The two largest hospitals in besieged eastern Aleppo have been put out of service in airstrikes overnight and on Wednesday morning, the latest in a devastating week-long bombing campaign that has claimed hundreds of lives.
The M2 and M10 hospitals, codenames used by local doctors to obscure the locations of the facilities, were hit at about 4am and then again at around 10am in what one health official described as a bombing campaign that was "catastrophic and unprecedented in modern history".
"If the hospital falls on top of us come pull us out from under the rubble but do not take pictures," said Bara'a, a nurse at the M2, in a message from the shelter to an online discussion group of journalists and doctors in besieged eastern Aleppo.
"Please don't take pictures, we won't gain anything from it and our dignity is too precious."
On Wednesday morning, doctors at the M2 hospital said they had sought shelter from shelling in the hospital's basement, and emerged to treat the wounded in the hospital once the bombing had ceased.
There are only 30 doctors remaining in eastern Aleppo. They have decried what they describe as a systematic campaign of destruction against doctors and medical facilities.
"It is extermination of a major city by starving and killing its 85,000 children using all modern and middle age weaponries," said Zaher Sahloul, a senior adviser for the Syrian American Medical Society (SAMS), which supports both hospitals that were bombed overnight.
Local health authorities said 18 people were killed on Tuesday and 88 wounded in another day of bombardment, though the numbers were an underestimate because they did not include those still under the rubble and others who were buried without being taken to local hospitals.
In a week of what residents have described as the worst airstrike campaign since the start of the civil war in Syria, forces loyal to the regime of Bashar al-Assad have begun the early stages of a ground offensive aimed at reclaiming eastern Aleppo, which has been under opposition control since 2012.
A brief ceasefire negotiated by Washington and Moscow collapsed last week in mutual recrimination. Since then, more advanced weaponry, such as bunker buster bombs, have been dropped on the embattled east of the city, which has been under siege for three months.
A victory in Aleppo would be a major boon for Assad, allowing him to lay claim to most of Syria's heavily populated urban centres, while relegating the rebellion into a rural insurgency.