Exhausted and overstretched, Syrian rescue worker Abu Mohammad Omar could barely catch his breath between back-to-back searches for survivors in his bombed-out hometown near Damascus.
The uptick in bombardment over the past three days on the rebel-held enclave of Eastern Ghouta has left already-overburdened medical staff and emergency workers struggling to rescue and treat affected residents.
"We can't keep up. We're trying as much as we can," Omar told AFP.
"We're rushing, doing the work that we're doing, but we can't get to everything."
On Wednesday, more than two dozen civilians were killed in Syrian government bombardment on Eastern Ghouta, where some 400,000 people live under government siege.
It followed one of Eastern Ghouta's bloodiest days yet, with 80 civilians killed and more than 200 wounded on Tuesday. At least 38 were killed on Wednesday and 31 on Monday.
With few bulldozers and precious little fuel to operate them, rescue workers are struggling to reach trapped civilians in time, said Omar.
The 23-year-old's voice cracked as he described trying to find survivors in the rubble of a five-storey building in the town of Douma on Tuesday.
"There was a huge, huge escalation against the city. More than one place was reduced to rubble. The machines we had couldn't keep up," he said.
They searched one collapsed building for 10 hours for any survivors, but eventually had to move on to another bomb site.
- 'Every minute counts' -
"If we had more machines or equipment, we could have saved a life. Every minute counts," Omar said.
At 1:00 am on Wednesday morning, after scouring the rubble for a single suspected survivor, a salvo of bullets and rockets forced them to abandon the search.
"Bombardment was still going on this morning. But despite everything, this guy under the rubble -- we won't leave him," he added.
"We'll bring him back to his family, even if he's dead."
Eastern Ghouta has been under siege since 2013, making food and medical supplies difficult to access and directly affecting the resources available for rescue workers.
Abu Samer, an ambulance driver in the town of Hammuriyeh, said he sometimes jumps into his vehicle to find the petrol tank empty.
"The difficulty for us is the lack of fuel. If there was fuel, I could go to any bomb site," the 40-year-old told AFP.
The city streets on Wednesday were a hellish scene, Abu Samer said: no signs of life, but piled high with rubble and human remains.
Doctors are also struggling at Eastern Ghouta's stretched hospitals.
"Every day, they bring us a lot of wounded people. Sometimes we can keep up, other times we can't," said Osama, a paramedic at the Damascus Countryside Specialised Hospital.
In the space of a single hour on Tuesday, he and fellow medics treated around 120 casualties.
"Our medical staff can't bear this. How long can we hold out in a situation like this?" he said.
"Only God knows, but the situation is disastrous."
- 'Bombing has been unreal' -
The horror continued into Wednesday, as dozens of civilians poured into another clinic.
"For three days there's been violent escalation and the bombing has been unreal," said Rabih Ahmad, 25.
The beleaguered emergency room supervisor said he treated around 60 people early this week, but the wounded had reached 70 by midday on Wednesday.
One case, he told AFP, stood out.
"Something happened to me earlier that will wreck your heart. It made me cry. I couldn't control my nerves," Ahmad said.
A young boy had been brought in with his foot nearly detached.
"I stabilised it with first aid when he arrived, and then he started kissing my hands and crying, 'Please, for God's sake, don't cut off my foot,'" Ahmad recalled.
"I left him and started crying. I didn't know what do," the medic said.
"It's an extremely depressing situation; may God bring us all relief".
The medical staff could not save the boy's foot. Hours later, it had to be amputated.