A shortage of well-supplied hospitals has resulted in countless deaths that might have been prevented had the mortally wounded been able to seek medical treatment — a shortage of doctors, many of whom have either been killed or fled Aleppo since the fighting erupted, has made the situation even more dire.
"We are 15 of the last doctors serving the remaining 300,000 citizens of eastern Aleppo," a group of doctors claiming to be among the last in the city wrote in a letter to US president Barack Obama on Thursday.
See the shocking conditions and destruction in the city:
Inside destruction and fighting in Aleppo, Syria
Inside destruction and fighting in Aleppo, Syria
A young Syrian boy cries as he sits on the rubble after a missile fired by Syrian government forces hit a residential area in the Maghayir district in the old quarter of the northern Syrian city of Aleppo on July 21, 2015. According to the Syrian Observatory of Human Rights more than 35 homes were destroyed in the attack killing at least 18 civilians, adding that the death toll was likely to rise. AFP PHOTO / KARAM AL-MASRI (Photo credit should read KARAM AL-MASRI/AFP/Getty Images)
Syrians carry a body on a stretcher over the rubble after a missile fired by Syrian government forces hit a residential area in the Maghayir district in the old quarter of the northern Syrian city of Aleppo on July 21, 2015. According to the Syrian Observatory of Human Rights more than 35 homes were destroyed in the attack killing at least 18 civilians, adding that the death toll was likely to rise. AFP PHOTO / KARAM AL-MASRI (Photo credit should read KARAM AL-MASRI/AFP/Getty Images)
People walk past a damaged building in the al-Kalasa neighbourhood of the northern Syrian city of Aleppo on July 19, 2015. AFP PHOTO / AMC / KHALED KHATEB (Photo credit should read KHALED KHATEB/AFP/Getty Images)
Syrians stand on the rubble of a destroyed building following a reportedly barrel bomb attack by Syrian government forces in an rebel-held area in the northern Syrian city of Aleppo on July 8, 2015. More than 230,000 people have been killed in Syria since the country's conflict began in March 2011 . AFP PHOTO / AMC / ZEIN AL-RIFAI (Photo credit should read ZEIN AL-RIFAI/AFP/Getty Images)
A Syrian man carries the body of a child wrapped in a cloth after its been removed from under the rubble of destroyed buildings following reported airstrikes by government forces on the rebel-controlled part of Aleppo's Maadi residential district, on June 21, 2015. AFP PHOTO / KARAM AL-MASRI (Photo credit should read KARAM AL-MASRI/AFP/Getty Images)
A member of the Syrian Red Crescent rests at the Garage al-Hajz crossing in the rebel-held neighbourhood of Bustan al-Qasr district in the northern Syrian city of Aleppo ahead of a reported exchange operation between the Syrian regime and rebel group fighters on June 11, 2015. Arabic writting on the wall reads' Free Masons are those who stand behind Bashar [al-Assad]'.AFP PHOTO / KARAM AL-MASRI (Photo credit should read KARAM AL-MASRI/AFP/Getty Images)
In this photo released by the Syrian official news agency SANA, Syrians gather in a street that was hit by shelling, in the predominantly Christian and Armenian neighborhood of Suleimaniyeh, Aleppo, Syria, Saturday, April 11, 2015. Syrian state television and an activist group say opposition fighters have shelled the government-held neighborhood in the northern city of Aleppo, killing several people and wounding dozens. (AP Photo/SANA)
Smoke rises from buildings in the area of Tal Sharba following government air strikes on the outskirts of the northern Syrian city of Aleppo on December 27, 2015, as government forces seized the area from Islamic State (IS) group jihadists. AFP PHOTO / GEORGE OURFALIAN / AFP / GEORGE OURFALIAN (Photo credit should read GEORGE OURFALIAN/AFP/Getty Images)
ALEPPO, SYRIA - DECEMBER 25: A man runs away as flames rise after the war crafts belonging to the Russian army carried out airstrikes on two hospital in the Azaz town of Aleppo, Syria on December 25, 2015. (Photo by IHH/Anadolu Agency/Getty Images)
ALEPPO, SYRIA - OCTOBER 13 : Wreckage of buildings are seen after Russian war crafts hit the Syrian opposition controlled town Hayan in Aleppo, Syria on October 13, 2015. (Photo by Ahmed Hasan Ubeyd/Anadolu Agency/Getty Images)
ALEPPO, SYRIA - OCTOBER 13: A view of the attack site after Russian war crafts hit the Syrian opposition controlled town Daret Ezza in Aleppo, Syria on October 13, 2015. (Photo by Mamun Abu Omer/Anadolu Agency/Getty Images)
ALEPPO, SYRIA - MAY 14 : Smoke rises after US-led coalition forces hit Daesh targets in northern Aleppo, Syria on May 14, 2015. (Photo by Huseyin Nasir/Anadolu Agency/Getty Images)
ALEPPO, SYRIA - MAY 12: Members of al-Shamiyya Front fire artillery as they attack the western side of Sehba Dam which is under control of Daesh in northern Aleppo, Syria on May 12, 2015. (Photo by Huseyin Nasir/Anadolu Agency/Getty Images)
ALEPPO, SYRIA - MAY 12: Members of al-Shamiyya Front are seen before they attack the western side of Sehba Dam which is under control of Daesh in northern Aleppo, Syria on May 12, 2015. (Photo by Salih Mahmud Leyla/Anadolu Agency/Getty Images)
ALEPPO, SYRIA - AUGUST 09: Smoke rises after Russian forces airstrike over opposition controlled cement plant located in southeast of Aleppo, Syria on August 09, 2016. (Photo by Beha El Halebi/Anadolu Agency/Getty Images)
ALEPPO, SYRIA - AUGUST 08: Members of the Syrian oppositions launch rocket attack to military headquarters at Assad Regime controlled Hamdaniya district of Aleppo, Syria on August 8, 2016. (Photo by Beha El Halebi/Anadolu Agency/Getty Images)
ALEPPO, SYRIA - JULY 26 : Syrians inspect the damage after Asad Regime forces' attack on opposition controlled Meshed region in Aleppo, Syria on July 26, 2016. (Photo by Mustafa Sultan/Anadolu Agency/Getty Images)
ALEPPO, SYRIA - JULY 17: Smoke rises after an ammunition depot belongs to Assad Regime forces, exploded due to an unknown reason at Sufayra district of Aleppo, Syria on July 17, 2016.
(Photo by Muhammed Kurab/Anadolu Agency/Getty Images)
People walk past a damaged barbershop in a government-controlled district of the northern Syrian city of Aleppo on May 21, 2016.
In Syrias second city Aleppo, war-weary residents have replaced their fragile glass windows with nylon plastic.
Because of the clashes, shelling and the sharp increase in the price of glass, residents across divided Aleppo no longer use glass.
A square meter of glass costs 3,300 Syrian pounds now -- compared to 425 before the war began. But a meter of nylon plastic costs a maximum of 500 Syrian pounds. / AFP / GEORGE OURFALIAN / TO GO WITH AFP STORY BY KARAM AL-MASRI AND AHMAD ABOUZEID (Photo credit should read GEORGE OURFALIAN/AFP/Getty Images)
Orphans children in a shelter in the city of Aleppo. Syria. (Photo by Eduardo Martins/NurPhoto via Getty Images)
ALEPPO, SYRIA - APRIL 5 : Wreckage of a Syrian Regime Forces' warplane is seen after it has been shot down by the opposition forces in Aleppo's Ays district, Syria on April 5, 2016. (Photo by Firas Faham/Anadolu Agency/Getty Images)
ALEPPO, SYRIA - APRIL 3: Smoke rises as the war-crafts belonging to the US-led coalition forces carry out airstrikes on Daesh terrorist organization's positions near the Tat village in Aleppo, Syria after Syrian opponents took control of three villages on April 3, 2016.
(Photo by Huseyin Nasr/Anadolu Agency/Getty Images)
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"Whether we live or die seems to be dependent on the ebbs and flows of the battlefield," they added. "Despite the horror, we choose to be here. We took a pledge to help those in need."
Allegations of war crimes by pro-government forces have been flying around for over a year, but the situation on the ground precludes a thorough investigation of human rights violations. The situation has rapidly deteriorated over the past month, as a government-imposed siege prevented food and medical supplies from entering the rebel-held east.
"We do not need tears or sympathy or even prayers," the letter read. "We need action."
The nearly monthlong government siege of Syria's largest city is now on the verge of collapse, after a week of heavy fighting in northern and eastern Aleppo led to the defeat of pro-regime forces by a coalition of Syrian opposition groups.
Fights are still erupting sporadically across the city, he said, and airstrikes continue to puncture any aura of calm.
Both the regime of Syrian president Bashar Assad — and its close ally, Russia — have offered to impose a temporary ceasefire on the city long enough to evacuate civilians. But the doctors, in their letter, characterized the proposals as "thinly-veiled threats" to essentially "flee now or face annihilation."
The note contains horrific details about doctors with limited resources who must regularly decide who is worth saving, based on the extent of their injuries.
Its harshest rebukes, however, are pointed towards the Obama administration's perceived inaction in attempting to end the violence.
"We have seen no effort on behalf of the United States to lift the siege or even use its influence to push the parties to protect civilians," the letter read.
"The burden of responsibility for the crimes of the Syrian government and its Russian ally must...be shared by those, including the United States, who allow them to continue."
The White House told CNN that they had seen the letter, and condemned the "indiscriminate bombing of medical facilities by the Assad regime in Aleppo and elsewhere in Syria." The statement made no mention of Russia, whom they hope to pressure, along with the UN, into allowing humanitarian aid to flow into Aleppo.
"These attacks are appalling and must cease," the White House official said. "We commend the bravery of medical professionals across Syria who are working every day in perilous circumstances with minimal supplies to save lives."