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After a major chemical attack in the former Syrian opposition bastion of Eastern Ghouta, hospitals are out of service and rescuers cannot reach the dead and injured.

Medical sources told °®Âþµº that at least 40 people were killed and over 1,000 injured after inhaling "sarin gas" in the town of Douma, as regime troops pressed an offensive to pressure rebels to withdraw.

"The regime has used internationally-prohibited sarin gas in the attack," the sources said.

"The victims' symptoms resemble that of sarin gas exposure such as difficulty breathing, vomiting and foaming from the nose and mouth. Chlorine attacks are not this deadly," they added.

Zahir Sakat, a documenter of chemical weapons attacks in Syria, also suspected the attack was carried out with Sarin gas, but that it was mixed with another chemical, making it difficult to detect.  He noted similarities between the gas and the one that was used in East Ghouta in August 2013, which resulted in the estimated deaths of more than 1000 people.

No hospitals

Activists from Douma told °®Âþµº that there are no hospitals in the city after medical centres had been subjected to "systematic and deliberate" aerial bombardments, and only one hospital is left partially operating. 

This hospital is only able to provide minimal assistance with limited resources, and is additionally stretched as much medical personnel has left to north Syria. 

"By 8.15pm on Saturday, helicopters threw explosive barrels found to contain toxic gases, resulting in a large number of cases of suffocation, showing symptoms of chemical weapons injuries," said a volunteer in Syria’s civil defence team. 

He added that warplanes bombarded a hospital full of injured people, and that rescue teams had no been able to reach all the injured during Sunday, as shelling continued on Ghouta.

"Many residents of the area are with us.  They want reassurances about their relatives at home but we can’t give this to everyone," he said. 

"In every basement we enter we find more victims and casualties.  So far, we can not talk about accurate and consistent statistics on casualty numbers."

The videos circulated on social media give a sense of the horrific scenes that wait volunteers; entire families including babies, lying dead, faces white, mouths open, but with no visible external injures.

The White Helmet volunteer stressed that the medical centres left are not able to respond to all casualties, left with a single room and minimum first aid, consisting of washing the injured and basic treatment with inhalers and oxygen.

"It’s a humanitarian disaster in every sense," he said.

Local human rights activist Ibrahim al-Fawal estimated that around 80% of medical staff from Douma had left to Idlib.

"The city is now experiencing a sever shortage of medical personnel and equipment," he said.

Syria's regime has been accused of using toxic gas - including chlorine and sarin - throughout the seven-year conflict, but it has repeatedly denied the claims.

A sarin chemical attack on Khan Sheikhoun last year killed up to a hundred civilians and led to the US launching cruise missiles strikes on a regime air base.

Despite disruptions to the internet and communications as bombardment continues, °®Âþµº attempted to communicate with survivors of the chemical massacre.

Abu Mahmoud, a resident in the targeted area of housing next to a central medical centre, said that conventional weapons appeared to be used initially during the bombardment. 

Out of reach

However residents in his building later experienced breathing difficulties after barrels of poisonous gas were thrown from a nearby regime helicopter.  He said they attempted to spray water on the injured, and put wet cloths of their faces as they foamed at the mouths before the White Helmets arrived. 

Abu Mahmoud added that the White Helmets were unable to reach all the bodies due to the absence of protective masks, and suspected lingering gas.

Media activist Qais Hassan spoke on a social media application after emerging with his family from a basement where he had been hiding with his family.

He said that many are injured by suffocation, even without heavy exposure to the chemical weapons, as hundreds were hiding in tiny cellars, meaning that shelling close to the basement could lead to many suffocating in smoke and dust from from bombed homes above. 

However, he said it was clear that the use of chemical weapons began at around nine o’clock yesterday evening.

"At first, people did not know exactly what happened, as communication stopped and no one could walk on the street" he said, adding that people became dizzy and short of breath, before falling on each other. 

Hassan estimated the death toll to be around 150, and said that two areas of Douma were affected by the bombardments.

Hassan said that people could only help their loved ones by applying water and vinegar to their foaming noses and mouths.  Civil defence forces were in a state of "complete paralysis" as a result of heavy shelling and disruption of communication, meaning they were unaware of the targeted areas. 

Hassan said that bombing had ceased on Sunday as a result of a deal was agreed for Jaish al-Islam to leave Douma within 48 hours.

The reports of the chemical massacre prompted international anger, with UN chief Antonio Guterres saying any confirmed use of chemical weapons would be "abhorrent".

Pope Francis described the allegations as "terrible news", adding that "nothing, nothing can justify the use of such devices of extermination against defenceless people and populations."

Meanwhile, the European Union said "the evidence points towards yet another chemical attack by the regime", while opposition ally Turkey stated it had a "strong suspicion" Assad was to blame. 

Reporting by Abd Rahmen Khadr, al-Araby al-Jadeed Syria corresspondants and Imogen Lambert