ALEPPO, Syria – It had been a calm day in Aleppo's Shifa Hospital, said Dr. Osman al-Haj Osman, his face etched with exhaustion from just three hours of sleep. Then, a man burst in bearing the shrieking bundle of a 6-year-old girl who'd had a machine-gun bullet rip through both her knees.
Two months into the battle for Syria's largest city, civilians are still bearing the brunt of the daily assaults of helicopter gunships, roaring jets and troops fighting in the streets.
Shoving aside the orderlies and armed rebels milling around the cramped lobby Tuesday afternoon, the man deposited Fatima Qassem onto a gurney as a nurse swooped in and began cutting away the blood-soaked bandages on her knees.
A doctor reached in and pulled out an inch-long fragment of metal. There was a gush of blood. Large sections of bone and muscle were missing from the back of her knee.
She cried out plaintively for "Baba," because the man who brought her was not her father — just someone who had rushed her across town to the hospital. The family was hopefully on its way.
There was a piercing scream as the nurse picked her up again, jostling her awkwardly dangling legs and carrying her around a narrow corner into a small operating theater. Her cries subsided into a steady moan.
Her father, Abdu Qassem, came in 15 minutes later, his shirt covered with blood, probably from carrying his daughter out of the car, and frantically asked the orderly behind the desk how she was doing.
Qassem said they had been driving through a neighborhood when their car was raked by machine-gun fire from government troops.
In the operating room, Fatima's crying grew muffled as an anesthetic was administered and her mouth went slack. Osman cleaned the blood away from the wound and tried to find a way to repair the damage.
Just a few feet away from the commotion, on the next bed, a nurse calmly bandaged the hand of a stone-faced rebel who was oblivious to the stricken child nearby.
A tiny boy walked in and stared with curiosity at the blood and ruin of Fatima's legs before a nurse suddenly saw him and ushered him out. It was Osman's 4-year-old son, Omar.
When Osman started pulling all-day and all-night shifts during Syria's civil war, his wife and two children moved into the hospital so that he would actually get to see them.
"He plays between the wounded. It's a great upbringing," Osman joked in the few calm moments before another patient was carried in. He spoke in English — a language he said he learned from watching the Fox Movie Channel on satellite TV. Perhaps another joke.
The 30-year-old doctor estimated that 80 percent of the patients are civilians, wounded by falling buildings and exploding shells from the constant bombardment that government forces mete out to the parts of the city outside their control.
On Tuesday, the Britain-based Syrian Observatory for Human Rights reported shelling in several areas across Aleppo that killed more than a dozen and collapsed a three- story building in the nearby neighborhood of Haideriya.
Forces loyal to President Bashar Assad have been increasingly relying on the government's artillery and air power to fight the tenacious rebels who so far refuse to be dislodged from Aleppo.
The city is Syria's commercial hub, and its middle and upper classes were bastions of support for Assad. If the rebels took such a key city, it would give them a quasi-capital to complement the large swaths of territory they control in the north, up to the Turkish border.
Osman said the rebels he treats mostly have gunshot wounds from the ubiquitous snipers scattered over the many front lines.
The hospital itself has been hit directly twice by shells, demolishing two of the upper floors. Bombs fell nearby several times, spraying the entrance with shrapnel and debris.
The hospital has a staff of only five doctors and no surgeons, so difficult cases are often farmed out to other facilities, including a hospital in the town of al-Bab, about 40 kilometers (25 miles) to the northeast.
While there are enough drugs in the hospital so far to deal with the daily violence — which on Monday killed 25 and wounded dozens in shelling believed to be in retaliation for the rebel capture of an army barracks — the staff is overstretched.
"What day is it? I don't know. What time is it? I don't know," Osman said, adding that he goes to sleep at 4 a.m. and wakes up at 8 a.m. — unless he's roused earlier for an emergency.
"My life is just the wounded and the dead," he said.
Outside the hospital, in the surprisingly bustling neighborhood of Tareeq al-Bab, there is the sound of gunfire. A helicopter gunship is lazily circling the neighborhood and rebels on the roofs of the apartment buildings are futilely emptying the clips of their inadequate Kalashnikovs into the sky.
Abu Hassan, who was once a carpenter, sells vegetables on the street facing the hospital because there is no other work. He navigates the tortuous jigsaw of rebel- and government-controlled neighborhoods every day.
"When we are under bombardment, the water and electricity can be cut for days," he said, explaining that if he had the money, he would try to follow the hundreds of thousands of other Syrians who have fled for the border. Since the uprising against Assad began 18 months ago, activists estimate that at least 23,000 people have been killed.
The streets between the shattered apartment buildings are choked with garbage that can no longer be collected.
Although meat is scarce, residents of Aleppo are eating adequately, said Alaa Mursi, gesturing at the eggs, chickpeas, tomatoes and other produce being sold. Many, however, are surviving on handouts.
"People give us food to eat," he said. "There are rich people who distribute food for us."
Just a few blocks away is the neighborhood of Hanano, on the city's edge, where the rebels began their assault two months ago. The streets are largely deserted because most residents were recent immigrants who could flee to relatives in the comparative safety of the countryside.
A few men lounge in the shade of a scraggly tree in the otherwise grim vista of cheaply built concrete five-story buildings.
Overhead is the whirring noise of a jet's engines — a mundane sound in the West that can mean sudden, inexplicable and random death in Aleppo.
"We are afraid to stay in the houses, so we hang out on the street," said Abu Alaa, a jovial 30-year-old who hasn't worked in months. "We sent our families to the countryside and we stay here to look after the place, in case of thieves."
The sound of the jet suddenly builds to a crescendo and there is a muffled crump, mercifully in the distance. Another airstrike. The men gesture in the direction of the explosion and say that just this morning, a bomb fell a block away, killing a woman.
"We can't sleep here during the night or day," said Abu Abed, who looks much older than his 40 years. "In the morning, it's the jets. In the afternoon, it's the helicopters. And at night, it's the shelling."