Dr. Mohammad — a trained dentist — is the most skilled medical professional in Madaya, a Syrian town that's been under siege since the summer of 2015 by Hezbollah, the Lebanese militia allied to the Syrian regime. On Wednesday, three children died in the makeshift hospital that's staffed by Dr. Mohammad, a veterinarian, and several untrained volunteers.
Their bodies had been blown apart by a landmine they found walking home from school on Wednesday.
"At least one of the boys could have survived," Dr. Mohammed told VICE News by phone on Thursday, had they been quickly transported to a more professional hospital in Damascus.
But Madaya is encircled by checkpoints and landmines and access in and out is tightly controlled. Ali Othman Dalati, 6, his brother Mohamad Wassim Dalati, 7, and their friend Yusef Muhammad Ammar, 7, exploded a mine when they mistook it for a can of food that international aid organizations occasional deliver to the town.
The three young boys could not access medical care because the town where they live has become a pawn in a deadly geopolitically balancing act. The Hezbollah militia surrounding Madaya and the nearby rebel controlled town of Zabadani only lift the siege when rebel forces surrounding two other villages, Fu'a and Kefraya, do the same. That arrangement was part of a complicated deal struck by the UN, Turkey, the Assad government, their allies Hezbollah, and rebels, this past September.
Osama Dalati, a cousin of the Dalati brothers, said that the family tried to negotiate to allow the boys safe passage out of town. But no parallel evacuation could be arranged in Fu'a and Kefraya — so the boys eventually bled out.
"It's not like we were telling them to get fighters out. We are not asking them to help out someone who was injured while fighting," Osama said. "We were asking to let kids out because of something that was their fault." The mines encircling the town, Osama says, were first laid by Hezbollah in the summer of 2015 to prevent anyone from fleeing.
The boys are not alone. In January, following the entrance of an inter-agency aid convoy into Madaya, the UN's Humanitarian Coordinator Stephen O'Brien reported that some 400 residents were in need of "immediate" medical evacuation. But according to figures provided by the World Health Organization (WHO), only 18 sick or injured residents have been allowed to leave the town since December 28, along with 53 accompanying family members.
The WHO says that at least 95 individuals, both those requiring urgent medical care and their family members, are currently in need of evacuation. A list with each of the 95 people's names has been shared with the Syrian Arab Red Crescent, which has liaisoned with the government of Bashar al-Assad — but little progress has been made.
On Wednesday, O'Brien once more briefed the Security Council, and offered a mixed assessment of relief operations in Syria. For the past month, guns have largely fallen silent in many parts of the country under a tentative truce reached in late February between rebels and the regime. UN convoys, said O'Brien, had reached some 150,000 people in 11 besieged areas since the beginning of the year, but added that only 30 percent of people in besieged areas, and less than 10 percent in so called "hard to reach areas" had been supplied by the UN and aid agencies.
"Even when we do gain access; serious concerns remain about the ongoing exclusion and removal of medical supplies and treatments from convoys," said O'Brien. "Over 80,000 treatments have been excluded or removed from convoys in 2016, the vast majority by the Syrian authorities."
Many of the areas the Syrian regime blocks the UN from delivering to are a "mere minutes' drive away from UN warehouses in Damascus," said O'Brien. And while Madaya has been reached by convoys on a monthly basis, its residents remain prisoners of the regime and Hezbollah, and, if they require medical evacuation, suffer under the quid pro quo set up under the four towns arrangement.
Raffiullah Qureshi, spokesperson for the International Committee of the Red Cross, described the deal as "tit for tat" that left no room for medical emergencies.
"I think any arrangement that does not take into account the urgency of a particular medical case is not going to help people who are in need, whether it be childbirth, a landmine victim or someone shot and bleeding to death," said Qureshi. "It's unfortunate if these children could not be retrieved, but this is how the situation is according to the agreement. Things are very procedural, they take time, and emergency evacuations are not possible on short notice."
The circumstances surrounding the boy's' death were relayed to VICE News by aid workers and family members inside of Madaya, but could not be independently verified.
The three boys exploded the mine, their cousin said, as they were picking grass after school.
"It's something the boys often did," he explained. Many in Madaya turned to leaves or grass to survive late last year amid widespread starvation. It was unclear if the boys planned to eat the grass.
"This is not something that's new to us," Dr. Mohammad told VICE News — he's had to treat seven people who have exploded mines since early December, 2015.
One of the boys died on the spot, but two were transferred to the makeshift hospital Dr. Mohammad oversees. For the next seven hours, the boys' relatives tried to negotiate with Hezbollah to arrange safe passage for the wounded children so they could be treated in a more advanced hospital just 30 miles away in Damascus.
Osama, the cousin, says that Hezbollah communicated to the family that the boys would get safe passage if the family swore that the injuries were not Hezbollah's fault. "Of course we agreed immediately," he says. The family, he says, communicated with Hezbollah through a mediator, and hours passed as they continued to negotiate the children's transport out of town.
After seven hours, the two surviving boys bled to death. Though Dr. Mohammad had dealt with explosion injuries in the past, he admits his own shortcomings. "What we lacked were doctors who specialized in bone surgeries and people who can perform anesthesia," he said. If the children were evacuated to Damascus, he says, there was a 70 percent chance they would have pulled through.
The bodies of the Dalati brothers were so mangled, their cousin says, family members prevented their mother from going into the hospital. Osama helped the boys father bury the brothers with his own hands, in the family's yard.
"Every mother today is watching her kid," Rajai, a 26-year old English and math teacher in Madaya said on Thursday. "The whole town is talking about it."
According to the Syrian Medical Society, an advocacy group that helps care providers in the country, 82 people have been killed in Madaya and Bakkin since the four towns deal was agreed upon. Those individuals died either from "regular sniping or landmine explosions while trying to escape," or from starvation. Nine deaths, the group says, resulted from landmines like the one that exploded this week. One woman, a 45 year old resident of Madaya suffering from kidney failure, died after she was not allowed passage to Damascus to receive life-saving dialysis.
As in the case of the two children, locals reached out to officials at the International Committee of the Red Cross and the Syrian Arab Red Crescent, to no avail.
"They reached out all day yesterday to people in Damascus," said Dr. Jaber Monla-Hassan, a member of SAMS based in the US who is in touch with locals in Madaya. "They've been in contact with ICRC and SARC. They begged them."
"Unless they strike a deal to evacuate someone from a different location, they cannot rescue anyone from Madaya," said Monla-Hassan.
Staffan De Mistura, the UN's special envoy for Syria, whose office helped broker the complicated siege arrangement, did not offer comment on this week's incident, but directed VICE News to remarks made Thursday by Jan Egeland, head of a UN humanitarian task force.
Speaking to reporters, Egeland said that medical personnel are "still not allowed into the besieged areas and medical evacuations are still not allowed."
"Those children should have been alive today," he said.
Reem Saad contributed to this report