EASTERN GHOUTA, Syria — Dr. Hamza, who declined to provide his last name for safety reasons, is exhausted. He has been sleeping for four or five hours a day over the past 10 weeks. Speaking to Al-Monitor, he said, “The medical supplies from the last United Nations convoy on March 5 were very limited. They got stuck in Douma because the road has been cut off from the rest of Ghouta.” Thirteen dialysis patients are being treated at the medical center where he works and where only 50 kits remain for hemodialysis. There are major shortages in surgical supplies and anesthesia. According to Dr. Basel Termanini, the vice president of the Syrian American Medical Society (SAMS), the health service capacity in Ghouta today is, at best, at 40%.

SAMS and other activists reported chlorine gas attacks on the besieged population of eastern Ghouta. US Defense Secretary James Mattis said March 11, “It would be very unwise for them [Syrian government forces] to use weaponized gas,” while specifically mentioning that “there’s an awful lot of reports about chlorine gas use or of symptoms that could be resulting from it.” On the face of it, the statement might be interpreted as a warning against the use of chlorine and possibly triggering a US military response. Yet practically, an intervention is highly unlikely, unless chemical weapons were to be used by the Syrian regime.

The Syrian regime, under the impetus of Russia, has been very careful not to violate the 2013 deal that specifically addressed the use of nerve gas agents — VX, sarin and mustard — as red lines that the United States and Europe would not tolerate. For this reason, according to some experts, low concentration doses of chlorine have been used in eastern Ghouta to avoid being qualified as weapons of mass destruction (WMD). Eastern Ghouta has been bombed with internationally prohibited munitions such as napalm, cluster bombs and barrel bombs, but these are not WMDs (nuclear, chemical and biological). Doctors on the ground are documenting that they are treating severe burns caused by napalm and other prohibited munitions.

The international community has been incapable of halting the humanitarian catastrophe in eastern Ghouta, and with the situation on the ground worsening rapidly, it has become increasingly difficult to interview civilians there. Some of the doctors Al-Monitor interviewed just a week ago are now unreachable, and direct contact with sources is becoming more limited. The work of activists and medical organizations outside Ghouta, such as SAMS, is proving to have a significant role in documenting what is happening on the ground and communicating it to the media.