Sky News has gained rare access to the warzone that is northwest Syria, now also hit by devastating earthquakes.
Children were found dying and others have been left mutilated after a string of delays by the international community to help the last-remaining opposition area.
The Sky team have visited the area twice, most recently spending another 48 hours inside the rebel-held area where an Islamist militant group is in control, and which was hit most badly by the string of earthquakes and multiple aftershocks and tremors over the last two weeks.
We found a string of babies born prematurely to mothers who were caught up in the earthquakes and whose tiny newborns are now only just clinging onto life with little aid and sparse, antiquated equipment.
We also saw children who are the sole survivors in their families but left with catastrophic injuries and others with life-changing amputations whose futures will never be the same.
There are whole towns and villages now living rough, in tents or with relatives and few, if any, belongings to their name.
And most worryingly, there’s a collective burgeoning anger and despair directed against the international community – particularly the United Nations – who they believe delayed getting help to them and sacrificed their children’s lives.
As aid and rescue teams from all over the world poured into Turkey immediately after the earthquake, in Syria they were left to fend for themselves.
It took more than four days for the first trickle of UN relief to arrive in northwestern Syria.
It was far too late for many, and these small convoys didn’t bring with them any of the heavy lifting equipment or rescue experts that could have made a difference to those still trapped under the rubble.
We saw a small scrap of a boy called Arsalan – which means “lion” in Arabic – struggling with every breath he gulped to stay alive.
The three-year-old was the only one of his family to survive the huge 7.8 magnitude earthquake which struck the region on 6 February.
The civil defence group called the White Helmets struggled to free him and his family for three days.
One by one they pulled out the family – his mother, his six-year-old sister, and his seven-year-old brother.
All had perished under the rubble.
‘We have no ICU’
Then the White Helmets saw the outline of a man’s body – it was Suleiman, his father.
He was crouched forward as though he’d used his body to shield his tiny son against the force of the earthquake and the rubble which enveloped them.
The volunteers slowly pulled his lifeless body out. This was the last brave act of a father who desperately tried to give his little boy the best chance of survival and sacrificed his own life to do so.
The White Helmets team could see beneath Suleiman’s body, a child’s arm poking out from the grey, stony tomb. As they scraped the rubble away and gently pulled the toddler free, the child opened his eyes, his eyelashes caked in dust, as he was passed along the human chain of rescuers.
“He’s alive, he’s alive,” the cry went up. “Alhamdulillah [thank God].”
It was a miracle anyone from the family had survived after nearly two days of being buried under the rocks and stones of their home, in wintry conditions with no food, water or specialised equipment to help locate and extract them.
The little boy named after a lion was showing enormous survival instincts way beyond his years. Doctors at the Aquabat Hospital on the Turkish border have been working ever since to save him with little specialised equipment and no proper intensive care unit. Not even their own CT scanner.
“We have no ICU,” Dr Sameeh Qaddour told us.
“Our ICU is his uncle and aunt by his bedside all day and night. We can give him some oxygen and painkillers and we’ve performed numerous operations to try to save his legs which are badly affected by crush syndrome.”
The little boy has had a stomach operation too and his bowels are struggling to work. His massive leg wounds are at constant risk of becoming infected and septicaemia setting in.
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The doctor is obviously moved by the boy’s spirit to live and how he’s already defied the odds to come this far. “Logically he should not have survived,” he tells the Sky News team.
“But when I see the video (of his rescue), he survived… logically he must not survive! But he survived the first, maybe he’ll survive the next… this is out of (the hands) and logic of medicine.”
The little boy opens his eyes and is responding to his uncle Izzat Humadi who is talking gently to him. “Come on, Arsalan,” he says to his nephew, “Come on, let’s go. Let’s get out of here.”
He’s willing the toddler with all his might to fight death, and cheat it again.
This little boy – and his siblings – were all born into a war which seems to have no end.
They were born into poverty, in an enclave filled with more than four million people who have run away from the fighting and bombing and shelling by the Syrian leader Bashar al Assad.
They’ve known no other life other than one lived in the shadow of war – and now a natural disaster has wiped out the entire family apart from this toddler.
‘This is all our responsibility’
Dr Qaddour is emotional as he examines Arsalan.
He’s angry at the lack of help for children like Arsalan and tells us: “Are these children responsible for what Assad is doing? Are they responsible for the borders? Or the international community?
“He’s lost everyone. Every single one of his family. He doesn’t know anything about these politics and he doesn’t care about this and I don’t care about this.
“I want this patient to survive – anyway. I have to give him all the chances. Arsalan survived under the rubble but maybe not survive now – but I have to give him all [the chances] that I can. This is all our responsibility.”
The tragedy suffered by Arsalan and his family is not even unique in northwest Syria where they’ve all endured nearly 12 years of war, of constant terror and homelessness, of rebuilding their lives over and over again, sleeping in fields, sheltering in tents, finding and building new homes, only to do it all over again a few months or years later.
It is a war which has gone on so long, an entire generation has been born into it and is growing up in it.
It is a life filled with armed checkpoints, constant battles between the armed stakeholders and shifting territorial claims and gains.
It’s a life inured in depravation and the repetitive uncertainty of shells and bombs. Those in northwest Syria are probably the only section of the global community which felt a bit of relief at the start of the war in Ukraine.
The consequences for them are that it has distracted the Russian support for Bashar al Assad and resulted in far fewer attacks against them as the Russian leader directs most of his military resources against the Ukrainians.
Yet Assad’s jets still flew over the area on the day of the first earthquakes and while we were inside Idlib following the second set a fortnight later, there were rockets being fired into the countryside in Idlib.
‘Why didn’t the UN help us?’
Even in less troubled times, the fear can never completely disappear for the beleaguered people of Idlib.
“Perhaps we should thank Bashar al Assad more than the United Nations in this crisis,” the admin manager of the Aquabat Hospital, Salahedin Abdulsalam tells us.
“Bashar al Assad taught us how to manage a crisis… by bombing us, killing our families, destroying everything.
“But the United Nations did nothing the first four or five days (of the earthquake) and our people died under the rubble and they just asked for permission from Bashar al Assad to help us.” It’s a constant refrain from those we talk to.
“Why didn’t the UN help us when we needed it most?” we keep getting asked.
The neonatal ICU in the Shams Hospital in Sarmada, near the Turkish border is packed with babies born into the world dangerously early as well as others struggling from the long-term denigration of medical facilities because of the war and now the earthquakes.
Dr Munzer al Rammah takes us past little cot after little cot.
“He’s suffering from pneumonia, she is too; he has bronchitis; he has severe dehydration. The main reason is the war,” the doctor tells us.
“Many of these families live in tents and suffer from cold and many more are now living in tents because of the earthquakes so it affects an already bad situation.”
‘There is no future for these children’
He takes us to another ward where he shows us the babies caught up in the earthquake.
Two are in adjacent transparent incubator cots. Both were born in the hours after the earthquake as terror and trauma forced their mothers into early labour and expelled them from their bodies a whole month early.
They are fragile and now facing the fight of their short lives to keep breathing and survive in horrendous conditions. They each weigh little more than a litre bottle of water.
They’re pitiful little things. I notice the feeding syringe laying next to one of them called Fatima is almost the same size as her.
She flails around as the nurse, who’s also called Fatima, slowly presses the specialised milk they are feeding her, down the feeding tube which is inserted into her nostril and takes the sustenance straight to her stomach.
She’s blinking up at her nursing saviour. Eight times a day she’s fed just 30ml of milk to try to keep her alive.
But even if the nurses and doctors succeed in building up their strength so they can leave hospital and return to their families, the majority will return to cold tents where their relatives are struggling to feed themselves and there are few choices.
“We see them return here over and over again with illnesses and nutritional problems,” nurse Fatima Khalid tells us.
“There is no future for these children with no school, no education, no proper hospital and not enough food.”
She, like so many here, blames the outside world for their lack of empathy, lack of care, and lack of action.
“If they’d helped us (to get rid of Assad) we might not be like this now. If we were able to get rid of Assad who bombed us and destroyed us, maybe it would be better – and now we have the earthquakes but still, we are here. We are alive. We resist death.”
In Jindiris, a town near Afrin in Aleppo Province in northern Syria, we find families putting up plastic sheeting to shelter against the cold, while others huddle in tents erected among the rubble and piles of rocks which used to be their homes.
Jindiris is among the worst hit by the earthquakes whose impact rippled with devastating effects across the border with Turkey.
We see many children scavenging amongst the debris for scraps they can sell or use. And whole families sifting through stones with their bare hands trying to find their IDs, phones or just memories of their dead.
No time for the luxury of grief
Majdolin Ahmed lost the youngest of her four children – a 10-year-old boy called Nebi. He was pulled out of the rubble after two days by his relatives. No one came to help them and there was an air of resignation from them.
Few ever help them. Here, it’s each man, woman and child for themselves. The families are excessively tight-knit here – because family is important in their culture but also because all they have are each other.
Few but Majdolin and his immediate family will mourn the death of Nebi. Everyone in Jindiris seems to have lost someone, sometimes multiple family members.
There is a stunned and despairing air permeating every devastated street and broken building or packed tent. Grieving is a luxury they don’t have time for. Survival is sucking up much of their emotions and their reserves of energy now.
“I’m just trying to find my phone so I can have photos of my son,” Majdolin tells us. Tears are welling up as she recounts what happened. Nebi was her baby, her youngest and none of them could do anything to save him. In the same town, there are remarkable tales of defying death.
‘I begged them to cut my leg off’
Reema is one of those who defied death. She’s 14 years old and was trapped under the rubble for three days, her right leg pinned down by concrete and a steel pin through her right ankle.
She tells us how she scrambled to escape the earthquake as her home shook, but the ceiling came crashing down on her as she raced to get out. When she came to she was trapped, her leg crushed and a dead body beside her. He was the guest of one of her neighbours. She screamed for help and could hear her mother and siblings outside.
They ran to get help from cousins and uncles and called the White Helmets and anyone who’d help try to free her. Their plea for help was answered by two medics. Together with the White Helmets and little equipment, they burrowed through the concrete and created a tunnel through eight metres of it to reach her.
They spent hours trying to chisel her out while also trying to placate her and reassure her.
“Don’t leave me, don’t leave me alone,” Reema kept crying to them. “Please just get me out of here.”
In the end, she was begging them to cut her leg off so she could get out. “I told them to please cut my leg,” she tells us from her hospital bed, “I had to get out”.
So one by one the medics took turns to crawl inside the cavity which was big enough for just one person at a time, and first they administered painkillers, then anaesthesia and then the amputation was carried out – beneath the rubble. “I don’t remember anything from that,” Reema tells us, “Because they anaesthetised me”.
We watch as she walks on her one leg using a walker. If she continues to heal, she hopes to get a prosthesis in about a month. “This is God’s decision,” she says with a smile, “Who am I to complain?”
Her family still haven’t told her that her father died in the earthquake. They want her to get stronger before delivering this terrible news. But life is likely to be tremendously hard for Reema living in a war zone with few facilities.
One of the medics who saved her life takes us to her family’s home. The apartment block they used to live in is a mound of uneven broken concrete slabs and rubble. He is the head of the Ambulance Services in Aleppo and his name is Mohammed al Hussein.
“We managed to get to Reema after 20 hours,” he tells us, “It was a really difficult decision to cut her leg. We didn’t want to and did everything to save her. But if we removed the block on top of her, the whole building was going to collapse on her and kill her. So we ended up amputating her leg in the rubble.”
He goes on: “Reema was lucky because we were able to save her. But what of all the other children around here who have not been saved?
“There’ve been so many other ‘earthquakes’ through the years,” he says.
“With bombings and shellings and attacks from Bashar al Assad but no one helped us or our children. And so many have died. No one did anything for us.”
Arsalan loses fight he could never hope to win
A few hours after we leave Idlib, we get word from the doctors that their valiant fight to save the little boy named after a lion, has failed.
Arsalan died around the same time of day the earthquake first struck this region, around 4am in the morning, a little over a fortnight later. The miracle they needed to save him eluded them.
A small group of Canadian doctors is in Idlib trying to prioritise what the area needs when there is so much need here. And they are furious at the lack of swift international help.
“I’m very angry, says Dr Anas al Kassem. “I’ve seen all kinds of injuries and all the crush injuries and it could have saved lives. These are children and it (a quicker response) could have saved their lives… and given them a better outcome”.
“The United Nations should be ashamed of their slow response,” he goes on.
Arsalan couldn’t wait for the response from the outside world. And like so many others, despite fighting so hard, despite defying the odds, despite the tremendous battle by the doctors, he lost a fight he probably could never hope to win. The doctors are now wondering how many more will go the same way.
Alex Crawford reports from Idlib in northwest Syria with cameraman Jake Britton and producers Chris Cunningham and Mahmoud Mosa as well as Guldenay Sonumut based in Turkey.