houses abandoned by other families, and then resorted to seeking shelter in tent camps. He and his two married sons now share three tents between them, but he described life there as bare subsistence, with no heating and little health care.
With nowhere else to go, some 270 families have taken refuge at a sports stadium in Idlib city, many living in tents pitched under the concrete terraces, where smoke from fires kindled for warmth mixes with the stench of sewage.
Some families at the stadium are from as far away as the former rebel strongholds in eastern Damascus, 270 km (170 miles) to the south, from where they were displaced years ago. Many have been uprooted several times by the Syrian forces steadily advancing since 2015, when Russia intervened to support Assad, turning the war decisively in his favor.
That includes 38-year old furniture maker Ragheed al-Masri and his four children who were evacuated three years ago from their hometown of Saqba, east of the capital, to Hama province. He said before being evacuated conditions in his once rebel-held hometown had become unbearable, with a blockade by government forces leaving it difficult to get even a kilo of rice.
After leaving Saqba, they had moved north to the town of Maarat al Numan, where they stayed until it was captured by government forces in January. Now, their home is a tent erected outside the sports stadium.
During a visit Thursday, children played among the tents, laundry hung along a fence inside the stadium, and workers unloaded sacks of food from a lorry. Painted on the walls of the stadium, in the northwest of the city which has been under rebel control for five years, are religious slogans reflecting the Islamist agenda of insurgent groups that hold sway in much of the province.
Twenty-year old Shaza Deek said she and her parents and siblings arrived about a week ago. She said her family had been forced to flee their village of Kafr Ruma, south of Idlib, late last year by the Russian-backed Syrian government offensive.
“They threw us from our houses into the cold. We went from house to house,” she said. After sheltering in an Idlib mosque for three weeks, her family moved to the stadium. “They bomb and scatter us, and no one helps us,” she said, noting the exception of Turkey which she said had given aid and support for the rebels.
“I didn’t expect things to reach this situation. In this revolution we lost everything... I wanted to be a doctor, to study. All our dreams are gone.”
Reporting by Dominic Evans; Editing by Cassell Bryan-Low.