The scale of destruction in the aftermath of Monday’s earthquake that hit large parts of Turkey and Syria is unprecedented, even for residents of the war-torn country.

On the Syrian side, the area affected by the magnitude 7.8 earthquake and its aftershocks is divided between government-controlled territory and the last piece of land held by the country’s opposition, surrounded by Russian-backed government troops.

The sound of air raids is a regular occurrence for the besieged enclave’s estimated 4.5 million inhabitants, but the roar of several buildings crumbling to the ground simultaneously was another disaster.

Ismail Alabdullah, a volunteer with the White Helmets in Idlib governorate, said at least five residential buildings had collapsed in the village of Sarmada, where his team has been racing for more than 30 hours to find survivors.

Each apartment in the multi-storey blocks “lived a family,” Alabdullah told Al Jazeera. “It will take us days, if not weeks, to reach the last person.”

At least 790 people were killed in opposition-held northwestern Syria and 2,200 injured.

The rescue group operating in opposition-controlled parts of Syria, known as the Syrian Civil Defence, shuttles its few available excavators from one city to another to respond to countless calls for help.

Watch a little girl rescued after rescuers dug through the rubble to pull her out of a collapsed building in Syria ⤵️ pic.twitter.com/D0XNtaoKPv

— Al Jazeera English (@AJEnglish) February 7, 2023

But resources are inadequate and volunteers often resort to digging with their bare hands. “Hundreds of people are still under the rubble, but we don’t have enough material to free them,” Alabdullah said.

Efforts to reach survivors have been hampered by rain, freezing temperatures and nearly 200 aftershocks that further collapse already collapsed buildings and standing war-torn buildings.

Survivors have camped in the streets or joined tent camps where resources were already scarce before the quakes, the volunteer added.

Humanitarian groups have said the quake added another layer to the suffering of the population in northwestern Syria, where some 4.1 million people are in need of assistance.

“People are traumatized, they feel helpless,” Adnan Hazem, Syria spokesperson for the International Committee of the Red Cross (ICRC), told Al Jazeera.

Already struggling with its first cholera outbreak in a decade, the region was braving snowstorms amid fuel shortages when the quake hit.

The needs are now “huge,” Hazem said.

Aid to Northwest Syria

Countries around the world have sent teams to assist with rescues in Turkey and the country’s disaster response agency said more than 24,400 aid workers are already on the scene.

But the delivery of aid to the last part of Syria still beyond the control of Syrian President Bashar al-Assad remains problematic after more than a decade of war.

“No one has contacted us to offer assistance,” said Alabdullah of the White Helmets.

Northwestern Syria has become one of the most difficult places to reach, with only one crossing point available to transport aid from Turkey into opposition-held areas. The quake’s epicenter in the nearby Turkish city of Gaziantep, a major United Nations relief center for northern Syria, was one of the towns hit.

The UN Office for the Coordination of Humanitarian Affairs (OCHA) said the earthquake disrupted the vital flow of cross-border aid.

“We are experiencing temporary disruption due to the roads, especially the road between Gaziantep and Reyhanli,” OCHA spokesperson Madevi Sun-Suon told Al Jazeera.

Not being able to reach Reyhanli, a key transfer point where the UN agency conducts surveillance operations and verification work before aid trucks enter Syria, has been “a major challenge,” Sun-Suon said.

Established in 2014, the aid mechanism across the Turkish border at the Bab al-Hawa border crossing is the only way UN aid can reach civilians without navigating through areas controlled by Syrian government forces.

It meets more than 80 percent of the needs of people living in rebel-held areas.

The al-Assad government has systematically refused humanitarian aid to large segments of its population since a popular uprising in 2011, and sought the surrender of opposition-held areas. Russia, one of al-Assad’s closest financiers, argued that the humanitarian mission violates Syria’s sovereignty.

Amnesty International on Monday called on the international community to mobilize resources and the Syrian government to “allow aid to reach all earthquake-affected areas without restrictions”.

Opposition media reports of nightly shelling in the town of Marea could also complicate rescue efforts. Syrian civil rights groups have called on the international community to put pressure on al-Assad and his allies to stop bombing the earthquake-hit areas.

It also urges the international community to support the rescue of civilians #Syria and to put pressure on the Assad regime and its Russian ally to ensure that bombings do not take place in the affected areas. 5/

— Syrian Society for the Dignity of Citizens (@SyrianACD) February 7, 2023

areas of the Syrian regime

The state news agency SANA said on Tuesday that at least 812 people were killed in the government areas of Aleppo, Latakia, Hama, Idlib and Tartous, bringing the country’s total to at least 1,602 people.

The United Arab Emirates has pledged about $13.6 million in humanitarian aid to Syria, state media reported, while Algeria announced it would join the rescue efforts with a specialized civil defense team.

The Syrian government denied asking for Israeli help after Tel Aviv said it had received a call for help and was ready to comply in what would have been a rare moment of cooperation between neighboring countries.

Syria and Israel are technically at war, and Israel is believed to carry out regular airstrikes against pro-Iran military sites in the country.

Western governments are expected to provide aid to Syria through non-governmental organizations to avoid collaborating with al-Assad’s government, which they do not recognize as legitimate.

The United States said it was “committed” to helping residents “on both sides” of the Turkish-Syrian border, but ruled out direct cooperation with the Syrian government.

British Foreign Secretary James Cleverly said delivering aid to Syria was “complicated”, adding that the UK “works through our UN partners on the ground”.

But UN-backed humanitarian programs in northwestern Syria have been underfunded for years and there is no planning for natural disasters.

The humanitarian response plan for Syria (2022-2023) received less than 50 percent of the required $4 billion, with the earthquake only widening the gap between funds and needs on the ground.

UN Secretary-General Antonio Guterres said the UN was counting on the international community to help the many thousands affected by the disaster, “many of whom were already in urgent need of humanitarian assistance in areas where access is a challenge”.

The UN Refugee Agency in Syria said it was “actively coordinating a response with UN agencies and other humanitarian actors to provide relief and support to those in need in Syria.”