A pharmacist, woken by the sound of explosions, rushed out to help the wounded – only to be blocked by his wife and children, who feared he would die in another wave of attacks. A pediatrician worried about how he would reach the clinic in the morning. A doctor wondered if he would see a family member lying in an ambulance.
This is how medical professionals in the divided city of Aleppo said their day began on Sunday. They say the violence there, even by the brutal standards of the Syrian civil war, has reached an unprecedented level.
At the same time, government troops, who launched an all-out Russian-backed offensive last week to rout the opposition from the eastern districts of the city, seized a rebel neighborhood. Damascus also rebuffed initiatives by U.N. officials to stop the carnage.
"A helicopter comes and drops two barrel bombs ... then a warplane comes and hits the same place with parachute bombs," Dr. Ghaith Suleiman, a 33-year-old pediatrician at the Children's Hospital in the rebel-held Al-Shaar neighborhood, said in a WhatsApp message, describing the intensity of the assault. "Then you have artillery, then rockets … and the helicopter comes back again."
"Before we had one or two neighborhoods attacked several times a day," he said. "Now almost all [opposition] neighborhoods are bombed in one go."
On Saturday, the attacks temporarily knocked out most major hospitals in eastern Aleppo, said Suleiman, sending doctors scrambling to move patients to other clinics. Others restarted work hours later.
A day later, almost all facilities were back online, but medical crews could barely keep up.
"You can't imagine the situation of the corridors on all the floors full of wounded and martyrs," said Radhwan Al-Kurdi, deputy of the opposition's Aleppo medical administration.
"Even before some of the hospitals were hit, they couldn't offer help due to the large number of patients."
At least 29 civilians were killed in the city Sunday, according to the U.K.-based Syrian Observatory for Human Rights, a pro-opposition watchdog with a network of activists on the ground.
Among them were eight children killed when the rebels struck Al-Furqan school in government-held western Aleppo, according to Syrian state news operator SANA.
"Some of children arrived in pieces," said Dr. Mazen Rahmoun, the deputy head of the state health directorate in Aleppo.
"They were taken directly to the morgue in body bags."
Yet it was the rebel enclave in eastern Aleppo, blockaded by government troops since July, that sustained the bulk of the damage. Since the beginning of the government's offensive Tuesday, almost 200 people – more than half of them civilians – have been killed, the Syrian Observatory for Human Rights said. Others, like Suleiman, put the number of dead at nearly twice that.
Earlier in the day, pro-government outlets reported that the Syrian army advanced into Masaken Hanano, a rebel-held neighborhood on the outskirts of the city's eastern flank. The move, if sustained, is a severe blow to the rebels, said Rami Abdul Rahman, the head of the observatory.
"The progress that the regime achieved today was the most significant one since 2013. This is the first real advance into major rebel-held territories in the city," he said.
With the death toll climbing, and fears of food supplies running out in eastern Aleppo, the U.N.'s special envoy to Syria, Staffan de Mistura, arrived in the capital, Damascus, hoping to stop the government from pursuing what he described as "a pyrrhic victory" in Aleppo.
The timing of the offensive, launched by Damascus and Moscow in the last weeks of the Obama administration, is seen as a way to establish a fait accompli before the end of the year and the inauguration of Donald Trump, widely thought to be less sympathetic to the rebels. The government wants to take Aleppo, Syria's largest city and a real as well as a symbolic prize, as proof it can reestablish control over all parts of the country.
Mistura, in a meeting with Syrian Foreign Minister Walid Moallem, proposed placing eastern Aleppo under the autonomous rule of opposition administrators once fighters affiliated with hard-line Islamist factions had withdrawn from the city and given safe passage to the neighboring rebel-held province of Idlib.
The rebel enclave has maintained its own city council since 2012.
But Moallem seemed in no mood for compromise. He issued a total rejection of the proposal, saying it affected Syria's national sovereignty.
"Is it possible that the U.N. comes to reward those terrorists who are still launching indiscriminate shells on western Aleppo?" asked Moallem in a televised news conference after the meeting, employing the Syrian government's routine description for the rebels.
"It is absolutely unacceptable that 275,000 of our people remain as hostages to the five, six or seven thousand gunmen," he said. "East Aleppo cannot be an exception among the rest of the areas that have undergone reconciliations."
The government has offered rebels who lay down their arms an amnesty, allowing those who reconcile to return to government areas while offering safe passage for those who refuse to submit.
Critics, however, say the policy is part of the government's starve-or-surrender tactic, in which it chokes off supplies from opposition areas it has besieged before forcibly evacuating the population.
Moallem also expressed hope that the incoming U.S. administration would revise Obama's stance toward Syria. The U.S. has given limited assistance to a number of rebel groups fighting under the banner of the Free Syrian Army, opposition groups that purport to espouse a secular outlook.
Both the CIA and the Pentagon have offered training, logistical support and antitank missiles; the latter have been crucial to previous opposition victories.
"Did this strategy achieve any goals for the American people when they spent millions of dollars to train and arm what they called the moderate opposition?" continued Moallem. "Any sane person would say this policy is wrong and must be corrected."