While foreign aid organisations cut funding to the health and development sector in most of Idlib province, regime forces have intensified airstrikes, threatening the lives of civilians.
As former Al Qaeda affiliate Hayat Tahrir Sham (HTS) took control of the majority of northern Syria's Idlib province by early January, civilians living the area risked being bombed by the Syrian regime.
Local fears were soon confirmed.
On January 29, Bashar al Assad's air force targeted the town of Maarat al Nouman, leaving 11 civilians dead and several dozen wounded.
It was the first hit the town had experienced in almost a year, but signalled that HTS-controlled areas could be lurching towards a violent showdown with regime forces.
Although emergency response teams were prepared for the January 29 attack, the death toll was inevitable.
Idlib Health Directorate spokesperson Rami Kelzi said that instead of helping civilians, the international community is cutting funding.
International NGOs and funding agencies from countries such as Germany and France suspended development projects at the Health Directorates across the rebel-controlled areas. With the help of foreign donations, the Directorate supported seven major hospitals and at least 40 primary healthcare centres.
“Health directorates are independent, impartial, and they play a buffer role between the international and local NGOs, and other authorities, whether they’re military factions or local groups,” Kelzi told TRT World.
“If the suspension or termination was impacted by some political decisions, that is a huge breach [of humanitarian principles],” he said.
Although most of the province is under HTS control, Kelzi said, it is a humanitarian responsibility to find ways to reach people, instead of leaving them without support.
Since the HTS takeover, 72 locations, including residential areas in Idlib, Aleppo and Hama provinces, have been hit by airstrikes. As a result, at least 19 people have died in less than a month, Syria Civil Defence told TRT World.
The Idlib Health Directorate says the number of casualties is likely to be around 300.
In autumn 2018, a ceasefire deal between Turkey and the Syrian regime’s ally Russia largely prevented a planned regime offensive on Idlib, which could have prompted yet another exodus and humanitarian catastrophe.
To escape both airstrikes and HTS persecution, which includes arbitrary arrests and the killing of ideological rivals, many civilians fled to the areas run by the Turkey-backed Free Syrian Army (FSA).
For medical workers, the situation is even more complex. In rebel-held areas, hospitals became targets and physicians were criminalised by the Syrian regime during the country's eight years of war.
The HTS Salvation Government on the other hand, unable to cope with the medical necessities with its one-person Ministry of Health, has not yet targeted hospitals as it seeks legitimacy by adopting a moderate tone. However, reports said a nurse Mohannad al Akel was arrested by HTS in Maarat al Nouman in late January.
Striking a blow to struggling health sector, about 30 doctors from different specialities have fled the country, refusing to work under HTS.
While most FSA fighters, their supporters and civil activists, have left the area, the remaining civilians continue denouncing HTS.
Noor Khattab, a shop owner in Maarat al Nouman, is among the residents who didn’t leave his house. But his wife and two children, aged three and four, were too afraid of airstrikes.
“From the first moment when the HTS came here, the civilians held demonstrations denouncing the military intervention inside the city,” he told TRT World, adding that the presence of the group will eventually lead to bombing.
Prior to the HTS takeover, the streets were buzzing with activity and aid distribution was fairly organised. But as the armed group took the reins of the administration, things changed.
“HTS is allowing some aid to reach the city, but they take a portion of it for their fighters. For them, their fighters are the first class,” Hattab said.
The Idlib Health Directorate, Zelki said, is concerned about ensuring the aid money reaches the right hands. The representatives of various health directorates have started meetings with the World Health Organization and representatives from the French and German governments.
“If the role of directorates is diminished, the aid organisations or foreign departments will be obliged to deal directly with the HTS and its so-called salvation government,” he said.
Local directorates predict that a lack of health services will cause huge waves of displacement and increase the possibility of outbreaks of communicable diseases.
Civilians are more likely to survive HTS rule, Zelki said, but they may not survive the impending health crisis.