Renewed intense conflict through late November in besieged areas near Damascus and Homs has led to significant increases in mass casualty influxes, says Médecins Sans Frontières (MSF). Multiple airstrikes hit east Ghouta again today; medics in the area are reporting many casualties, including women and children, but the tally of today’s war-wounded and war-dead is not yet complete.

Since 17 November, MSF-supported facilities in east Ghouta (an area of besieged towns near Damascus) and Al Waer (a besieged community near Homs) have reported very high numbers of war-wounded and dead. Hospitals in the east Ghouta area reported 261 wounded and 30 dead, while the hospital in Al Waer reported 100 wounded and 13 dead on just one day of intense bombing and shelling. During this period, one paramedic in east Ghouta was severely wounded during an airstrike, an anaesthesia technician was wounded by sniper fire in Zabadani, three ambulances were hit and destroyed, and one MSF-supported hospital in the east Ghouta area was damaged when a bomb hit the neighbouring building, putting the intensive care unit out of action at a time when the service was desperately needed for wounded casualties.

Schools and residential areas have been hit, suggesting at least some of these attacks are indiscriminate bombing and shelling of civilian areas. While we don’t yet have the full data breakdown of ages and gender for Al Waer, in east Ghouta 43 per cent of the wounded and 60 per cent of the dead are children under 15 years old and women.

“While we continue to raise our voice about the catastrophic situation in east Aleppo, alarm bells are again ringing loud in several other areas of intense conflict,” says Anja Wolz, medical manager of MSF medical support programmes in Syria. “Just yesterday, two schools in east Ghouta were hit in aerial attacks as the students were leaving at the end of the day. All but one of the wounded were women and children, with 16 being treated at an MSF-supported facility and others referred to other facilities in the area by ambulance. And last Sunday a rescue team trying to dig victims out of bomb rubble in Al Waer found themselves under sustained mortar shelling, resulting in nine of the rescue workers being wounded and requiring treatment themselves.”

“Yet again, we are horrified at the numbers of women and children among the wounded and dead coming to MSF-supported medical facilities,” continues Wolz. “We should all be very concerned indeed about the fate of civilians trapped in these areas of intense conflict. If the bombing and fighting cannot be stopped, at the very least, extreme care must be taken by the warring parties to avoid hitting the medics and ambulance teams going about their lifesaving work.”

MSF-supported medical staff have reported that many residents in these areas are gathered together in basements for fear of regular bombing and shelling hitting their residential areas. Ambulances are dispatched around the area, rather than being based in centralised emergency-response depots, for fear of having them all destroyed in one strike. And some hospitals have had to shut down regular medical activities as the staff are all needed permanently in the emergency room and surgical departments.

The levels of supplies are running low in some of these hospitals. MSF has received and responded to three emergency requests for IV fluids, antibiotics and analgesics. In addition, our team is currently preparing for 19 other requests to resupply the facilities in east Ghouta.