Only one health facility remains operational in the Islamic State-held part of Raqqa, serving thousands of civilians trapped in the Syrian city with virtually no emergency services or rescue personnel as the intense US-backed campaign to liberate the city continues, Physicians for Human Rights said Friday.
The New York-based group described "nightmarish" conditions in the ever-shrinking area controlled by IS militants amid an incessant bombing campaign. The wounded civilians are left under the rubble because civilians fear being struck by further airstrikes.
The lone operating hospital is using salt water to sanitize wounds and treatment of traumatic injuries is limited to stopping the bleeding, the group said based on interviews it carried out with survivors, physicians and aid workers from the city.
The US-led campaign, which began in earnest in June, left only the national hospital functioning at reduced capacity, as others were either bombed or closed, the group said according to witnesses it interviewed.
One doctor who escaped in mid-August told PHR he operated out of his home because civilians feared going to the hospital in case it was shelled, or to avoid extortion by IS. Militants from the extremist group administer the hospital, which has been divided in two sections, one for civilians and another for the group's fighters. Amid the campaign, the last of the hospital's remaining services were forced underground, providing very basic medical care, PHR said.
In recent weeks, medical supplies dwindled and pharmacies were closed. The doctor finally left Raqqa after two of his colleagues were killed in airstrikes that struck their homes. As he fled, his daughter was killed in a land mine explosion.
"Raqqa is a deathtrap where civilians who have already suffered for years under (IS) rule now also suffer the deadly consequences of the fight against (IS)," said Racha Mouawieh, Syria researcher for PHR.
The U.N. has estimated that up to 25,000 civilians remain trapped in the city, unable to leave either because IS holds them to use as human shields, or because of land mines along the roads and the heavy bombing.
For those who survived escaping the city, the closest health facility is 50 miles away, in Tal Abyad, or 90 miles away in Kobane for a specialized trauma unit. A new private hospital opened in Tabqa, about 25 miles from Raqqa, last week, PHR said.
The group called on parties to the conflict to ensure civilian access to medical care and safe evacuation.
The US-led coalition has said it does everything "within its powers" to limit harm to civilians, but that casualties are inevitable in a street-by-street battle with the militants.
Since the campaign began in June, US-backed Syrian fighters have seized more than 60 per cent of the city, tightening the noose on hundreds of IS militants who are fighting to the death for the city, and trapping thousands of civilians with them. The U.N. and rights groups have expressed concern for civilian safety, with one official urging a "humanitarian pause."
Meanwhile, Russia's Ministry of Defense said Friday it has killed four IS leaders, including one it described as the group's war minister, in an airstrike outside the eastern Syria city of Deir el-Zour, south of Raqqa.
Russia has been providing air cover for Syrian President Bashar Assad's offensive on IS since 2015.
The defense ministry said its airstrike killed 40 militants, including four prominent warlords who gathered for a meeting of IS commanders in an underground bunker outside Deir el-Zour.
Heavy clashes are taking place between Syrian government forces and IS around Deir el-Zour as militants fight to reinstate a years-long siege of the city.
Assad's troops on Tuesday broke the nearly three-year militant blockade of parts of the city, marking a significant advance against the extremists.
The Russian military named Abu Muhammad al-Shimali and Gulmurod Khalimov as two of the four IS leaders killed in the airstrike. The other two were not named in the statement.
Al-Shimali reportedly headed the movement of foreign fighters into Syria and processed the group's new recruits.
Khalimov, a colonel who received US training while heading the riot police force in his native Tajikistan, has often been described as the IS' minister of war. The United States last year placed a $3 million bounty on his head.
The House voted overwhelmingly on Friday to send a $15.3 billion disaster aid package to President Donald Trump, overcoming conservative objections to linking the emergency legislation to a temporary increase in America's borrowing authority. The legislation also keeps the government funded into December.
The 316-90 vote would refill depleted emergency accounts as Florida braces for the impact of Hurricane Irma this weekend and Texas picks up the pieces after the devastation of the Harvey storm.
It's just the first installment of a federal aid package that could rival or exceed the $110 billion federal response after Hurricane Katrina, though future installments are likely to be more difficult to pass. It also kicks budget decisions into December and forces another politically difficult debt limit vote next year.
White House budget director Mick Mulvaney, a former tea party congressman from South Carolina who took a hard line against debt increases during his years in the House, and Treasury Secretary Steven Mnuchin pitched the measure to House Republicans at a closed-door meeting held just before the vote.
They were given a hard time from some Republicans upset with being forced to choose between voting for disaster aid and the debt limit increase.
Mnuchin elicited hisses when he told a closed-door meeting of House Republicans "vote for the debt ceiling for me," said Rep. Mark Walker, R-N.C.
Rep. Ryan Costello, R-Pa., described a surreal scene with Mnuchin, a former Democratic donor, and Office of Management and Budget Director Mulvaney, who opposed clean debt ceiling hike's as a congressman, pressing Republicans to rally around the disaster aid package.
"It's kind of like 'Where am I? What's going on here?'" Costello said, "if it wasn't so serious it kind of would have been funny."
Trump stunned Republicans by cutting a deal with Democratic leaders Sen. Chuck Schumer and Rep. Nancy Pelosi to increase the debt limit for three months, rather than the long-term approach preferred by the GOP leaders that would have gotten the issue fixed through next year's midterms.
Conservatives disliked both options. Voting on the debt limit is politically toxic for Republicans, and the deal will make the GOP vote twice ahead of next year's midterm elections.
Fiscal conservatives have clamored for deep cuts in spending in exchange for any increase in the government's borrowing authority. The storm relief measure had widespread support, but the linkage with the debt ceiling left many Republicans frustrated.
"It's like the Washington that Trump campaigned against," said Rep. Joe Barton, R-Texas.
"So, as much as I want to help Texas, I can't vote for something that just is a blank check on the debt."
But most in the GOP said they weren't upset with Trump himself.
Democratic votes are invariably needed to increase the debt limit - and avert a potential market-quaking default on government obligations - and Schumer and Pelosi successfully pressed to waive the debt limit through December 8.
As a practical measure, since the arcane debt-limit suspension replenishes Treasury's ability to tap other accounts to maintain cash flows, the actual date of a potential default wouldn't come before February or March. That's according to a back-of-the-envelope calculation by Shai Akabas, who tracks the issue for the Bipartisan Policy Center, a Washington think tank.
Late Wednesday, Senate Majority Leader Mitch McConnell, R-Ky., added $7.4 billion in rebuilding funding to Trump's $7.9 billion request to deal with the immediate emergency in Texas and parts of Louisiana.