Gaziantep/Amman - Besieged east Aleppo's struggling healthcare system suffered its worst day yet on 14 October, with confirmed attacks on four hospitals and on an ambulance, leaving at least two doctors injured and one ambulance driver dead. This was the worst damage to health facilities from airstrikes by Syrian and Russian forces since the collapse of the brief ceasefire at the end of September.

The latest destruction comes amidst an intensification of the bombing campaign on the besieged northern Syrian city, where at least 62 people died and 467 people, including 98 children, were wounded between 11 and 13 October, according to reports obtained from the Directorate of Health and the forensic centre of east Aleppo. These casualty figures may be an underestimate, as many families have been burying dead relatives themselves, rather than bringing their bodies to hospitals.

"The indiscriminate bombing campaign has taken a clear turn for the worse," says Carlos Francisco, MSF Head of Mission for Syria. "One of the hospitals hit yesterday received huge damage. It was a major trauma centre that had been already hit three times in recent weeks. The pace of attacks is suffocating what little capacity for medical care the healthcare system still has, in a city which is rapidly falling apart, day by day and hour by hour. By damaging the few remaining places where lives can be saved, it is clear that Syria and Russia are squeezing the life out of east Aleppo."

According to reports shared with MSF by hospital sources, the warehouse keeper of one of the hospitals received burns in the attack yesterday and two doctors were injured. Before yesterday, there were just 35 doctors left for a besieged population of about 250,000, seven of them surgeons with the necessary skills to treat the many war-wounded, according to the Directorate of Health. Since the beginning of the siege on east Aleppo in July, hospitals have been hit 27 times, and not a single hospital has survived the bombing intact during this period.

In addition, yesterday's bombing completely destroyed an ambulance run by Al Sham Humanitarian Foundation (AHF), an NGO that has been providing free medical aid to the people of Syria since 2011, and killed the ambulance's driver. The Directorate of Health reported earlier this week that only 11 ambulances were left in working condition in the city after recent attacks and a lack of spare parts due to the blockade. A small number of basic vehicles for emergency transport of the wounded are run by volunteers and NGOs such as AHF.

"We have said it before and we say it again: all parties to the conflict must allow – now, before it is too late – a safe evacuation of the seriously wounded and sick from east Aleppo, and must let in essential medical supplies and vital goods for a population suffering not only from a continuous hail of bombs, but from the lack of any kind of assistance," says Pablo Marco, MSF Operational Manager in the Middle East.