AMMAN: A bloody, inter-rebel civil war is paralyzing movement within the encircled, rebel-held east Damascus suburbs as residents navigate the crossfire of shelling and snipers in order to reach medical facilities, separated relatives and places of employment.

The outcome of the internal battles is a near-total shutdown of all transportation—commercial, humanitarian and medical—across East Ghouta as the power struggle between rival rebel factions enters its third week, with hundreds of fighters and civilians dead on both sides.

Central to the dispute is one of East Ghouta’s largest roads, the primary artery that runs the length of the opposition pocket.

Today, dozens of checkpoints, berms and unpredictable gunfire are preventing civilians from traversing East Ghouta’s once-busy, central highway, five local residents tell Syria Direct. The result, they say, has been “devastating": Teachers are separated from their schools, doctors from their hospitals, family members from each other and an entire region split at the seams.

“No one makes the trip [between the two sides] unless they are absolutely forced to,” says Hakim a-Dimashqi, an East Ghouta photographer and video producer. “The road has become long and dangerous, and at any moment there could be renewed clashes with civilians caught in the shooting.”

East Ghouta, comprising roughly a dozen bombed-out towns and villages immediately east of Damascus, is home to an estimated 400,000 people. The Assad regime has encircled the opposition stronghold since 2012, tightly controlling the entry and exit of all food, medicine and people. Although regime artillery continues to hit East Ghouta, the opposition-controlled pocket has been largely spared from regime and Russian airstrikes in recent days following a May 6 international plan to create de-escalation zones in certain rebel-held areas.

In the north of the divided rebel enclave, East Ghouta’s strongest military and political faction, Jaish al-Islam, controls the pocket’s de facto capital of Douma city. To the south, also referred to by residents as East Ghouta’s “Central Section,” are Failaq a-Rahman and Hay’at Tahrir a-Sham (HTS), an Islamist coalition that includes Al-Qaeda-linked Jabhat Fatah a-Sham as a leading member.

Inter-rebel clashes broke out in April when Jaish al-Islam attacked HTS headquarters in what the former later called a campaign to eliminate “Jabhat a-Nusra,” the former name of Jabhat Fatah a-Sham, from East Ghouta.

East Ghouta residents protest rebel infighting on April with signs that read: “Shame…No to infighting between factions." Photo courtesy of the Ghouta Media Center.

In order to move between the two sides of East Ghouta, residents must take a circuitous and dangerous detour, one that winds through active rebel battlefronts and passes just meters from a commonly used regime sniping position. With fuel in East Ghouta in such short supply, the path is most often traveled on foot, turning what should be a 10-minute trip into a deadly, hours-long journey.

At least three people, including two children, have been killed due to rebel gunfire on this route since rebel factions turned their heavy weapons on each other and fighting first erupted in late April. More than 400 fighters and civilians have died in clashes since then, said local activist a-Dimashqi.

The ongoing rebel row is not the first for East Ghouta. Exactly one year before the current outbreak of violence, rebel factions took up arms against one other for two weeks in April and May 2016, culminating in the loss of large swathes of agricultural area to regime forces, Syria Direct reported at the time.

But this round, a-Dimashqi tells Syria Direct, is “far more intense and far more dangerous than last time.”

Unlike in 2016, ambulances are reportedly being prevented from crossing between areas held by the warring sides via the disputed central road. Failaq a-Rahman accuses Jaish al-Islam of using ambulances to move snipers across checkpoints, “which forced us to stop allowing ambulances into the Central Section,” Failaq spokesman Wael Alwan told Syria Direct.

Jaish al-Islam refuted the accusation, calling into a “baseless claim that is far removed from the truth,” Hamzah Beriqdar, the group’s spokesman, told Syria Direct.

'We're blockading ourselves'

The latest rebel infighting is exacerbating East Ghouta’s already understaffed and ill-equipped healthcare system.

Douma, for example, is the only East Ghouta city with dialysis machines. Patients in kidney failure must navigate active battlefronts in order to receive medical care. The southern East Ghouta town of Kafr Batna, meanwhile, hosts the area’s only infectious disease center, now dealing with a months-long measles epidemic.

The rebel infighting is “depriving people of medical services that are not available on the other side” of Ghouta, Yaser Abu Nazir, a spokesman for the Hakim Medical Center in East Ghouta’s south, told Syria Direct. While Abu Nazir’s workplace is in Failaq a-Rahman-controlled territory, he lives in the Jaish al-Islam stronghold of Douma, meaning that he must travel for more than an hour by bicycle every day to work.

An East Ghouta resident inspects a hospital after a May 1 airstrike. Photo courtesy of Sameer Al-Doumy/AFP/Getty Images.

“Just look, the regime is blockading us, and on top of that, we’re blockading ourselves,” says East Ghouta photographer and video producer Hakim a-Dimashqi, referring to the rebel factions’ blocking the free flow of food and medical supplies. “It’s a siege within a siege.”

Since the outbreak of fighting in April, East Ghouta medical organizations have accused local rebel factions on multiple occasions of violating neutral hospitals and medical centers for their own political advancement.

One employee at Jaish al-Islam-affiliated medical organization in East Ghouta’s Central Section says he was detained when Jabhat Fatah a-Sham raided his workplace earlier this month.

“The center was shut down, all of its staff were detained for a number of hours, and we were forced to go to Douma on the basis that we were working for a Jaish al-Islam medical center,” the employee, Mahmoud, tells Syria Direct. “Now, I’m stuck in Douma and unable to return to my home without facing arrest even though I don’t belong to one side or the other. I’m just an employee.”

“This situation defies logic,” Mahmoud said. “The factions have plunged civilians into their infighting; they’ve torn families in half, and they’ve sown hatred among residents.”

On May 13, a team of doctors affiliated with the Ghouta Medical Office “came under attack from a local armed group” and were “forcibly detained as they were traveling to a nearby hospital,” the Syrian American Medical Society announced in a press release that same day. It is not clear which faction made the arrests.

“When other health workers came to the location to stand in solidarity with their colleagues, the armed fighters began shooting at their vehicles,” the statement added.

In yet another instance, Doctors Without Borders (MSF) announced earlier this month a suspension of medical activities in East Ghouta “following recent violations of medical facilities” by armed opposition factions. MSF’s statement alleged that dozens of "masked and armed men" stormed East Ghouta's Hazzeh Hospital on April 29 in search of certain wounded patients, and of stealing the hospital’s ambulance while gunfire from the infighting struck a separate medical point a few kilometers south.

The suspension of activities is a decision “made under extreme circumstances," the statement read, adding that "such attacks on health care facilities and workers will not be tolerated by MSF or the medical staff it supports.”