Syria in Pieces

Planes rumbled threateningly overhead, shaking the walls. Amani Ballour’s hands flew up to her ears, her body tense. The doctor knew all too well what would come next. For years, government airstrikes had pounded eastern Ghouta, Syria. The Middle Eastern country’s civil war had reduced the once-bustling area to rubble, forcing its residents underground to survive. 

Planes rumbled threateningly overhead, shaking the walls. Amani Ballour’s hands flew up to her ears. Her body was tense. The doctor knew all too well what would come next. For years, government airstrikes had pounded eastern Ghouta, Syria. The Middle Eastern country’s civil war had reduced the once-bustling area to rubble. The war had forced its residents underground to survive.

Bombs thundered down, each blast closer than the last. Only when the attack stopped, after the roar of fire and metal and concrete settled, did Ballour exhale. Hidden in the tunnels of her underground hospital, she had survived another strike. 

Her relief was short-lived, however. Minutes later, people began rushing in with the injured. They carried kids and babies who’d been wounded by shrapnel, their lungs choked with ash and dust. It was up to Ballour and her staff to save them.

Bombs thundered down. Each blast was closer than the last. Finally, the attack stopped. The roar of fire and metal and concrete settled. Only then did Ballour exhale. Hidden in the tunnels of her underground hospital, she had survived another strike.

But her relief was short-lived. Minutes later, people began rushing in with the injured. They carried kids and babies who had been wounded by shrapnel, their lungs choked with ash and dust. It was up to Ballour and her staff to save them.

From 2012 to 2018, Ballour treated thousands of people in war-torn Syria, until the violence finally forced her to flee the country. Today, Syria’s civil war still rages on. The conflict has killed hundreds of thousands of people, flattened cities, and forced millions of Syrians from their homes. At least half of the country’s people are now displaced.

The war started in 2011. For years, Syrian President Bashar al-Assad and his allies have been fighting rebel groups for control of the country. The rebels want to force out Assad, an authoritarian leader who has ruled his people harshly for decades. 

Now, Assad and his allies seem poised to win. They have cornered the rebels in northwestern Syria, near Turkey’s border. They spent months this past winter pounding the area with airstrikes. The bombing finally stopped in March—thanks to a cease-fire. But experts say the uneasy calm won’t last. 

Assad’s airstrikes have gravely endangered his people. Earlier in the war, families desperate for safety fled to northwestern Syria to escape fighting in other parts of the country. Today, about 1 million displaced Syrians are trapped between Turkey’s border and Assad’s forces. With little more than the clothes on their backs, they spent months helpless against their president’s attacks—and Syria’s freezing winter temperatures.

The situation is a humanitarian nightmare, experts say.

“The Syrian crisis is bigger than anything over the last 200 years, short of the Second World War,” says Mufaddal Hamadeh of the Syrian American Medical Society, a group that provides aid in Syria. “It is an unbelievable catastrophe, and the world is not paying attention.” 

From 2012 to 2018, Ballour treated thousands of people in war-torn Syria. She stayed until the violence finally forced her to flee the country. Today, Syria’s civil war still rages on. The conflict has killed hundreds of thousands of people. It has flattened cities. It has forced millions of Syrians from their homes. At least half of the country’s people are now displaced.

The war started in 2011. For years, Syrian President Bashar al-Assad and his allies have been fighting rebel groups for control of the country. The rebels want to force out Assad. He is an authoritarian leader who has ruled his people harshly for decades.

Now, Assad and his allies seem about to win. They have cornered the rebels in northwestern Syria, near Turkey’s border. They spent months this past winter pounding the area with airstrikes. The bombing finally stopped in March, thanks to a cease-fire. But experts say the uneasy calm will not last.

Assad’s airstrikes have seriously endangered his people. Earlier in the war, families desperate for safety fled to northwestern Syria. They were trying to escape fighting in other parts of the country. Today, about 1 million displaced Syrians are trapped between Turkey’s border and Assad’s forces. With little more than the clothes on their backs, they spent months helpless against their president’s attacks. They also were helpless against Syria’s freezing winter temperatures.

The situation is a humanitarian nightmare, experts say.

“The Syrian crisis is bigger than anything over the last 200 years, short of the Second World War,” says Mufaddal Hamadeh. He works for the Syrian American Medical Society, a group that provides aid in Syria. “It is an unbelievable catastrophe, and the world is not paying attention.”

The violence started, experts say, with peaceful protests. In late 2010, people in some Middle Eastern and North African countries began staging pro-democracy demonstrations. Together, these became known as the Arab Spring. After Tunisia and Egypt overthrew their authoritarian leaders, Syrians launched protests of their own, in March 2011.

Assad’s regime has long been known for violently crushing political opposition and denying its people basic rights, including free speech. Syria’s economy was also struggling in 2011, says Steven Heydemann, a Syria scholar at Smith College in Massachusetts.

“People in Syria, especially young people, had very few opportunities to find jobs,” he explains. At the same time, “education and health care were seen as very poor quality. Syrians could see on the internet that they were living very differently than people in other countries.”

Experts say the violence started with peaceful protests. In late 2010, people in some Middle Eastern and North African countries began staging pro-democracy demonstrations. Together, these became known as the Arab Spring. After Tunisia and Egypt overthrew their authoritarian leaders, Syrians launched protests of their own. That was in March 2011.

Assad’s regime has long been known for violently crushing political opposition. It denies its people basic rights, including free speech. Syria’s economy was also struggling in 2011, says Steven Heydemann. He is a Syria scholar at Smith College in Massachusetts.

“People in Syria, especially young people, had very few opportunities to find jobs,” he explains. At the same time, “education and health care were seen as very poor quality. Syrians could see on the internet that they were living very differently than people in other countries.”

When the nonviolent protests began, Assad sent his army to stop them, calling the demonstrations a terrorist threat. As the uprisings spread, the army used deadly force. In one city, hundreds of protesters were killed in just three months. 

Soon, anti-Assad groups began to fight back. Other nations—including the United States, Turkey, and France—offered the rebels limited financial and military support. Meanwhile, Iran and Russia allied with Assad to keep him in power and spread their influence in the region.

Foreign involvement—mostly from Russia, Iran, and Turkey—increased the conflict’s toll by pumping weapons and money into Syria, some experts say. 

“This made the war much longer and bloodier than it would have been otherwise,” explains Joshua Landis of the Center for Middle East Studies at the University of Oklahoma. 

When the nonviolent protests began, Assad sent his army to stop them. He called the demonstrations a terrorist threat. As the uprisings spread, the army used deadly force. In one city, hundreds of protesters were killed in just three months.

Soon, anti-Assad groups began to fight back. Other nations offered the rebels limited financial and military support. Those nations included the United States, Turkey, and France. Meanwhile, Iran and Russia allied with Assad to keep him in power and spread their influence in the region.

Foreign involvement increased the conflict’s toll by pumping weapons and money into Syria, some experts say. That was mostly from Russia, Iran, and Turkey.

“This made the war much longer and bloodier than it would have been otherwise,” explains Joshua Landis. He is with the Center for Middle East Studies at the University of Oklahoma.

Syrian civilians, ultimately, are the ones paying the price, aid groups say. Assad’s regime has used chemical weapons more than 300 times during the war, according to a report last year by the Global Public Policy Institute. One such attack killed at least 1,400 people, more than a third of them children. 

Much of the bombing has been in heavily populated areas, with families caught in the cross fire. Assad’s military and its allies have repeatedly launched airstrikes on hospitals and schools in rebel-held cities to weaken the opposition, using the excuse that rebel fighters might be hiding in those places.

Ballour’s hospital was bombed multiple times from 2013 to 2018, during Assad’s siege on eastern Ghouta. The region was targeted because it was a rebel stronghold. As the hospital’s manager, Ballour eventually made the life-or-death decision to move her patients and staff underground to protect them. 

She and her team cared for premature babies in narrow tunnels and performed emergency surgeries in the basement kitchen. The hospital’s surgeon had no anesthesia (drugs that reduce or prevent pain). Instead, he would play classical music on his phone to distract patients while he operated on them. 

In this way, Ballour and the other doctors were able to help countless people, many of them children. But far too often, the doctors found themselves helpless. The five-year siege had cut off access to food, medicine, and other key supplies. When families brought in children who were slowly starving to death as a result, there was nothing the hospital staff could do to help. 

In quiet moments, Ballour would sneak away to cry. “How can I hold back tears while witnessing humanity being destroyed?” she later said. 

In spring 2018, as Assad’s forces prepared to move into the area, Ballour and her staff evacuated. They loaded their patients onto crowded buses and drove into the night. Ballour ended up in Turkey, along with millions of other Syrians.

Aid groups say that Syrian civilians are ultimately the ones paying the price. Assad’s regime has used chemical weapons more than 300 times during the war. That is according to a report last year by the Global Public Policy Institute. One such attack killed at least 1,400 people. More than a third of those killed were children.

Much of the bombing has been in heavily populated areas. Families have been caught in the cross fire. Assad’s military and its allies have repeatedly launched airstrikes on hospitals and schools in rebel-held cities. They have done that to weaken the opposition. They have used the excuse that rebel fighters might be hiding in those places.

Ballour’s hospital was bombed multiple times from 2013 to 2018. That was during Assad’s siege on eastern Ghouta. The region was targeted because it was a rebel stronghold. Ballour was the hospital’s manager. Eventually, she made the life-or-death decision to move her patients and staff underground to protect them.

Ballour and her team cared for premature babies in narrow tunnels. They performed emergency surgeries in the basement kitchen. The hospital’s surgeon had no anesthesia (drugs that reduce or prevent pain). Instead, he would play classical music on his phone to distract patients while he operated on them.

In this way, Ballour and the other doctors were able to help countless people, many of them children. But far too often, the doctors found themselves helpless. The five-year siege had cut off access to food, medicine, and other key supplies. Families brought in children who were slowly starving to death as a result. But there was nothing the hospital staff could do to help.

In quiet moments, Ballour would sneak away to cry. “How can I hold back tears while witnessing humanity being destroyed?” she later said.

In spring 2018, Assad’s forces prepared to move into the area. So Ballour and her staff evacuated. They loaded their patients onto crowded buses and drove into the night. Like millions of other Syrians, Ballour ended up in Turkey.

Since the start of the war, Turkey has taken in about 3.7 million Syrian refugees. Like Ballour, people fled there after violence and airstrikes destroyed their cities and towns. 

But Turkey is struggling with a weak economy. It closed its borders in 2015, severely limiting who could enter. So millions of displaced Syrian citizens ended up hunkering down in Idlib province in northwest Syria instead. The region had once been a declared “safe zone,” free of fighting. But as the last remaining rebel stronghold, it eventually became a target of Syrian and Russian airstrikes.

Since the start of the war, Turkey has taken in about 3.7 million Syrian refugees. Like Ballour, people fled there after violence and airstrikes destroyed their cities and towns.

But Turkey is struggling with a weak economy. It closed its borders in 2015. And it severely limited who could enter. So millions of displaced Syrian citizens ended up hunkering down in Idlib province in northwest Syria. The region had once been a declared “safe zone,” free of fighting. But as the last remaining rebel stronghold, it eventually became a target of Syrian and Russian airstrikes.

When those attacks on Idlib started, the families fled again—this time to Turkey’s border, hoping to somehow cross. Unable to do so, and with few supplies left, many are now living in tents or in bombed-out buildings with no windows or doors. Some have no choice but to sleep out in the open, with no protection from the frigid air. At least nine children there died from exposure to the cold this past winter, aid workers say.

“Many of these families have already been displaced four, five, or six times,” Heydemann says. “There is no safe zone in Syria anymore.” 

When those attacks on Idlib started, the families fled again. This time, they fled to Turkey’s border. They were hoping to somehow cross. Unable to do so, many are now living in tents or in bombed-out buildings with no windows or doors. They have few supplies left. Some have no choice but to sleep out in the open. They have no protection from the bitter-cold air. At least nine children there died from exposure to the cold this past winter, aid workers say.

“Many of these families have already been displaced four, five, or six times,” Heydemann says. “There is no safe zone in Syria anymore.”

Despite the odds against them, anti-Assad forces are still fighting for a rebel victory. In February, Turkey sent 20,000 troops into Idlib to counter attacks by Assad and Russia. Then, in March, after weeks of fierce fighting, the presidents of Turkey and Russia negotiated a cease-fire. Still, past cease-fire attempts have failed.  

Experts say it is only a matter of time before Assad seizes the region and wins the war. And when he does, Syrians will face even more severe oppression and economic hardship than before, Heydemann predicts.

“The Assad regime will reassert its control over the population and detain people it views as supporters of the opposition,” he says. 

But Ballour and many other Syrians refuse to give up hope that Assad will be stopped. The doctor’s work in eastern Ghouta was chronicled in a 2019 documentary, The Cave. She is using the film to raise global awareness about the plight of Syrian civilians. 

Still based in Turkey, Ballour regularly posts on Twitter, sharing pictures of the war and urging Americans and others to take action. She wants them to share Syrians’ story on social media and to urge world leaders to stop Assad from killing civilians. “The people of Idlib need us,” she posted recently. “Let’s not forget about them.”

Despite the odds against them, anti-Assad forces are still fighting for a rebel victory. In February, Turkey sent 20,000 troops into Idlib to oppose attacks by Assad and Russia. After weeks of fierce fighting, the presidents of Turkey and Russia agreed to a cease-fire in March. Still, past cease-fire attempts have failed.

Experts say it is only a matter of time before Assad seizes the region and wins the war. And when he does, Syrians will face even more severe oppression and economic hardship than before, Heydemann predicts.

“The Assad regime will reassert its control over the population and detain people it views as supporters of the opposition,” he says.

But Ballour and many other Syrians refuse to give up hope that Assad will be stopped. The doctor’s work in eastern Ghouta was chronicled in a 2019 documentary called The Cave. She is using the film to raise global awareness about the serious problems of Syrian civilians.

Still based in Turkey, Ballour regularly posts on Twitter. She shares pictures of the war. And she urges Americans and others to take action. She wants them to share Syrians’ story on social media and to urge world leaders to stop Assad from killing civilians. “The people of Idlib need us,” she posted recently. “Let’s not forget about them.”