As Syria’s civil war enters its fourth year, a new report from global children’s advocacy group Save The Children has detailed how 10,000 children have died not just as a result of the fighting, but also from treatable or preventable diseases that have metastasized in the country.

Save the Children, in its report “A Devastating Toll” published on Sunday, details the consequences of Syria’s collapsed health care system. Among the revelations are that children are having limbs amputated because clinics don’t have the right equipment for treatment, newborn babies are dying in incubators during power cuts and patients are being knocked out with metal bars because of the lack of anesthesia.

“Children inside are enduring barbaric conditions,” says Save the Children’s regional director, Roger Hearn. “The desperate measures to which medical personnel are resorting to to keep children alive are increasingly harrowing.”

The report notes the reemergence of deadly and previously easily treatable diseases such as polio and diarrhea that are now silently spreading across the country, where 60% of hospitals are either damaged or destroyed. Some 200,000 Syrians have died of treatable chronic diseases like diabetes—double the estimated numbers of those killed by violence.

The group, which drew its findings from data issued by organizations such as the United Nations and World Health Organization, says over 5 million Syrian children are in need of basics such as food and adequate health care.

Write to Kharunya Paramaguru at kharunya.paramaguru@time.com.