There was a time in Ghouta, amid the planes, bombs and hunger, when ways to ease the suffering remained within reach. Even as the siege closed in, residents in the suburb near Damascus had access to smuggled food and medicine, and a drip-feed of weapons and money kept the militants among them in the fight.

That came to a halt late last year. First, the supply lines of food slowed. Then, in January, a Jordan-based, US-run, military room that had provided weapons to two militant groups was shuttered. Regular cash transfers stopped being sent to rebel groups inside Syria. Qatar and Saudi Arabia, which had backed the militants after the popular uprising in 2011, had grown tired of the cause to oust Bashar al-Assad. And the Trump administration no longer wanted to underwrite their efforts.



The blockade of Ghouta, where a Russian and Syrian air blitz entered a second week on Wednesday, is now the most crippling in Syria, and the estimated 350,000 to 400,000 people below the bombs is the most desperate population group in the devastated country.

As regime forces prepare for a final ground push, those inside Ghouta say they have been abandoned to their fate by regional powers who had encouraged them to revolt in the heady early days, but moved on when their early gains turned to grind, then losses.



Eastern Ghouta is another Srebrenica, we are looking away again | Simon Tisdall Read more

“They didn’t have the stamina for this,” said Afif Ahmed, a merchant from Douma inside Ghouta, who has huddled with his family in the ruins of his shop since Sunday. “Iran and Russia do. At least they don’t abandon their friends.”



Far from Ghouta, in northern Syria, Turkey, another of the opposition’s main backers, has also reframed its involvement, from fulsomely backing anti-Assad militants earlier in the war, to using the same anti-Assad proxy force it helped raise to instead turn their guns on Kurds along its border.



An opposition momentum, driven by foreign patrons, has now reversed across the country. Syria remains a proxy war, but it is the foreign backers of the regime, Iran and Russia, who now have progress on their side, licensed by an international community which locals in Ghouta say is indifferent to their suffering.



“They used to tell us ‘have faith, tyranny will not win’,” said a former rebel, Adnan Shamli, who fled Ghouta in June last year. “It was the Arab states that we met with in Jordan mainly. There were lots of people with promises. To this day I regret leaving and not staying in my home to die with my friends.”



Civilian targets across the enclave on the outskirts of Damascus are being systematically targeted by jets and helicopters, and the death toll in the past three days alone is close to 250 – among them large numbers of women, children and elderly. Without the weapons to combat them, or numbers to counter attack, the two main opposition groups – the Islamically-conservative Jeysh al-Islam, which was backed by Saudi Arabia, and Falaq al-Rahman, a patron of Qatar, say they can do nothing to stop the assault.



“The carnage has been like nothing you could imagine,” said Wael Rahman, a spokesman for Falaq al-Rahman. “Qatar has given us no reason for why it stopped the funding. And we hope they’ll resume their support as Qatar and Turkey have been big supporters throughout the revolution.”



Play Video 0:57 Bodycam footage shows children being rescued from rubble in eastern Ghouta, Syria – video

Doctors inside Ghouta say up to 12 medical facilities have been bombed – most of them severely damaged – in the past three days alone. The violence has been described as the worst in Syria at any point in the past three years, belying claims that the war is winding down, or that internally displaced civilians and refugees who have fled Syria’s borders should consider returning.



“Blatant war crimes have been an everyday feature of the conduct of the war in Syria,” said Susannah Sirkin, the director for international policy at Physicians For Human Rights. “There is absolutely no doubt that the Syrian and Russian governments meant to harm the civilian population in eastern Ghouta, in direct defiance of international humanitarian norms.



“As long as the nations of the world with the responsibility to protect fail to act to stop this violence, we will see these crimes against humanity repeated again and again: first in Aleppo, now in eastern Ghouta, soon in Idlib and Hama.”



The UN and other aid organisations have been denied access to Ghouta since late last year and have resorted to increasingly loud – and so far futile – calls for Syrian officials to again allow aid in. The organisation says children have been among the heaviest hit by the blockade, with 11.9% of children under five acutely malnourished.

Although some food is available in the enclave, what can be smuggled in is often beyond the means of families whose incomes have crashed since 2013. “We don’t have money for food or heating,” said Maha Yassin, a mother-of-four from east Ghouta. “No-one does. The only mercy from our God this year is that the winter has not been severe.

“Last night when the planes came again I wished they would take us all,” she said. “What comes next will be worse than yesterday. And yesterday we couldn’t endure.”

Those who remain in Ghouta are preparing for the inevitable: a ground invasion by forces loyal to the regime that will push them from their enclave and into a pool of more than six million already displaced and desperate people. “The game plan is to bomb them into submission, just like Aleppo,” said a Lebanese political leader, citing Lebanon’s disassociation policy in the Syrian conflict as a reason for shielding his name. “No one will help them and the international community is immune to the carnage. These poor people cannot go to Jordan, the ruins of Deraa, or Quneitra,” he said, referring to two towns in southern Syria, “or maybe the long slow march to Idlib”.

Quick guide What is happening in eastern Ghouta? Show Hide Where is it and why is it important? Eastern Ghouta is a rebel-held enclave that borders the city of Damascus. Once a breadbasket of the Syrian capital, since 2013 it has been under a siege that has tightened severely over the last year. In 2013 the area was targeted in a chemical attack by the Syrian regime that killed more than a thousand civilians and nearly prompted a US intervention in the war. Who controls it? The enclave is controlled by a mix of rebel groups dominated by the Islamist leaning Jaysh al-Islam, though the day-to-day affairs of the towns in the area are run by local civilian councils. How bad is the humanitarian situation? The situation is catastrophic for the 400,000 civilians who still live in eastern Ghouta. Prices for basic foodstuffs have skyrocketed and medical supplies are mostly absent because of the siege. Treating the injured is especially difficult because of the repeated bombing of hospitals and clinics. An estimated 700 civilians have been killed in the area in the last three months alone, not including those killed over the last week of escalation. The first aid convoy to the region in months arrived a week ago but did not do much to alleviate the suffering. Photograph: Hamza Al-Ajweh/AFP

Where Syria’s newest refugees will be forced to go is now being discussed by an international community that has found no answers to slow the disintegration of Syria, and has scrambled without result to slow the savagery in Ghouta.

A Beirut-based western diplomat said: “There isn’t a contingency plan for them. There will need to be humanitarian corridor of some sort, but how that would work is unclear. I can’t see how they could be forced to go to Idlib with millions of displaced. What would the route be for starters? This will inevitably be discussed at the UNSC, but of course the UN can’t endorse forced movement of people.”

Idlib is now home to an estimated 2.6 million people, around half of them displaced from elsewhere in the country. It has been used as a dumping ground for opposition communities that have surrendered to regime forces after prolonged blockades elsewhere in Syria. Islamic fundamentalists hold sway across much of Idlib province and among those transferred from other parts of the country, there are growing fears that their new communities will be the next targeted.

“We can all see the trap,” said Alaa al-Zrour who moved from Zabadani, near Damascus, during a surrender deal last year. “We look at Ghouta with horror and sympathy, but with anger as well. No one will care when they do the same to us.”

Additional reporting: Salem Rizk