It was like hell. In the hospital it was very quiet despite all the people. Everyone was crying, crying from the gas, crying from looking at the bodies. It was so full, people were laid out on the floor. I almost stepped on the body of my friend. I didn’t even realise it was him,” said Nour Aden, an activist from East Ghouta, remembering the events of 21 August 2013.
Four years ago, thousands of people in the besieged rebel district of Damascus were rushed to hospital – after an air raid in the early hours – with symptoms such as convulsions, suffocation, coughing up blood and foaming at the mouth.
In the then two years since Syria’s civil war broke out, doctors had grown used to treating trauma and conflict wounds. But the overwhelmed medical staff didn’t know how to treat these patients with no visible signs of injury. Children dropped like flies in front of them because of what international investigators would later confirm were the effects of sarin gas, a chemical agent that targets the central nervous system.
It’s still not known how many people died – estimates range from 281 to 1,729. All sides agree, however, that East Ghouta was one of the worst chemical incidents in modern history.
Images of entire families dead in their beds, with dark rings around their mouths and eyes and faces contorted in pain, caused outrage around the world. The Syrian regime had crossed a “red line”, the then US President Barack Obama had said. Military intervention was proposed in a bill that never actually made it to a floor vote in the House or Senate.
“Usually, when a bad thing happens, with time the wounds heal and the bad memories fade,” said Dr Kassam Eid, who treated patients during the attack.
“Unlike the other bad things in my life, and there have been many, the more time passes without any accountability or seeing these attacks stop, the more and more painful it gets. Every new chemical attack against civilians reminds me we are not treated like humans by the wider world or the regime.”
While the international watchdog Organisation for the Prevention of Chemical Weapons (OPCW) did not explicitly blame Syrian President Bashar al-Assad’s government, there is no other fighting force in Syria capable of launching such a huge attack.
Syrian, Russian and far-right and far-left conspiracy claims that it was a “false flag” attack by the rebels have been thoroughly debunked – but the regime agreed to give up its chemical weapons stocks in the wake of the Ghouta incident as a mark of transparency. Assad has repeatedly denied using chemical weapons, and continues to blame rebels for attacks.
Since then, however, war monitors such as the UK-based Syrian Observatory for Human Rights report there have been dozens of alleged chlorine attacks and at least one major sarin attack.
Officials from the Obama administration said they always believed it was possible some weapons had been held back, trying to refer instead to the destruction of Syria’s “declared” chemical weapons stocks, although the nuance has often been lost.
While the OPCW team in Syria has carried out 18 chemical site visits since 2013, it has effectively given up, Reuters reported last week, because Syria has failed to provide sufficient or accurate information as to the operation of its facilities.
In April this year, a sarin attack in the rebel-held village of Khan Sheikhoun, which killed around 130 civilians, once again led to calls for Assad to be held accountable for gassing his own people.
This time, US President Donald Trump was quick to retaliate.
Mr Trump ordered what the White House called a “warning shot” barrage of 59 Tomahawk missiles which struck the regime-operated Shayrat airbase near Homs in what marked the first direct action against Assad’s forces taken by the US since the civil war began more than six years ago.
