Rescue teams had combed the rubble for hours. When they found her, crushed between floor and ceiling, it felt to them a rare miracle. At least 14 people were killed in the same attack, apparently an air strike, and the fate of the girl's family remains unknown.

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Fast-paced videos of the White Helmets’ rescue missions have been shared millions of times online, earning global plaudits and several nominations for the Nobel Peace Prize. But this is the part we don’t see: When ambulance doors close, the dust and chaos fades. And many of those rescued have been too severely wounded to survive the ride to hospital.

Supported by U.S. State Department funding, the Syria Civil Defense group, made up of almost 3,000 volunteers, is believed to have saved more than 60,000 lives across eight provinces since Syria’s conflict began five years ago.

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Monitoring groups say the regime of Syrian President Bashar al-Assad has killed more civilians than any other side in the civil war. Most have died from airstrikes and barrel bombs, the sorts of attacks the White Helmets wake up and wait for.

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But as attacks intensify, especially around the besieged eastern neighborhoods of Aleppo, it is now these rescue workers who are under attack. On Saturday, warplanes targeted three out of their four headquarters there, just days after a four-hour assault on a U.N. aid convoy and the rescue workers who came out to save relief workers left alive.

The scene recorded in the Idlib ambulance this week is not unusual. At least 145 White Helmets have been killed in action since 2013 and trauma is common among volunteers.

Many report flashbacks and nearly all recall nightmares. “You cannot escape them these days. Everything comes back when I close my eyes,” said Khaled Khatib, a 20-year-old White Helmet who was still a student when Syria’s war began. “The world knows us as heroes, but this is work that breaks you.”

Addressing an audience in Washington this week, the group’s founder, Raed Saleh, described the work as “devastating and depressing beyond belief.”