Millions of people in northwest Syria have been left vulnerable by 12 years of conflict, according to the United Nations, which says 2.9 million people in the region have been displaced and 1.8 million are living in camps.

A steady stream of injured flowed into an overwhelmed hospital in the town of Darkush, in rebel-held northwestern Syria, after the deadly earthquake struck on Monday. Mothers hovered over crying children.

Amid the chaos, one man sat with a dazed expression, his face covered with abrasions.

The man, Osama Abdul Hamid, barely made it out alive with his wife and four children from his apartment building in the nearby village of Azmarin. Many of their neighbours were not so lucky.

“The building is four stories, and from three of them, no one made it out,” Abdul Hamid said, breaking down in tears.

Much of Syria’s last rebel-held enclave in the northwest is already destroyed by years of fighting.

Many of the displaced live in dire conditions in makeshift camps with poorly constructed concrete homes that easily collapsed or are vulnerable to aftershocks.

The quake caused total or partial damage to buildings in at least 58 villages, towns and cities in northwestern Syria, according to the Syrian Observatory for Human Rights, a United Kingdom-based war monitor.

‘Beyond our capacity’

Hospitals are overwhelmed. Syrian civil defence worker Ismail Abdullah told Al Jazeera that bombing by government forces of health facilities over the years had killed many doctors and staff.

“Now, the medical sector cannot handle all of the injured. We need shelter for those who lost their houses. We need kits for those sleeping outdoors, and even drinkable water. Those people underneath the rubble in northwest Syria need [rescue] equipment. We don’t have enough to handle this catastrophe,” Abdullah said.

Majdi al-Ibrahim, a surgeon at the hospital in Darkush, said “urgent help” was desperately needed. “The danger is beyond our capacity,” he said.