Beirut - When a shell landed next to 13-year-old Ghadeer in the street last year, her whole life changed in an instant.
"An artillery shell exploded while we were walking down the street on our way to visit our relatives," she told Al Jazeera. "My mother and siblings died; I had my leg amputated."
In Eastern Ghouta, many children bear the scars of Syria's brutal conflict. Hundreds have lost limbs amid years of armed clashes and aerial bombardments in the region on the outskirts of the capital Damascus.
Ghadeer had a prosthetic limb fitted six months ago, and thanks to local aid workers at the Farha Foundation, an underground clinic and prosthetics workshop in Eastern Ghouta, she now has a space to practise walking, climbing stairs or playing football.
A new independent initiative launched in collaboration with Farha, called the Human Hope Team, aims to get more children like Ghadeer much-needed treatment and support - and crucially, prosthetic limbs - to help them rebuild their lives. Over the past two months, the team has assisted more than two dozen children.
Founder Razan, who declined to provide her last name for security reasons, studied at Damascus University before the uprising, but was drawn into relief work after her brother's leg was badly injured during government shelling.
"I realised that people [like him] did not receive treatment. There are a lot of medical organisations working to support children in Ghouta, but the lack of medical supplies means they're unable to adequately provide for child amputees," Razan told Al Jazeera. "Most organisations don't provide much for children beyond painkillers and meals, in addition to simple psycho-social gatherings. But this isn't enough."
Among those being helped by the programme is 13-year-old Raneem, who lost a leg during shelling. With support from the local town council, the Human Hope Team now buses Raneem to the Farha clinic three times a week for rehabilitation exercises on her new prosthetic limb.
"It was hard to get from home to the centre. There is no transport … and my dad was martyred [during the shelling]," Raneem told Al Jazeera.
Dr Mohamed Katoub, a manager with the Syrian American Medical Society (SAMS), says that medical facilities such as Farha have come under strain amid Syria's protracted civil war. An estimated 90 percent of physicians from Eastern Ghouta have left the area since the war broke out in 2011, while siege conditions have made receiving aid deliveries and replenishing medical stocks more difficult.
"It's very clear that such a facility would become overloaded, especially after the use of cluster bombs," Katoub told Al Jazeera, noting that in recent months, this practice has "doubled the number of amputees in Eastern Ghouta".
SAMS estimates that there at least 5,000 amputees in Eastern Ghouta. About 20 percent are children, Farha says.
The components for children's prosthetics are very difficult either to make or to get from Damascus. Areas of central Damascus don't have a lot of child amputees, so there aren't a lot of prosthetic parts.
In Eastern Ghouta, war reaches into almost every corner of daily life. A week after residents observed the three-year anniversary of the August 2013 chemical weapons attack, government shelling hit Ghouta's Hamouriyeh district, injuring four civilians, according to the Syrian Civil Defence. Air strikes and shelling continue each week.
Because Ghouta is officially classified as a besieged area by the United Nations and the US-based monitoring group Siege Watch, food and medical supplies are sporadic.
In rare cases, international organisations have organised evacuations for medical treatment. Last month, amid an international campaign by diplomats and rights groups, conjoined newborn twins Moaz and Nawraz were evacuated from Eastern Ghouta by the Syrian Arab Red Crescent, although they later died in a Damascus hospital before they could be transferred out of Syria for life-saving heart surgery.
In the past, some serious medical cases have been evacuated through smuggling tunnels to neighbouring rebel-held Damascus suburbs, while basic goods and medical supplies have been smuggled back in the opposite direction.
But this is not a fail-safe route, noted Farha's executive director, Bilal al-Sharkasy.
"Often the government directly arrests amputees. Why? Because they think: 'You're an amputee? You must be a terrorist,'" he told Al Jazeera, estimating that about half of the people who attempt to cross through the tunnels are caught.
"Also, the components for children's prosthetics are very difficult either to make or to get from Damascus. Areas of central Damascus don't have a lot of child amputees, so there aren't a lot of prosthetic parts," Sharkasy said, noting that high costs pose another obstacle. "A Chinese-manufactured knee joint for an adult costs about $300, but a knee joint for a child might cost about $800."
Farha's team is currently trying to source prosthetic parts from further afield, before having them smuggled back into Ghouta, as the war rages on around them.
Source: Al Jazeera