“You could be sleeping. You could be walking to the shop. At any time a bomb can happen,” says an MSF health worker in one of the hospitals the organisation runs in northern Syria. This reports aims at depicting the dreadful humanitarian situation in Aleppo city and surrounding areas especially since mid-December 2013, when the Syrian forces started a campaign of aerial bombardments and dropping of barrel bombs in this strategic area of the country.

Barrel bombs have caused thousands of fatal casualties and wounded and have had a devastating damage to infrastructure and homes. Dropped in densely populated areas, they create a climate of fear due to their unpredictable and indiscriminate nature.

Many victims become permanently maimed. Losing a limb in Aleppo city is particularly traumatic, both physically and psychologically, since wheelchairs aren’t available and the context of war makes it harder for them to adapt to a new life. Moreover, shortages in medical equipment and poor levels of post-operative care have meant that in many cases doctors carry out amputations when under other circumstances the limb could have been preserved.

However, access to healthcare is now virtually impossible due to lack of supplies and qualified medical staff and medical services for the residents of eastern Aleppo have diminished to alarming levels. From an estimated 2,500 doctors working in Aleppo at the beginning of the conflict, less than a hundred remain in the medical structures still operating in the city. The rest have fled, become internally displaced or refugees, or have been kidnapped or killed.

The aerial bombardments have led to lack of electricity and destruction of houses and infrastructure. People are now seeking new ways of heating, and the widespread use of home-made combustibles has caused a number of domestic accidents, such as burnt cases among children. Treating burnt patients is very challenging in the current scenario of war and lack of medical care in Aleppo.

Vaccination campaigns are also desperately needed, but it is impossible to carry them out in eastern Aleppo: normal daily life has stopped, people are running away, and markets, schools and any place with presence of civilians are likely to be bombed.

MSF’s teams have also observed an increase of obstetrical complications due to exposure of pregnant women to stress as well as lack of antenatal care for prevention and treatment of complications such as preeclampsia which in turns increases risk of preterm delivery, miscarriage and small for gestational age newborns. Premature babies need a special neo-natal care that it is hardly available now in eastern Aleppo.

Ghost neighbourhoods are the metaphor of violence and displacement. Out of the 97,000 Syrian refugees in Turkey’s border town of Kilis, a 20% (19,400) arrived during the last six months. The ones staying behind do not have the financial means to move, or they fear their houses will be looted.

The psychological dimension of the war is difficult to grasp, but Aleppo, once the economic and vibrant hub of Syria and now almost destroyed and deserted, is a living tale of the collective descent into chaos. Virtually every individual has a tragic story to tell because war has affected family, friends and dear ones.