AMMAN: Doctors and residents of the besieged eastern suburbs of Damascus tell Syria Direct on Tuesday that the combination of bloody rebel-rebel clashes and unrelenting regime and Russian airstrikes are taking a devastating toll on the area's already undersupplied, overburdened medical sector.

As of mid-day Tuesday, Civil Defense personnel in East Ghouta were digging through the wreckage of region’s second-largest hospital, working to salvage any medical equipment they could after the facility was hit by a reportedly Russian airstrike the day before.

The Arbin Surgical Hospital, located just 4km east of Damascus, was hit by a single missile that ripped through four stories and killed two people, medical sources told Syria Direct on Tuesday. The projectile ultimately detonated in the building's basement, destroying operating and recovery rooms in the Syrian American Medical Society (SAMS)-supported hospital.

Aftermath of Monday airstrike on East Ghouta’s Arbin Hospital. Photo courtesy of the Arbin Surgical Hospital.

Arbin hospital staff told Syria Direct that they were still working to relocate more than a dozen patients in need of intensive care on Tuesday, more than 24 hours after the initial attack.

SAMS confirmed on Monday that the Arbin hospital, which once provided 125 major surgeries per month, is “out of service.”

Neither Russian nor Syrian state media reported the attack.

The loss of the Arbin Surgical Hospital on Monday came the same day that Doctors Without Borders (MSF) announced they would be suspending medical activities in East Ghouta “following recent violations of medical facilities” by armed opposition groups.

For the past five days, rival rebel factions in East Ghouta have battled each other in bloody infighting that has led to the deaths of up to 120 people, Syria Direct reported on Monday.

MSF's Monday 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, "such attacks on health care facilities and workers will not be tolerated by MSF or the medical staff it supports."

MSF support for East Ghouta will remain suspended pending "clear signs that fighting parties will respect the provision of health care," concluded the statement.

Jaish al-Islam—a faction that largely dominates rebel-held East Ghouta politically and militarily—responded to the MSF's move via Twitter on Monday, claiming that they “protect the peace of all medical facilities, health centers and hospitals in all of the towns and cities of East Ghouta.”

The armed group added that they “forbid any of the facilities to be used or equipped for military purposes."

A nurse stands before the wreckage of the Arbin Hospital following Monday’s airstrike. Photo courtesy of SAMS.

Doctors in the 400,000-person rebel pocket criticized the actions of Jaish al-Islam on Tuesday, saying they were “shocked by the crimes” of the armed group.

“These factions are irresponsible and indifferent,” Dr. Ali Omar, an internal medicine specialist in East Ghouta, who was shot in the leg while demonstrating against Jaish al-Islam on Saturday, told Syria Direct. “The people did not rise up to be ruled by such factions.”

Rebel infighting erupted this past Friday between Jaish al-Islam on one side and Failaq a-Rahman and Hay’at Tahrir a-Sham (HTS), an Islamist coalition which includes al-Qaeda inspired Jabhat Fatah a-Sham, on the other.

“People are just waiting in a state of fear,” Abu Ahmed, an East Ghouta resident, told Syria Direct on Tuesday. “I’ve been trapped in my home for three days, and I’ve practically run out of everything that I’ve got.”

“Meanwhile, as the infighting is ongoing, the regime is bombing medical facilities, which is double the suffering,” he added.

The outbreak of infighting on Friday comes exactly one year after the last round of intra-rebel clashes in the East Ghouta suburbs. Two weeks of infighting in April and May 2016 weakened rebel defenses and culminated in the loss of large swathes of agricultural area to regime forces, Syria Direct reported at the time.

Meanwhile, United Nations officials announced Monday that the organization’s personnel in Syria have “not reached any part of eastern Ghouta since October last year.”

With additional reporting by Alaa Rateb, Aya Emad, Mohammad Alloush and Mohammad Ali