Five years of near-continuous violence have pushed hundreds of thousands of people to flee Syria’s largest city, but not all of Aleppo’s residents have left. As Syria’s war drags on into its sixth year, we meet some of the residents who have chosen to remain.

ALEPPO, Syria: Last May, the human rights group Amnesty International delivered a report on the Syrian city of Aleppo simply called: “Death Everywhere.” It described how civilians in the city have been bombed indiscriminately so often by the Assad regime that it was a war crime.

The city, one of the oldest continuously inhabited cities in the world and famed for being a key post on the Silk Road, the ancient trade route that ran from China to the Mediterranean, was until very recently the most crowded in the country, with an official population of 2.302 million in 2005.

The ancient metropolis has now been cleaved into two halves: the regime of Bashar al-Assad controls the west and the armed opposition rules the east. The west side is believed to have more than 1 million people left while around 300,000 remain on the opposition side.

As the Guardian newspaper recently wrote: “Aleppo had withstood more than six millennia of pillage and insurrection, but the past three years have damaged more of its civilisation and displaced more of its people than perhaps all its earlier conflicts.”

The question is – who has stayed in this city, which is quite possibly the worst place in the world right now, and why?

For some, it has been because they have been unable to get out. Others have refused to leave – because it is home. They still believe they have a role to play in reconstructing Syria.

In order to reach safety, many displaced people have put their lives at risk – dozens have been killed and injured, including women and children, while trying to pass through the minefields placed by the Islamic State to prevent them from escaping, and many others were forced to pass through battle fronts, and the territorial borders between the Islamic State and the opposition Free Syrian Army, which have been targeted by Russian aircraft.

Um Ameen lives in a city in rural northeastern Aleppo that is under the control of the Islamic State. Um Ameen has refused her children’s many attempts to convince her to come join them in Turkey.

“I will never leave my house,” she said. “I have spent half of my life in this house. I know every little stone in its walls.”

Her oldest son, Ameen, said he has tried countless times to convince her to join him in Turkey.

“I get very scared when I hear that there has been an air raid; every time the city gets bombed, I frantically follow the news on activists’ websites,” Ameen said. “My brothers and I try very hard to convince her to come and live with us, but she always refuses. We cannot stay because we cannot live under the control of the Islamic State.”

Abu Hassan, a man in his fifties living in rural eastern Aleppo, refused to leave his house, and has stayed despite all the dangers that surround him, from the aerial bombardment to the harassment that he and his family face from members of ISIS.

“Politicians on all sides keep saying that the war will end soon,” Abu Hassan said. “They say that Aleppo has become hell, but they don’t always tell the truth. They tend to exaggerate.”

His main concern is how to meet his family’s daily needs, Abu Hassan said. One of his sons works in Turkey, but the rest of the family lives together in one house. “Our biggest issue is the lack of water and electricity,” he said. “Everything is expensive; a five-person family needs at least $100 a month in order to have a reasonable life.”

His family relies on generators to produce electricity, and in the winter, they use locally refined diesel to run generators. Abu Hassan dug a well with his neighbor next to their building to provide water.

“Yes, life is hard here, but I, and many others like me, live here in rural Aleppo alongside the bombing and the destruction. We are used to this,” he said. “We still visit friends, even though we’re almost always watching the news on television.”

Abu Mohammed, 63, a resident of the al-Qatarji neighborhood in Aleppo city, reflected on life in Aleppo while sitting on a chair in front of the front door to his house. “We’ve grown accustomed to a medieval life: no water and no electricity. When the electricity comes, our kids can’t believe it,” he said.

“Unfortunately our lives have become cards in the hands of international players who are preventing an end to the war in Syria. As a citizen, all I want right now is some water and electricity – even just a few hours a day would do.”

Many of the renewed clashes between armed opposition forces and troops loyal to embattled president Bashar al-Assad are concentrated in areas close to Aleppo’s high-voltage transmission lines to the city’s south. Additionally, residents said the regime’s electric company has frequently and intentionally cut service to opposition-controlled areas, which consequently shuts off the water as well.

“We used to get fuel from the border areas, but ever since the regime took control of the village of Maarastah Khan, we cannot get fuel anymore,” said Aya Hrietani, who lives in the al-Sukkari neighborhood in Aleppo.

“Due to lack of fuel, all electric generators stopped, which has consequently affected many other services – water pumps and bakeries stopped as well, and people are back to making their bread at home,” she said. “Hospitals have also been affected: although we have hospitals and clinics that can treat any medical condition, the lack of fuel has prevented many of them from providing people with any services.”

Though Aleppo has lost most of its civil servants, the few that remain work to keep the opposition-controlled neighborhoods running.

“As a school principal, leaving was never a choice for me,” said Safwan Badawi, principal of Fatima al­-Zahraa elementary school. “I believe that we have to educate the new generation and prepare them to, one day, build a future Syria.”

Badawi holds classes in basements to avoid the constant bombing, and due to the shortage of teachers, he hires college students and high-school graduates to lead classes.

Qamar, a college student, had to quit school because of the war, so she decided to tutor elementary school children in her own house. “A whole generation has lost access to education,” she said. “They have been out of school for the last two or three years; some children should be in the sixth grade, but they haven’t even finished the third grade.”

Around a year ago, she decided to hold tutoring sessions in reading, math and Arabic language. Qamar now has 14 students, whom she tutors for a small fee to cover her expenses, until she can go back to college.

Many teachers have fled the country because of violence, like millions of other Syrians. Others have had to give up teaching when obtaining their salary became impossible; hundreds of teachers in the province’s rural areas have lost their incomes because they cannot get paid unless they travel to the city to collect their money in person.

Ameen al­-Ali has been an elementary teacher in rural Aleppo for 12 years. He said his salary was put on hold because he did not show up to receive it.

“Someone sent a report to the authorities that my friend and I were with the opposition, so when we went last time to receive our salaries, the accountant told us that we could not collect them until we check in with the security department,” said al-Ali, who since been forced to find an alternative form of employment.

There is a severe shortage of doctors, medical equipment and functioning hospitals, as well. The rebel-held half of the city has a mere 10 hospitals, only five of which have surgical capabilities.

“Most of the equipment we have is left over from other hospitals, and is very old,” said Hamza al­-Khateeb, one of the few general surgeons left in the city. “We also suffer from a shortage of staff; we have only 30 specialist physicians, and they are not always available.”

Since the advent of conflict, most doctors have left the country. Available medical services are typically provided by physicians’ assistants, medical school students and recent graduates who have refused to leave. Some organizations have also launched nursing training courses in order to increase the number of medical workers.

Despite the war and shortage of other services, the city of Aleppo appears somewhat garbage ­free, according local residents. This is thanks to the opposition’s local city council, which developed a department of hygiene and hired 350 workers to collect garbage.

Abdul Aziz, 42, a department of hygiene employee, said: ” We use simple tools – an old three­-wheeler and some brooms. I decided to work with the department of hygiene because there was no more work for me in construction and I didn’t have the resources to leave the country. We make a salary of around $100 per worker. It’s barely enough to manage, but it’s something.”