Beseiged Aleppo came under another deadly barrage of airstrikes and shelling on April 29. The assaults—which involve both regime airstrikes and rebel attacks on pro-government neighborhoods—have killed 200 people in the last week, according to the Britain-based Syrian Observatory for Human Rights. The latest round of suffering in Aleppo beginning Wednesday night when 14 people, including at least two doctors, were killed Wednesday night in the bombing of a hospital supported by Doctors Without Borders/Médecins Sans Frontières (MSF) in the northern Syrian city of Aleppo, the medical humanitarian organization reported on April 28.
According to hospital staff on the ground, the Al Quds hospital in Aleppo was destroyed by at least one airstrike which directly hit the building, reducing it to rubble. Other airstrikes in the neighborhood also hit areas close to the hospital.
“MSF categorically condemns this outrageous targeting of yet another medical facility in Syria,” said Muskilda Zancada, MSF head of mission for Syria. “This devastating attack has destroyed a vital hospital in Aleppo, and the main referral center for pediatric care in the area. Where is the outrage among those with the power and obligation to stop this carnage?”
In Washington Secretary of State John Kerry condemned the attack. "While we are still trying to gather the facts surrounding the circumstances of this attack," he said, "it appears to have been a deliberate strike on a known medical facility and follows the Assad regime’s appalling record of striking such facilities and first responders. These strikes have killed hundreds of innocent Syrians."
According to Kerry, the United Nations has assessed the situation in Aleppo "to be catastrophic, and the regime’s most recent offensive actions there—despite the cessation of hostilities—compound the violence and undermine the cessation of hostilities."
He added, "Russia has an urgent responsibility to press the regime to fulfill its commitments under UNSCR 2254, including in particular to stop attacking civilians, medical facilities, and first responders, and to abide fully by the cessation of hostilities."
Just a day later, however, the U.S. State Department had to deny reports in Russian media that a U.S.-brokered agreement with Russia, which made progress on a temporary cessation of hostilities in the northwestern region of Latakia and the Damascus suburb of eastern Ghouta beginning Friday night, had excluded the partially rebel-held city. In a teleconference with reporters today, a State Department official confirmed progress on reducing attacks in Latakia and Ghouta, but explained U.S. negotiators would continue to press for the end of attacks in Aleppo. "Aleppo is a very important place. And then you’ve seen the horrific civilian casualties there," the official told reporters. "So we are working on Aleppo just as we are working on the other places. For the moment, this is what we have to go forward with, but we are working constantly on Aleppo and other areas."
The State Department official acknowledged that "there is a Nusrah presence in Aleppo; nobody’s saying that there isn’t... our view is that there are two designated terrorist groups in this conflict, and that’s Daesh and Nusrah.
"Our point has always been...neither Nusrah nor Daesh, of course, can avail themselves of any of the protections that exist under the cessation." But the official argued that groups that are participating in the cessation agreement should be protected from attack. "We’ve tried to prevent any attacks on them both to sustain the cessation itself but to sustain the kind of buy-in that we would have from these opposition groups."
The situation in Aleppo city, consistently at the frontlines of the brutal conflict, was critical even before this week's attack, according to MSF. An estimated 250,000 people remain in the city. Only one road remains open in and out of the non-government held areas.
Over the last week, several other medical structures have been attacked and destroyed in Aleppo, and five rescue workers from the Syrian Civil Defense organization have been killed. MSF has donated medical supplies to Al Quds hospital since 2012 and has built a very strong working relationship with the staff there.
“Compounding this tragedy is that the dedication and commitment of the staff of Al Quds, working under unimaginable conditions, has been unwavering throughout this bloody conflict,” said Zancada.
The surge in fighting has caused the collapse of a two-month cease-fire brokered by the U.S. and Russia. It also has raised fears of an all-out government assault on Aleppo and warnings of a humanitarian disaster in the 5-year-old civil war.
“The cessation of hostilities gave people in Aleppo hope. They were able to breathe again, to walk in the park and to live again," Bishop Antoine Audo, president of the Catholic aid group Caritas Syria, said. "However, in light of recent attacks, hope is fading fast. World leaders must urgently act to bring about an immediate end to attacks by all sides of the conflict.”
In rebel-held neighborhoods, medical facilities, bakeries and a water station have been pounded by a government bombardment, residents say. Electricity is down to a few hours a week. A single road out of Aleppo is the only supply line for the insurgent-controlled districts, where an estimated 250,000 people remain. If forces loyal to President Bashar Assad take the road, there could be major shortages of food and medicines.
"People have already started fleeing the city," said Baraa al-Halaby, an activist who watched older men, women and children leave his rebel-held neighborhood Friday. "If Aleppo comes under siege, people will starve to death within a month."
Assad's military declared a brief truce in the capital of Damascus and its outskirts and the coastal province of Latakia—but not in Aleppo.
That could signal plans for a ground assault. Pro-Assad media in Lebanon have been reporting for weeks that reinforcements are preparing for the "grand battle of Aleppo."
Syria's largest city and its commercial center before the war, Aleppo has been divided between the two camps. Now it is once more the main battleground after peace talks stalled in Geneva.
Zeid Ra'ad Al Hussein, the U.N. High Commissioner for Human Rights, said the latest fighting showed a "monstrous disregard for civilian lives by all parties to the conflict."
In a statement released in Geneva, Zeid urged the sides to step back from a return to all-out war.
"In short, the violence is soaring back to the levels we saw prior to the cessation of hostilities. There are deeply disturbing reports of military buildups indicating preparations for a lethal escalation," he said.
After a brief lull overnight, government airstrikes resumed Friday morning on rebel-held areas. At least 10 people died and dozens were wounded, according to the Local Coordination Committees and Bibars Mishal, a volunteer with the first-response Civil Defense Teams in Aleppo. The Syrian Observatory for Human Rights, a Britain-based group that monitors the conflict, put the death toll at 11.
The rebel rockets struck the Malla Khan mosque after noon in the government-held Bab al-Faraj districts, killing 15 and wounding 30, state TV reported.
In opposition areas, air raids prompted religious leaders to suspend the collective Friday prayers in mosques for the first time.
"The heart of the believers is aching ... but preserving lives is an important religious duty," the Religious Council of Aleppo, an opposition body that runs religious affairs, said in an online statement.