An injured woman reacts at a site hit by airstrikes in the rebel-held area of Aleppo, Syria, in April. (Abdalrhman Ismail /Reuters)

Before the war convulsed his native Syria, Marea Marea relished retire­ment. He enjoyed leisurely morning walks, played with his grandchildren and took afternoon catnaps.

Then the fighting began in rebel-held eastern Aleppo. Airstrikes have pulverized his neighborhood, and a brutal siege has forced him to skimp on food so other members of his family have enough to eat.

Now the 70-year-old feels weak, frightened and helpless.

“My entire life has been spent trying to build something for my family,” he said, speaking by Skype from his home in the war-divided city. “I built this home. My body aches from the decades of work that I did to make them a better life. But now this? There’s little dignity in this kind of life.”

The war has taken an immense toll on the more than 200,000 people still in eastern Aleppo. Marea and other older residents face especially difficult circumstances, according to aid workers and doctors there. Some choose — or are asked — to make sacrifices for younger family members or are left to cope on their own after their children and grandchildren flee to safety in other countries.

Marea Marea sits with part of his family in their house in a rebel-held district of Aleppo. (Family Photo)

“People are being forced to make sacrifices, and this often involves the older people getting neglected,” said Bacry al-Ebeid, who distributes food to residents in rebel areas of Aleppo for Mercy-USA, a Michigan-based charity.

Aleppo, Syria’s largest city before the war, has become perhaps the most important battleground in the conflict, which began in 2011 and has left more than 400,000 dead and millions displaced. Rebels seized the city’s eastern districts in 2012, and forces loyal to President Bashar al-Assad have intensified efforts to take them back. If they do, it would mark a significant victory for the embattled leader.

In recent months, warplanes operated by Assad’s government and its ally, Russia, have increasingly bombed hospitals and homes in the city’s opposition-held areas. Food and fuel shortages have worsened because of the siege imposed by pro-government forces, who control the city’s west end.

As a result, residents and aid workers in eastern Aleppo say, it has become nearly impossible to find medicine to treat heart disease, diabetes, rheumatism and other conditions most commonly experienced by older people. Overstretched medical facilities must turn away people suffering from such conditions because of the overwhelming number of more-urgent cases, such as people with shrapnel wounds and other ­war-related injuries.

Pablo Marco, Middle East operations manager for the medical charity Doctors Without Borders, said the situation is so bad that fewer than three dozen doctors are still working in eastern Aleppo. The area has only one functioning dialysis unit left, he said.

“If that unit stopped working, then that would mean more deaths,” he said. “The doctors just don’t have the time and facilities to take care of chronic diseases that, if not properly treated, will kill you in a matter of weeks and months.”

As some become frail, they might see themselves as a burden on their family, which can fuel anxiety, Ebeid said.

Some families have had to take ­extreme measures and have abandoned older family members, he said. In Arab societies, older people generally live with their children until death.

There are no reliable age breakdowns of people living in the city’s besieged eastern areas, but before the war, Aleppo had a population approaching 3 million. Hundreds of thousands of residents have fled since the conflict erupted.

“In a lot of cases, though, what we see are elderly people who refuse to leave their homes,” Ebeid said. “So that means their families, when they flee to other countries, are forced to leave them behind.”

In another neighborhood of eastern Aleppo, 83-year-old Reema Salama lives alone in the home where she raised her children. Most of her family escaped to Turkey last year, but Salama chose to stay put, she said during a recent interview over Skype. Because of the siege, she cannot leave, and her family cannot visit.

She receives food from Ebeid’s organization but struggles to cook it, relying on neighbors for help.

“I’m all alone! I’m going to die alone here!” she said before abruptly ending the conversation.

Marea said he would never leave his home. To pay for it, he worked for years as a freelance farmhand and day laborer.

But even if he tried to leave, the government’s siege would prevent him. So he spends most of his time at home feeling isolated and hoping airstrikes do not obliterate him and his family.

“I’m afraid our house will get bombed but that we won’t die in the attack,” he said, describing the fate of many people in his area of town. “We’ll just be stuck in the rubble for days and slowly die.”

He also thinks constantly about trying to balance what he and his 70-year-old wife, Ajoun, need to survive with the demands of the 10 children and grandchildren living with them. Already, the family struggles to care for one son, 45-year-old Ahmed, whose leg was amputated last year after shrapnel struck it during an attack.

“We eat twice — once in the morning and once in the evening — because we are trying to reduce the amount we eat so the kids still have enough,” he said. He fears the effect this could have on his wife, who suffers from high blood pressure and rheumatism.

Marea has received unexpected help from another son, Hameed, who was visiting from Turkey and became trapped in the city when the government imposed its siege several weeks ago.

Asked whether Hameed intends to return to Turkey, Marea choked up.

“No, he can’t go back. The siege. He can’t leave us here,” Marea said.

Then, he said, “I’m an old man. I shouldn’t have to think about these kind of things.”

Heba Habib in Stockholm and Zakaria Zakaria in Istanbul contributed to this report.