In a hospital located in Aleppo’s crowded Tariq al Bab neighborhood, there’s a gruesome routine. First comes the sound of an explosion of heavy artillery landing nearby, followed five minutes later by the screech of an ambulance arriving with the blast’s victims.

Friends and doctors lift a young man out of the back of the ambulance. Another mortar crashes a few blocks away and the ambulance races off. The young man, who has a gaping hole in his inner thigh, is carried in to the hospital. This is what a constant bombardment of a city of millions looks like and sometimes the only sounds to be heard are screams and sirens.
“The most common injury is from airplane bombing and mortars,” said a hospital doctor who gave only the name Osram. Most medical staff wouldn’t give their names for fear of reprisals by the military or the pro-government militias, known as the shabiha. All requested that the hospital’s name not be given to avoid further attacks on the building.
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Fighter planes and helicopters carrying what the rebel Free Syrian Army call “barrel bombs” fly over the city daily. These 500-kilo munitions can destroy half of a city block. As the rebels lack the weapons to systematically take down aircraft, the helicopters seem unconcerned patrolling the skies, taking their time to find their next target.
Aleppo is the center of Syria’s whirlwind of violence. What started 18 months ago with peaceful marches demanding a change in government has turned into suicide bombers massacring dozens in pro-government zones and government jet fighters bombing civilian neighborhoods.
Hundreds of thousands have fled the fighting, whole families living in miserable refugee camps inside and out of Syria. Around 30,000 have beenkilled and the bloodshed is increasing—a record 4,000 were killed in August alone. Activists expect September to surpass even that.
It’s in hospitals like this one where the extent of the carnage is seen—as is how civilians are bearing the brunt of the violence.
In opposition parts of Aleppo, doctors say the majority of the people they treat are civilians.
“Eighty percent of the people are civilians. Twenty percent are Free Syrian Army,” said Osram.
The hospital is so full that most days the building’s lobby serves as the emergency ward. One old man seemed to come in and out of consciousness as he lay on the floor surrounded by doctors. His left leg below the knee had been blown off. A nurse swatted away flies that settled on his arm.
Pools of blood, pieces of clothing ripped off mangled limbs and trash sat on the floor.
In rare breaks in between bombings, doctors chain-smoked. The hospital is itself deliberately being targeted by the Syrian military, says Osram.
“The hospital has been hit three times. Mortars have exploded close, so shrapnel has hit the building,” the doctor said.
The hospital now no longer uses its top floors, fearing an airstrike or a direct hit. A couple of blocks away, a corner building has almost completely collapsed and many buildings show signs of having been hit by mortars.
Ambulance drivers use towels to cover their vehicles’ flashing lights—one said that helicopters were targeting ambulances.
Rebel commanders say that the heavy civilian toll is not a mistake.
When the FSA brigades took control of certain neighborhoods, they installed themselves in solid, sturdy buildings and waited for the military’s counterattack. Yet it didn’t come. Instead, civilian neighborhoods took the heaviest bombing.
“The government deliberately targets civilians. It wants to scare the people of Aleppo into not supporting the FSA,’’ said Omar, one of the activists who’s been filming government attacks and posting them to YouTube for the Free Syrian Army.
As the war for Aleppo has dragged on, as rebels have pushed forward and then seen many advances lost, a change seems to have come over the opposition neighborhoods. In the first days of the rebels’ assault, YouTube videos show civilians happily smiling, giving peace signs to the camera. Now, it’s the rare civilian that allows themselves to be photographed or interviewed. Civilians now fear retribution from a government that once must have looked like it had just weeks left.
Back at the hospital, an orderly took advantage of a brief break to spray the floor and mop up blood. Outside, there’s a heavy crash of another nearby mortar. The doctors put out their cigarettes. In minutes, three of the injured arrive. They share a stunned look. A man sat in his underwear, his hair and body covered in gray dust, blinking as he looked around at the doctors and other patients.
The ambulance driver says that they were taken from an apartment that received a direct hit—they only survived because they were in the backroom.