Families huddle terrified in basements, stalked by staggeringly powerful explosions shaking the streets above. Wounded children writhe untreated on dirty clinic floors. Hospitals and rescue centers — a ravaged city's last ragged line of defense — crumble daily into rubble, often appearing to have been methodically targeted.
Even by the brutal benchmarks of the Syrian conflict, Russian and Syrian bombardment of rebel-held districts in the northern Syrian city of Aleppo this last week has been marked by a degree of unparalleled savagery and suffering, according to longtime observers of the multi-sided fighting.
And geopolitical reverberations are growing at a parallel pace. Secretary of State John F. Kerry on Wednesday threatened to suspend "bilateral engagement" with the Kremlin in Syria unless the aerial onslaught against Aleppo, once a cultural and historic jewel, is halted. A suspension would likely be a death knell for American efforts to enlist Russia in the common fight against Islamic State militants.
As recently as last week, diplomat after diplomat at the U.N. General Assembly asserted that there was no military path to ending the conflict. With the war having devolved into a stalemate, Syrian President Bashar Assad and his Russian backers are seemingly attempting to seize the battlefield initiative by capturing the opposition-held sector of Aleppo, whatever the human cost.
A regime victory in Aleppo, once the country's most populous city and its main commercial center, would deprive the Syrian opposition of its main urban stronghold, setting in motion a potentially decisive change in the course of the conflict. And the unbridled fierceness of the latest fighting is sending a new flood of refugees out into a world already beginning to stagger under the burden.
Until now, analysts say, the Assad regime had been deterred primarily by its own forces' weakness. That state of affairs in some ways dovetailed neatly with international fears that an all-out battle for Aleppo's east, where between a quarter-million and 300,000 civilians are believed trapped, would lead to a bloodbath unseen thus far in this war.
But newfound Russian willingness to deploy its warplanes in a ferocious bombardment of eastern Aleppo — with battlefield weaponry not previously used in a densely populated Syrian city — has dramatically altered the equation. The aerial campaign signaled the start of a broad offensive against opposition-held Aleppo announced by the Assad government on Sept. 22. The push has included ground fighting in recent days — the first time since 2012 that Syrian government troops had crossed into those rebel-held areas.
One turning point in Aleppo has been the use — not acknowledged by Russia or Syria, but publicly alleged by senior diplomats and the Syrian opposition — of "bunker-buster" bombs, capable of penetrating heavily fortified underground installations.
"They're actually a very strange choice to use against cities unless you're trying to hit something in particular, so they're likely to be on the basis of specific intelligence — hitting things like buried supply tunnels, underground command centers," said Justin Bronk, a military scientist with the Royal United Services Institute, a British think tank. "Or civilian shelters — they would go straight through."
Analysts believe the employing of such weaponry, together with armaments such as internationally outlawed cluster munitions, suggests that the Syrian regime not only believes it can root out and destroy the opposition's leadership in Aleppo by such means, but that carnage involving civilians is simply not part of the calculus.
"What is equally criminal, in my view, is that those who are committing these crimes do so with a sense of impunity and immunity that is absolute," Frederic Hof, the director of the Atlantic Council's Rafik Hariri Center for the Middle East, said at a Washington forum this week.
"They have measured the reaction of the West to civilian slaughter over the past five years and they have concluded — quite rationally — that they may do as they wish, when they wish, to anyone they wish," he said.
The Aleppo assault intensified on Wednesday, with humanitarian groups reporting that two hospitals — codenamed M2 and M10 by medical personnel to obscure their locations — were knocked out of commission by bombardment, sending debris showering onto the faces of terrified patients.
The international group Medecins Sans Frontieres, or Doctors Without Borders, which supported both facilities, said at least two patients died and two medical personnel were wounded. Only seven surgeons remain in the area that is under attack, the group said.
"We have never seen so much death and injury in our hospitals," an orthopedic surgeon, Dr. Bakry Maaz, told the relief group USSOM. "This massacre is taking place before our eyes."
Against a backdrop of starvation and deprivation, one of eastern Aleppo's few remaining bakeries was hit in the latest bombardment as well, witnesses and activists said.
As always in this war, the most vulnerable have borne the brunt. The United Nations' children's agency, UNICEF, said that at least 96 children had been killed and 223 injured in eastern Aleppo since Friday. "The children of Aleppo are trapped in a living nightmare," the agency's deputy chief, Justin Forsyth, said Wednesday. "There are no words left to describe the suffering they are experiencing."
At the U.N., Secretary-General Ban Ki-moon could scarcely contain his outrage over the offensive, which began even as the world body was trying to shore up a failing cease-fire agreed to earlier this month. At a gathering of the Security Council on Wednesday, the outgoing U.N. chief made his strongest war-crimes accusation against the Syrian government and its ally, Russia.
"They know they are committing war crimes," he declared.
"Imagine the destruction," he said. "People with their limbs blown off, children in terrible pain with no relief…. Imagine a slaughterhouse. This is worse."
Frustration and fury on diplomats' part have been building for days. Speaking to the council on Sunday, the U.N.'s special envoy for Syria, Staffan de Mistura, cited evidence pointing to the use of bunker-buster bombs, coupled with reports of "incendiary bombs that create fireballs of such intensity that they light up the pitch darkness in eastern Aleppo, as though it was actually daylight."
If confirmed, De Mistura said, "the systematic, indiscriminate use of such weapons in areas where civilians and civilian infrastructure are present may amount to war crimes."
In Syria, where half the population has already been driven from homes, bombardment like that seen in Aleppo is the leading cause of forced displacement, a French nongovernmental organization said in a study released Wednesday. Drawing on refugee interviews and patterns of displacement, it said relentless use of artillery shells, rockets and aerial bombardment was the "overriding factor" behind the migratory wave that threatens to destabilize Syria's neighbors and is roiling the European political scene.
Despite the West's obvious self-interest in preventing more death and displacement in Syria, those on the ground increasingly fear the world has forgotten them.
"It's already so dire, and it seems that things will just get worse and worse," said Laila Alawa, of the nonprofit group Nuday Syria, whose focus is working to support mothers and children. Citing talks with people in embattled areas including Aleppo province, she reported a crushing sense of abandonment — a belief that political polarization in the United States has eroded the will to take decisive political steps to try to stem the bloodshed.
"It gets harder all the time for the Syrian people to trust in outsiders," Alawa said. "There's a feeling that no one really cares about what's happening to Aleppo."
Staff writer Tracy Wilkinson contributed to this report from Washington.
MORE WORLD NEWS