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 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.
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 opposition to the regime and the need to give medical care to civilians and rebels.
The seven-story hospital is only 400-500 yards from the front line in a heavily shelled neighborhood. Nearly three months into the rebel offensive in Aleppo, it has taken at least six direct hits.
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 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.
Osman, 30, spoke of the snap life-or-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.
"In the early days, we used to cry when we had a child with a severe injury, then recharge our psychological energy before we return to work. Now, there is just no time for that."
Overflow of patients
When AP journalists first arrived, there were only a handful of patients being treated. A man approached Dr. Abu Rayan, complaining of pain from shrapnel lodged in his right leg.
"Forget it; it will never come out," the 35-year-old doctor told him.
Nearby, Zakariya Khojah lay on a gurney, a tube draining a wound in his side. He had a lifeless stare fixed on the ceiling. Standing at his side was his son Bashar.
"Papa, is there anything hurting you beside your chest?" the boy, 13, asked. The father replied with a slow shake of his head.
"I was walking just ahead of him when a bomb fell close to us," Bashar said. "He's all I got. My mother died three years ago."
Around 3:10 p.m., artillery blasts were heard nearby. In minutes, the small, three-bed intensive care unit was filled, and the overflow of patients had to be treated on the floor of the lobby.
Word quickly spread that the wounded, about 15 in all, had been standing in a bread line when a shell fell nearby.
A fighter carrying an RPG launcher on his shoulder walked over the wounded on the floor as he made his way to the narrow staircase leading to the X-ray room in the basement. A woman wearing the Muslim hijab and a blood-soaked black coat was on a gurney waiting for help. A man on the floor had a hole in his back the size of a tennis ball.
"May God curse Bashar Assad until he goes to his grave!" yelled a robed man.
A series of blasts shortly after 4 p.m. brought a fresh wave of wounded, many of them children.
"Uncle, please take me to my mum at home," said one of them, a 9-year-old named Fatimah, pleading to a journalist.
Fatimah had shrapnel wounds to her arms and lower torso, and was in shock. She had been shopping with three aunts and several cousins when a shell fell nearby. One aunt died in the hospital.
"It's OK, sweetie. Just ask God to exact revenge on Bashar," a fighter told the girl.
Undeterred by all the gore, Osman's two children, Omar and Rushd, wandered around the lobby the same way others their age would walk in a park.
"Don't worry about them. They've become used to this," he said. "As a family, we made a decision to live together. There is no such thing as a safe place. So, we live here and we die here. At least we will die while providing a service to our cause."
Around 9 p.m., guerrilla commander Sheikh Hussein and a band of armed fighters stormed into the hospital carrying a wounded man named Ali Al-Sheikh, who died minutes later. "Ali has been martyred, you guys," Hussein said, fighting back tears. His men began weeping.
Thursday morning was ushered in with an airstrike and intense shelling that sounded much closer than the previous day's attack.
There were more injured: a sniper victim who prayed loudly until he died from his chest wound; a child no more than 10 who stared at his severed left foot lying in front of him; a man who begged for help and was told firmly by a medic: "Act as a believer and wait for your turn."
The power went off, and a generator kicked in as the shelling grew louder.
"I don't know whether we will ever be able to lead normal lives again," Osman said. "Will we have dreams and ambitions like regular people, or have we been scarred forever?"