Manu Brabo, Associated Press
ALEPPO, Syria — The injured arrive at the hospital in taxis or in the back of pickup trucks, to the blare of car horns and shouts of "Help!"
Sometimes, they are battle-hardened rebels with gaping wounds. Sometimes, they are children, peppered with shrapnel and screaming in pain.
Those who die are left on the sidewalk outside, to be claimed hours later by relatives.
An Associated Press team spent 24 hours at Dar al-Shifa hospital in Aleppo and witnessed the frantic work by overtaxed doctors and nurses to save those wounded in the battle for control of Syria's largest city.
The AP first visited the hospital last month and returned this week to get a fuller impression of how its staff is coping amid Syria's civil war. The routine is as simple as it is brutal: A barrage of shelling echoes over the city, and about 15 minutes later, the wounded flow in.
The medics work amid the wails of traumatized children, badly wounded men shouting Islam's declaration of faith in their final minutes, and rebel fighters holding RPGs mourning dead comrades, with tears streaming down their gunpowder-blackened cheeks.
Blood is everywhere. Orderlies mop it up as more wounded arrive. Amid the din of groans and cries for help, a worker spots a severed limb on the floor and tries to break the tension with some black humor.
"Anyone missing a foot?" he asks.
Once a private clinic owned by a businessman loyal to President Bashar Assad, Dar al-Shifa hospital has been taken over by volunteer doctors, nurses and aides united by their opposition to the regime and the need to give medical care to civilians and rebels.
Nearly three months into the rebels' offensive in Aleppo, the seven-story hospital stands only 400-500 meters (yards) from the front line in a neighborhood that is heavily shelled. It has so far taken at least six direct hits, mostly affecting the upper stories; its staff uses the bottom three floors.
Most of the surrounding apartment blocks are badly damaged and deserted, with the only evidence of life being the fluttering of clothes on laundry lines or an occasional resident stepping onto a balcony to get a better cellphone signal.
Dar al-Shifa has only seven doctors, two of whom are trained for emergency duties, and two nurses. The atmosphere is a bizarre and somewhat unnerving mixture of urgency, nonchalance, resolve and anger.
The staff smokes freely in the corridors, watching TV during breaks in treating the waves of wounded. Dr. Osman al-Haj Osman even has moved his wife and two small children into the facility in order to be close to them.
Hospital officials say they see about 100-120 cases a day, of which 10 or 15 are children. Eighty percent of the cases are of civilians; the rest are mostly rebel fighters. In the 24-hour period that the AP was there on Wednesday and Thursday, the hospital's records showed nine dead and 107 wounded.
Because the hospital has no morgue, the dead are left on the sidewalk outside, where it is cooler. If the bodies are not identified and claimed within 12 hours, they are photographed and then buried. Residents who come to the hospital looking for missing relatives are shown the photos and — if they recognize a loved one — are given the choice of exhuming the remains for reburial elsewhere.
Osman, 30, spoke of the snap life-and-death decisions that he and others have to make when the hospital is flooded by casualties two or three times a day.
"I have to make a choice between a child with a 10 percent chance of survival and one with a 25 percent chance," he said.
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