By Amina Ismail

BEIRUT (Reuters) – In part of northern Syria’s last rebel enclave, doctors have pulled back into cave shelters to treat the wounded and protect their patients from a government offensive that has hit health centers and hospitals.

The assault began in late April with air strikes, barrel bombs and shelling against the southern flank of the enclave, centered on Idlib province and nominally under the protection of a Russian-Turkish ceasefire agreed more than eight months ago. Limited ground advances have additionally taken place this week.

“The makeshift hospitals are very primitive,” Osama al-Shami, a 36-year-old doctor, told Reuters from the area. “We can barely save lives with the equipment we have and many of the injured die because of the lack of resources and equipment.”

The insurgents, dominated by the jihadist Tahrir al-Sham, describe the offensive as an invasion while the government accuses the rebels of violating the deal.

President Bashar al-Assad has sworn to take back every inch of Syria and the enclave including Idlib is the last big bastion of the rebellion that flared against him 2011.

The United Nations said last year that half of the region’s 3 million inhabitants had fled their homes, and the bombing has now caused a new wave of displacement.

More than 150,000 had left since April 29, The U.N. said on Tuesday, with bombs falling on over 50 villages, destroying at least 10 schools and hitting at least 12 health centers.

Under the bombs, medics are turning back to tactics used at other times in the eight-year war, moving patients into shelters under buildings or hacked into the ground. Some are opening up their houses as temporary health centers, said one surgeon.

But they are getting overwhelmed and Shami said several wounded children had died in his arms.

“One of them was a nine-year-old child who had a head and a chest injury and was severely bleeding. We tried to resuscitate him but he died within 15 minutes. There are no blood banks nearby or an equipped operating theater,” he said.

FRENCH, BRITISH CONCERNS

A war monitor, the Syrian Observatory for Human Rights, said that, in the latest escalation of fighting and bombardments, 188 people including 85 civilians had been killed since April 30.

France’s President Emmanuel Macron said on Tuesday he had “grave concerns” over the escalation of violence in Syria including the strikes on hospitals.

British Foreign Secretary Jeremy Hunt called the offensive a “flagrant violation of the ceasefire agreement”.

Backed by Russian air power and Iran-backed militias, Assad has retaken most of Syria.

U.S.-backed Kurdish forces hold the country’s northeast quarter, while control of the northwest is divided between jihadist groups and rebel factions supported by Turkey.

The current government offensive is focused on the southern flank of the rebel enclave.

On Wednesday, the Syrian army advanced into the town of Kafr Nabouda, rebels and a military media unit run by Assad’s ally Hezbollah reported.

The Observatory said fighters of Tahrir al-Sham – an incarnation of the former al-Qaeda affiliate the Nusra Front – launched a suicide attack against the army, detonating a bomb in an armored vehicle.

Rebels said heavy fighting continued at the town – close to where Shami is running his makeshift clinic – while the Hezbollah media unit said the army had gained complete control of it.

(Reporting By Amina Ismail, writing by Angus McDowall; editing by John Stonestreet)