The historic Syrian city of Aleppo is in tatters.
Since 2012, it's been one of the bloodiest fronts in Syria's civil war, with pro-government forces playing tug-of-war with rebel factions. As the war continues to rage with Shiite fighting Sunni, the city's neighborhoods and strategic points have been carved into territories under the control of the Islamic State, al Qaeda in the Levant, Kurdish forces, and the Syrian government.
There are only a few dozen medical doctors remaining in the destroyed city, according to CNN, and they're tasked with caring for the approximately 300,000 people caught in the middle.
On August 11, those doctors revealed the text of a letter they sent to President Barack Obama, imploring him to help ease the humanitarian crisis and chiding him for not doing everything in his power to ease the suffering among civilians.
"We do not need tears or sympathy or even prayers," the 15 doctors wrote to Obama. "We need action."
The surviving medical professionals say supplies are dwindling, there are too many injured and sick to take care of, and most of the city's infrastructure has collapsed during the four years of fighting.
Without the staff or supplies they need to save lives, the doctors said they have to make heart-wrenching decisions on who to treat based on their chances of survival.
"What pains us most, as doctors, is choosing who will live and who will die," the doctors wrote. "Young children are sometimes brought into our emergency rooms so badly injured that we have to prioritize those with better chances, or simply don't have the equipment to help them."
The White House has received the letter, according to an unnamed official who spoke to CNN but would not go on-record. The official did not promise help and instead deflected blame.
"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. We commend the bravery of medical professionals across Syria who are working every day in perilous circumstances with minimal supplies to save lives."
The remaining doctors seek more than commendations for their bravery. Medical professionals say their facilities are attacked daily, and believe it's only a matter of time before hospitals and other medical facilities are destroyed.
Russian-backed forces hit medical facilities about once every 17 hours, medical professionals in Aleppo told The Guardian. The combatants -- including the Russian government -- have said they will suspend the bombardments over the city for three-hour stretches every day to allow humanitarian assistance, but one doctor who spoke to the Guardian said combat continues to rage even when both sides agree to temporary cease-fires.
“It’s a lie,” Osama Aboul Ezz, a doctor in Aleppo, told the British newspaper. “During the time of the ceasefire there were air raids in the city and there are a lot of wounded in Aleppo today, and other doctors have told us that they received wounded during the time the Russians declared the ceasefire.”
One Syrian doctor, who identified himself by the name Hamza, responded angrily to the White House official's words.
"Speaking about humanitarian assistance and speaking about negotiation and diplomatic solution is very ironic while the Russian air forces are right above our heads and striking us with every weapon that any man can imagine" Hamza told CNN. "The White House knows exactly what is happening."