A field hospital damaged by air strikes in rebel-held AleppoAbdalrhman Ismail / Reuters

You can calculate the number of people who have died in a conflict, the relative strength of various factions, the amount of territory each holds. Hope is much harder to measure. But it’s no less a factor in the arithmetic of war. Hope is a bulwark of humanity. In many cases, hope is all that civilians beset by violence have left.

Consider the Syrian Civil War: Hope—for the most basic international action to ease the suffering of Syrians, let alone efforts to halt hostilities or end the war—is in especially short supply these days. The shortage is evident in the reaction this week to the images and video of a stunned, bloodied five-year-old boy being whisked from a bombed building to an ambulance. The visuals are being widely shared online, but often with dark resignation. There’s little expectation that world leaders will be moved to do what’s necessary to resolve the humanitarian catastrophe in Aleppo, which for months now has been starved of food, water, and medical supplies as Syrian government and rebel forces battle for control of the city.

“Watch this video from Aleppo tonight. And watch it again,” the Australian journalist Sophie McNeill tweeted on Wednesday, in reference to the footage of the Syrian child. “And remind yourself that with .” This is less a call to action than a challenge to stare straight at collective inaction—and not turn away in disgust. McNeill’s message has been shared thousands of times.

The shortage of hope is also evident in a letter that 15 of the last doctors in rebel-controlled eastern Aleppo recently sent to Barack Obama. The physicians spoke of horrors that haven’t gone viral on the internet: attacks on medical facilities, often by suspected Russian or Syrian government warplanes, occurring roughly every 17 hours; four newborn babies suffocating to death after an explosion cut off oxygen to their incubators. The letter’s signatories urged the U.S. president to exert more pressure on the various parties in the conflict to protect civilians and lift the siege on the city. But a number of doctors declined to sign the letter, believing the plea for international support to be futile. And when the BBC asked one of the signatories about that decision by her colleagues, she admitted that she didn’t expect the United States to actually help either.

“We just write that letter to the world to know what’s happening here. But I don’t think that anyone can help us,” Farida, the only remaining female OBGYN in eastern Aleppo, told the BBC. (In most media interviews, she’s used only her first name for security reasons.) “Everyone is doing nothing. …  Everyone is watching and we just see sympathy from them. But there’s no work. We don’t see anyone working for us. They just watch and just talk and do nothing. People here are dying every day with chlorine, and with barrels, with air strikes. The women are dying, and some women are dying when they are pregnant, and some women have miscarriages because of the air strikes. But no one helping. Just watching.”

We can’t say we didn’t know.

On Tuesday, PRI’s The World aired an interview with Farida that captures her profound isolation and desperation. Listen to the exchange carefully, however, and you also get the sense that she still retains some hope, apparent in her improbable laughter and devotion to her work:

Carol Hills: Doctor Farida, did I just hear a noise there? Was that some sort of attack that I just heard?

Doctor Farida: It’s attack. [Laughs]. It’s normal. It’s away from me. Not next to me. These noises are all the time.

Hills: Do you and the doctors and patients you work with feel safe inside the place where you’re working?

Farida: No. It’s not safe. I work at the third floor in my hospital. And many times the wall was perforated. So every woman came to the hospital, she knows that there is a danger on her life. So they just give the delivery, or give the birth, and then go home. She escapes to home because she knows our hospital is always targeted. And near to my home, there is air strikes always. Every day. Every day. Every morning and every night there is air strikes. The glass in my kitchen is on the ground. I stay now without windows.

Hills: Do you sleep in your house at night with those open windows?

Farida: Yeah, yeah. [Laughs]. Sometimes I sleep at bathroom. [Laughs] I accommodate with this situation.

Hills: What keeps you doing the work you’re doing as a doctor?

Farida: I love my work and I love the patients and I love little babies.

Hills: Do you have any children?

Farida: Yeah I have little daughter. She’s seven years.

Hills: And is she staying at home?

Farida: Yeah. When the airplane is close to my house I tell her to go to the bathroom and I give her an iPad and I ask to make her to watch a movie, or to play game, just not to hear anything. But she’s afraid always. She’s afraid.

Hills: Doctor Farida, you’re a doctor and your job is to bring new babies into the world. Is that a difficult thing when you’re bringing them into a setting of war and destruction?

Farida: It’s difficult. It’s very, very, very difficult. And when the woman comes to the hospital she has to be happy when she has little baby. But when she go to hospital and when she saw all that people who have lost his leg, she goes out, so bad. So bad. I see things which I can’t imagine that I will see one day. One woman came to us without her legs. She was pregnant. She lost her legs. When I was a doctor, when I was in the university, I can’t imagine that these things will happen in Syria. But now I see everything. You can’t imagine this.

Hills: Doctor Farida, are you the only OBGYN left at your hospital?

Farida: The only female OBG. Now the air strike has a bomb next to my house. Now. Can you hear this?

Hills: Yes. Right now. We can hear it.

Farida: [Laughs]. It’s always. I accommodate with this situation.

Hills: Is there any message you want to send to our listeners? Anything you want to say about the situation in Aleppo, and what you need?

Farida: Bashar al-Assad is monster. And everyone cooperate with him. No one cares about us. No one cares about us as doctors, and always doctors are dying in their hospitals. And the people here are humans. We are not animals. But no one cares. But we have God. And God will help us.

Last week, an unnamed official in the Obama administration told CNN that the White House had indeed received the letter from the besieged doctors of Aleppo. “The U.S. has repeatedly condemned indiscriminate bombing of medical facilities by the Assad regime in Aleppo and elsewhere in Syria,” the official said. “These attacks are appalling and must cease.” If the United States has a plan for how they might cease, and when, the official didn’t mention it.

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