Syrian families are still desperately digging in earthquake rubble - not for survivors anymore, but any last possessions finally lost after 12 years of war.
Wednesday this week marks another grim milestone in the civil war-torn country, as it enters the 13th year since President Bashar al-Assad launched a crackdown against pro-democracy protesters now thought to have seen upwards of 500,000 people killed and as many as 16.5million forced from their homes.
Millions of children have grown up not knowing any different, while few families have escaped losing not only shelter but also loved ones in a bombardment of shelling, village invasions and panicked escapes into neighbouring countries and beyond.
The country was also suffering the impact of a nationwide cholera epidemic even before the 7.8-magnitude earthquake which hit Turkey and Syria on February 6, so far killing more than 50,000 people - including at least 6,000 in already-war-ravaged Syria.
Aid workers on the ground have now told Metro how today’s latest anniversary throws into even starker relief the suffering upon suffering endured by those who have not managed to make it out of the country, such as to struggling-neighbours such as Turkey, Lebanon and Jordan.
Chiran Livera, head of the Syria earthquake response for the International Federation of Red Cross and Red Crescent Societies (IFRC) described the harrowing sight of families dutifully trudging among the remains of what homes they did still have until last month.
He told Metro: ‘People still require emergency items - food, medicine, water, shelter.
"Just try to put yourselves in the shoes of someone who’s lost their home, possibly family members too - who’s had to flee to another part of the country - and then this happens, and you’ve lost any chance of a livelihood yet again.
"People are showing such resilience but this population is extremely vulnerable.
"You still see families clearing the rubble from the streets, hoping to find any pieces of their lost belongings - and also sentimental items like photos, toys, what few things they’ve kept hold amid everything which can’t be replaced.
"One of the biggest things is, people are tired. This has been 12 years now - they’re thankful for any help, but what about next month? And all those after that?"
People left homeless in urban areas tend to have been sleeping in schools and mosques, he said, while those in rural regions have had to depend on other families putting them up - but even aid workers given rare access to humanitarian corridors are struggling.
He said: "There’s a fuel shortage - there’s simply not enough to purchase, so we have to buy from Jordan and other countries and make tough decisions which deliveries to prioritise.
"There need to be political solutions as well as humanitarian assistance - resources and advocacy, so people have any hope of rebuilding their lives."
Fear and suspicion can now seem hardwired within even some of Syria’s youngest, beaten down by all-surrounding destruction, threats and attacks, and ever-present military watches.
The threat came not from an AK47-toting militant nor patrolling soldier but a knee-high four-year-old boy.
The enduring effects on women and children appear especially bleak, according to the charity ActionAid - warning about heightened danger of severe trauma, renewed threats of sexual and gender-based violence, and child marriage.
The number of female-headed households has leapt by 80 per cent since March 15 2011, while food prices have soared by 40 per cent in the last month.
And reported suicide cases more than tripled last year - with girls under 18 making up the largest group, 40 per cent, recorded as killing themselves between early 2021 and the start of last year.
Mother-of-three Noor, forced from one home by the civil war and then from another by last month’s quake, said: "I lost my husband about three years ago when I was pregnant with my young son.
"It is a difficult challenge for a woman to be alone, without a breadwinner, without a family, without anyone beside her - it’s really hard.
"Life is hard especially in these conditions - war and earthquakes and people taking advantage of this. Everything became difficult."
Racha Nasreddine, Lebanon-based regional director of ActionAid’s Arab region, said: "The current disaster is only exacerbating the risks and vulnerabilities women and girls are facing.
"We know that this crisis will fall the hardest on women like Noor who are running out of coping mechanisms to deal with the trauma of repeat and renewed crises."
Vital infrastructure already shattered by the civil war and territorial disputes between the Assad region and rebel militia-held areas have also hampered attempts to help, over the past months as well as since March 2011.
Just on Monday this week, a United Nations-backed commission ruled the international community and the Syrian government did not act quickly enough last month to help people in need in the rebel-held north-west of the country.
The Independent International Commission of Inquiry on Syria said there should be an investigation into why it took a week to open border crossings for aid to flow - and demanded a ‘comprehensive ceasefire that is fully respected’ to allow civilians, plus aid workers, to be kept safe.
A week lapsed before the UN and Mr Assad’s government agree on opening two more border crossings into the rebel-held region bordering Turkey, even as people remained trapped beneath rubble.
The Syrian president eventually signalled two new crossing points from Turkey could open for three months.
For so long beforehand, the UN was only been permitted to deliver aid to the north-west Idlib area through a single crossing at Bab Al-Hawa - said to be on the demands of Assad ally Vladimir Putin’s Russia.
UN spokesperson Stephane Dujarric said their legal position came under the mandate of the UN Security Council, adding: "The UN did everything in its power as quickly as possible to help all of the people in Syria."
Meanwhile, even those who have managed to escape to safety say they feel “survivor’s guilt” as the torment back home not only endures for others but comes with so many gruelling fresh setbacks.
Hanan Al-Wandi, who now works for the British Red Cross, said: “The recent earthquake reignited the trauma for those who have suffered in the conflict in Syria for the past 12 years.
“Before the earthquake, people were rebuilding their lives. We had so much hope for Aleppo in particular - there was so much work being done to rebuild it to what it used to be.
“I think this is the first time in a long time people feel shaken up again - it adds an additional layer of trauma to what we are already going through.
“My survivor’s guilt has increased tenfold - I think this is something that a lot of people are experiencing right now.
“I feel guilty that I’m here and that they are there. Why do I get to be in a great building and do this great job and have a home and not have to worry about food.
“I know this is something a lot of Syrians who now live so far away from home are feeling.”
Pro-Assad forces have not only arrested, tortured, executed or ‘disappeared’ supposed rebels in their thousands but also launched incessant rocket and chemical attacks on villages, cities and towns across the country.
Meanwhile sieges have denied food, medicines and other aid to towns and cities including Darayya, Moadamiya and Homs, the western and third largest city now reduced to little more than rubble-strewn ruins.
Then-international development secretary Justine Greening told Metro on the conflict’s five-year mark in 2016 that Britain was leading the way in Syria relief, as an international summit was hosted in London.
But under Boris Johnson the Department for International Development was folded into the Foreign Office and the UK’s commitment to spending 0.7 per cent of GDP on foreign aid was cut to 0.5 per cent.
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