Inside the emergency room of a hospital of the Syrian capital, an elderly woman with Covid-19 waited for a bed at an intensive care unit packed with coronavirus patients.
Sitting on a wheelchair barely an arms-length from another patient, the woman in her seventies tilted her head back as a doctor wedged between them covered her face with an oxygen mask.
"We receive many cases who need a ventilator, and there are many patients who need intensive care," said the doctor, Asma Sbayni of Mouwasat Hospital, one of the largest in Damascus.
"Unfortunately, there are many critical cases who die in front of us... We can't do anything for them" the 26-year-old told AFP, only her eyes visible beneath a veil and two masks.
In mid-March, a health ministry official said intensive care units (ICUs) dedicated to coronavirus patients had reached full capacity across the capital for the first time since coronavirus swept into Syria.
The latest virus surge which many are referring to as a "third wave" has overwhelmed hospitals to the extent that Covid-19 patients are being transferred outside the city for treatment, according to the health ministry.
Authorities have responded by urging compliance with safety measures but stopped short of imposing a strict lockdown, which could aggravate Syria's economic crisis.
Jotting down vitals on a small note pad, Sbayni said she had already attended to at least 10 Covid-19 patients that day with more expected to follow.
"Sometimes we get more than 40 Covid-19 cases per day and this is more than we can handle," she said, an oximeter tied around her neck.
- 'Virus peak' -
The government has recorded 19,000 Covid-19 cases, including more than 1,200 deaths, in the two thirds of war-battered Syria under its control.
But the real number is likely higher especially due to limited testing capacity and the prevalence of asymptomatic cases, according to the United Nations humanitarian coordination office, OCHA.
Sitting inside his office at Mouwasat hospital, director Issam al-Amin said official figures are based only on PCR test results filed by hospitals and travellers.
"Syria is besieged and at war, it does not have a large amount of testing kits," he told AFP, clad in a white lab coat.
The doctor said "only the most serious cases" are admitted to hospital, with "dozens" treated at home under the supervision of medical professionals.
"We have not yet reached a virus peak," he said.
But "we are receiving more cases than yesterday, and yesterday we received more cases than the day before."
More than 650 health workers have themselves contracted the virus, including 29 who have died, the World Health Organization and OCHA said in a joint statement last month.
This has further compromised the "overstretched capacity" of Syria's "fragile healthcare system", it warned.
The government said it started vaccinating frontline health workers at the end of February after receiving doses from an unidentified "friendly country".
It said 2,500 frontline workers would be covered, but Syria, under war-related sanctions, is still waiting to launch a general vaccination campaign.
- Vaccine delays -
Syria has signed on to the Covax initiative to procure enough jabs to cover 20 percent of the population by the end of the year.
But a first shipment of the AstraZeneca vaccine which was due in April has been delayed, "at least till May", WHO Syria representative Akjemal Magtymova told AFP.
"It's a very regrettable situation... I am worried," she added.
In a separate statement last week, WHO said the production of AstraZeneca vaccines was "insufficient to meet the global demand, resulting in delays" to Syria.
At the Mouwasat hospital, Doctor Ali Rostom rejoiced at the recovery of one Covid-19 patient.
He then instructed a nursing crew to sterilise the patient's bed so someone else could have a fighting "chance for survival".
"The virus is spreading at a very fast rate and the number of new cases has grown explosively," said the doctor.
After wrapping up a meeting with colleagues, Doctor Bassam Quaider said the facility's intensive care unit was "never unoccupied".
"There are always people putting their names down on waiting lists," he added, as an ambulance siren announced the arrival of another patient.