Casualty numbers in Syria’s besieged East Ghouta enclave are soaring beyond imagination as the capacity to provide healthcare is in its final throes, said Médecins Sans Frontières (MSF) today.

Hospitals and clinics supported by MSF had seen more than 2,500 wounded and more than 520 dead after just five days of intense bombing and shelling – from evening of Sunday 18 to evening of Friday 23 February, certainly an under-estimate the number of facilities who managed to report is decreasing and as many facilities in the area that MSF does not support have also received wounded and dead. Many of these are women and children. Yesterday, Friday 23 February, women and children represented 58 percent of the wounded and 48 percent of the deceased recorded by the 9 MSF-supported supported facilities that managed to report.

Over the same period 13 medical facilities, fully or partially supported by MSF, have been hit by bombs or shells. Medics in East Ghouta who were already pushed to the brink have been working now for six days straight, without a break, with no realistic hope of being able to adequately treat their patients in such extreme circumstances. MSF calls for an immediate ceasefire to enable the basic human act of helping the sick and wounded.

As a nurse who has worked through extremely grim conflicts, I am devastated to hear doctors and nurses in East Ghouta saying they have 100 wounded patients and no hospital because it has just been reduced to rubble by bombing,” says Meinie Nicolai, General Director of MSF.

There is a level of desperation and exhaustion that comes from working round the clock, finding no time to sleep, no time to eat, permanently surrounded by bombing, and simply being in the middle of absolute distress. Adrenaline can only keep you going for so long. If doctors and nurses collapse, humanity collapses. We must be determined to not let that happen.”

On the third day of this offensive, the medics that MSF supports were calling for increased medical supplies. Now, after six days of incessant bombardment, they are saying that even with supplies they would have no physical capacity left to keep treating the wounded, and they call for something else – for the bombing to just stop.

As the war in Syria has increased in intensity, the frequent calls by MSF and others to respect International Humanitarian Law (IHL) – the rules of war – have demonstrably fallen on deaf ears. We will not abandon our calls for IHL to be respected, but we add now a specific plea: for the medics to be able to do their job the shelling and bombing by the Government of Syria and the armed opposition groups in East Ghouta must pause immediately, and we call on the supporters of these belligerents to use their influence to alleviate this extreme situation. With high numbers of medical facilities hit and damaged or destroyed, with roads for transferring patients either impassable because of bomb-rubble or from fear of bombing, with medical supplies limited or entirely lacking, and with extraordinary numbers of patients and extraordinarily exhausted medics, a humanitarian response is urgently required.

MSF insists the following should be included in the response:

• pause the bombing and shelling to allow a reorganisation of the medical response;
• allow medical evacuation of the most critical patients;
• allow independent humanitarian medical bodies to enter the area to provide hands-on assistance;
• provide a massive resupply of life-saving medicines and medical supplies; and
• ensure before, during and after any pause in fighting that civilian areas on both sides, including medical facilities, are not hit.

We call individually on the member states of the UN that are militarily engaged in Syria or are supporting warring parties in Syria to acknowledge their complicity in the unfolding medical catastrophe and to urgently exert their influence to alleviate this crisis.