In the two weeks between the evening of 18 February to the evening of 3 March 2018, the medical data reveals 4,829 wounded and 1,005 dead – or 344 wounded and 71 dead per day. This data is collected from 10 medical facilities to which MSF provides a full package of support, and a further 10 facilities to which MSF has been providing emergency medical donations from its remaining medical stocks inside the East Ghouta enclave. Two of these facilities have yet to submit data for 3 March, so this is an underestimate. There are many other medical facilities in East Ghouta that are not supported by MSF, sothe overall toll is significantly higher.

“The numbers alone speak volumes. But even more telling are the words we hear from the medics we are supporting on the ground,” said Meinie Nicolai, MSF General Director.

“Daily, we hear of an increasing sense of hopelessness and despair, as our medical colleagues reach the limits of what a person can be expected to do. They are exhausted to the point of collapse, grabbing a few moments’ sleep as and when possible, permanently in fear of bombs or shells directly hitting their locations. They are trying their best to keep some semblance of a medical service operating, but everything is overwhelmingly stacked against them. The situation, and the unrelenting trampling of the rules of war by the fighting parties, are pushing them to do the impossible.”

MSF reserve stocks of medical supplies in East Ghouta are being distributed amid the almost ceaseless bombing and shelling, but these supplies are being rapidly consumed by the supported facilities and some key items, particularly for surgery, have run out. An official aid convoy that was granted access to the northern part of the enclave on Monday had medical items removed by the government of Syria, according the UN, which was co-managing the convoy. The need for a massive medical re-supply, without life-saving items being removed, is increasingly urgent with each passing hour.

Of the 20 hospitals and clinics MSF is supporting, 15 have been hit by bombing or shelling, with varying degrees of damage. This further reduces their capacity to provide care. Four of the medics MSF supports have been killed and 20 wounded.

The medical needs go beyond war-wounded patients. In most neighbourhoods of East Ghouta, the majority of residents are living in basements and makeshift underground shelters, in unsanitary conditions with limited safe drinking water and often no hygiene or sanitation facilities. Before the enclave-wide military offensive started on 18 February, MSF had already been boosting assistance to a field hospital in the Harasta neighbourhood, where bombing and shelling have been intense since November 2017 and some 70 percent of the population were already living underground. The medical data from that neighbourhood showed clear increases in respiratory infections, diarrhoeal diseases and skin infections, with many of these patients being children.

In accordance with basic rules of International Humanitarian Law, MSF reiterates its urgent call to all the fighting parties and their supporters: