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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 neighbors 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. “God gave me a new lease on life.�

At an equally overwhelmed hospital in Idlib city, Shajul Islam, a British doctor who works with several non-governmental organizations, was having the worst day of his seven years working in Syria.

“I’m literally taking a patient off a ventilator to give another patient a chance, having to decide which patient has more of a chance of surviving or not,� Islam said.

The hospital, already struggling with weak health infrastructure and funding cuts, he said, was particularly overburdened after the earthquake because other hospitals in the area were out of commission.

“We’ve got quite a lot of hospitals that had been previously hit in the war. So they had already the foundations, everything had already been weakened,� he said. With the added blow of the earthquake, he said, "We’ve had at least three or four hospitals that I know of that have been put out of service."

wreaked new damage and suffering in Syria’s last rebel-held enclave after years of fighting and bombardment.

Hospitals and clinics were flooded with injured people. The enclave, centered in Idlib province, houses millions of displaced Syrians who had fled their homes during the country’s civil war. Many of the displaced live in dire conditions in makeshift camps. Many others there and in neighboring government-held areas are housed in buildings weakened by past bombings, leaving them even more vulnerable to shocks from earthquakes.

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 Britain-based war monitor.

More than 4,000 people were killed in Turkey and Syria, with the toll expected to climb. In the opposition-held territory in Syria, at least 450 were reported dead, but hundreds more were believed be buried under the rubble of their homes.

“This disaster will worsen the suffering of Syrians already struggling with a severe humanitarian crisis,� Carsten Hansen, the director for the Middle East at the Norwegian Refugee Council, said in a statement. “Millions have already been forced to flee by war in the wider region and now many more will be displaced by disaster.�

In the hospital in Darkush in western Idlib, Abdel Hamid said his family were sleeping in their apartment when they were roused by powerful, prolonged shaking. They ran from the apartment, but “before we reached the door of the building, the whole building came down on us,� he said.

A wooden door shielded them from the worst force of the collapse — they all got out alive. He and his wife and three of the children suffered head injuries, but are all in stable condition.

The scale of the casualties quickly overwhelmed the hospital’s resources, said Majdi al-Ibrahim, a general surgeon at the hospital.

“We need urgent help. The danger is beyond our capacity,� he said.

The Syrian American Medical Society, which runs hospitals in northern Syria and southern Turkey, said in a statement that its facilities are “overwhelmed with patients filling the hallways� and called urgently for “trauma supplies and a comprehensive emergency response to save lives and treat the injured.�

The opposition territory in the northwest corner of Syria has held out for years even after Syrian government forces retook most rebel-held areas around the country.

Fighting still flares from time to time with Russian-backed Syrian forces nearby. Parts of the territory are run by rebel groups, including a dominant al-Qaida-linked militant faction, while parts are under a Turkish-backed administration known as the Syrian Interim Government.

The disaster came on the heels of severe winter storms, further adding to the misery of those left without shelter.

“There is rain and the weather is very cold, there is snow in some of the areas,� Abdel Hakim al-Masri, economy minister with the Turkish-backed regional administration, told The Associated Press. He noted that some of the displacement camps in the area had been decimated by the quake.

Al-Masri said that efforts have begun to find temporary shelter for the people now doubly displaced by the earthquake, but that the magnitude of the response required is well beyond the local resources available.

“There is a huge amount of suffering, and this will increase it,� he said. "This matter calls for rapid action by all countries of the world.�

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Sewell reported from Beirut.