As the opposition’s last bastion at the edge of Damascus, Eastern Ghouta has been cut off from the world. United Nations aid convoys visit rarely. A blitz by Syrian government warplanes early this month killed at least 210 people and sent hundreds more pouring into what remains of a buckling hospital network.
The spike in violence came amid a broader escalation throughout the Syrian battlefields that still elude President Bashar al-Assad’s control. Since 2012, his military has routinely used aerial bombs to recapture territory that fell to Syria’s armed opposition after a popular uprising. What distinguishes Eastern Ghouta’s traumas from the rest is that residents have nowhere to turn for help.
The international powers involved in other parts of Syria have little strategic interest in a suburb with fewer than 350,000 people and no international borders. As a result, there is no power broker such as Turkey, Russia or the United States to deploy ground troops or strike a backroom deal, moves that helped lessen violence elsewhere in the country.
After a rare visit to Eastern Ghouta this past week, the United Nations described the situation as “far graver than imagined.” Its reports last year assessed malnutrition levels there as similar to those in parts of sub-Saharan Africa.
In peacetime, before the spread of government and opposition checkpoints, the suburb was a 20-minute drive from central Damascus. Government forces besieged the rebel stronghold in April 2013, and the flow of goods has been heavily restricted ever since, sending prices soaring and causing dozens of deaths related to a lack of food or medicine.
Aid groups are reliant on the Syrian government’s permission to enter Eastern Ghouta, and ultimately, Assad’s security forces have the final say on which goods the convoys can carry into the enclave.
The United Nations said Friday that its latest aid delivery had reached less than 3 percent of the population, with humanitarian workers prevented from loading the trucks with clean water or winter blankets. The Syrian government denies restricting access and publicizes the rare deliveries to Eastern Ghouta across state media.
“Humanitarian diplomacy has failed so far. We’re talking to deaf ears,” said Panos Moumtzis, the U.N.’s regional coordinator.
Residents said that the skies over Eastern Ghouta were quiet Saturday but that government artillery continued to pound the area.
“We are still anxious,” said Samir Salim, 45, a rescue worker from the White Helmets civil defense force. “It is well known that the regime is gearing up for a fresh assault on Eastern Ghouta and intends to attack it from all sides.”
Monitoring groups said Saturday that pro-Assad forces were massing near the enclave and preparing for a “large scale operation.”
The Syrian government insists that its attacks have targeted rebel forces that use artillery to hit districts under state control. But residents, civil defense workers and medical staff said government bombs routinely have targeted areas densely populated with civilians.
Recently, as Salim’s rescue van sped toward the site of a government airstrike, he noted that the streets were growing more familiar by the minute.
“I was thinking, ‘This is my area, this is my street.’ Then I realized it was my home,” he said. “I knew my family were in there.”
When he arrived, he could hear his neighbors wailing and then, somewhere under the cinder blocks, the howls of his month-old nephew. Residents, interviewed over the phone, described watching Salim dive into the rubble, pulling out the baby and then heaving countless stones aside in a frenzied search for his relatives.
Huddled in what was left of a single room, he found his brother’s wife, his children, and his 85-year-old father, all alive. Salim’s mother, the relatives said, had been in the other room.
Salim found her wedged under the ceiling. The rescue worker said he pulled and pushed the stone slab until his muscles felt like jelly.
“There was nothing I could do. It was too heavy. The rescue vehicle had already gone and it was in the next street,” Salim said. “This was my mom, and I couldn’t do anything to help her.”
In footage from the day, the rescue worker looks dazed and inconsolable. “Please help me, guys. Oh God, she died,” he says in the video, shared by the White Helmets on their Twitter account.
As the number of dead in Eastern Ghouta grows, so do the preparations. Gravediggers say they have between 20 and 50 pits on standby at any one time. When bodies are beyond recognition, or when there are no family members left to claim them, they are buried in mass graves at night. A small group of coroners and physicians conduct only the most basic of rites, according to local doctors, before hurrying back to vehicles and leaving under the cover of darkness to avoid the bombs.
At the United Nations this month, Swedish and Kuwaiti officials scrambled to find a solution, circulating a resolution calling for a 30-day pause in fighting. But there was little hope of a breakthrough. One European diplomat said that Russia, one of the Syrian government’s most important allies, was attempting to water down the proposal.
Addressing reporters outside the Security Council chamber, U.N. Syria envoy Staffan de Mistura described the latest escalation, coupled with a lack of access for humanitarian aid convoys, as “one of the most potentially dangerous moments” he had witnessed.
In Eastern Ghouta, doctors said that more than 1,000 patients required urgent evacuation, their names recorded on lists submitted to the United Nations and the Syrian Arab Red Crescent.
For some households, already surviving on just one meal a day, the fears and exhaustion sparked by the latest round of bombardment has pushed family relationships to a breaking point.
“Sometimes my son sneaks out to play with his friends. It makes me crazy,” said Om Mohamed, the aid worker. “He goes to sleep knowing I am cross with him. I go to sleep every day praying that God will grant us another day together.”
Liz Sly in Beirut and Heba Habib in Cairo contributed to this report.