The Syrian war crossed a wretched threshold Thursday, marking seven years since the start of the protests against President Bashar Assad's regime. Within months Assad had sent troops to crush the uprising, sparking a civil war that has gathered antagonists at a rate only exceeded by its human costs — which, by many estimations, have left roughly 400,000 people dead and displaced half the population.

But the milestone meant little to the civilians and medics huddled in basements in eastern Ghouta, the disputed suburban sprawl just outside Damascus. There they hid in squalid conditions, as many have for weeks, from the relentless blasts sounding out a dreadful beat above them.

"The conditions in some of those basements, we're told — with real problems with sanitation, with running water, often not having either — means that those places are now desperately unsanitary," Jeremy Bowen, the BBC's Middle East editor, told Here & Now on Thursday. "It's hard to think of life being any more miserable — because of course, if they go out on the streets there's a real risk they'll get killed."

And, as one local doctor told NPR's Ruth Sherlock, the proof of that risk is readily evident: "The wounded are everywhere in the streets."

For weeks the Syrian government has been bombarding the suburbs with shelling and airstrikes, aiming to dislodge several rebel organizations from their perches just outside the capital. By Thursday those barrages appeared to yield a major advance, as Syria's state-run media reported the country's military had "regained full control" of the town of Hamouria from the Faylaq al Rahman militant group.

By the end of the day, more than 12,500 civilians had fled the town using a protected corridor opened by the government, according to the Syrian Observatory for Human Rights, a U.K.-based monitoring group. State-run television depicted what the SOHR called "the largest mass displacement" seen in the area since 2013, with civilians fleeing to regime-held areas on foot, by bus or in vans with the help of the Syrian Arab Red Crescent.

Elsewhere in eastern Ghouta, in the town of Douma held by still another rebel group, the Red Crescent entered in a convoy of 25 trucks packing 340 tons of food. The "humanitarian pause" — which had been negotiated between Russia, a key Syrian ally, and Jaysh al-Islam, an Islamist militia — brought a rare respite to the northern end of eastern Ghouta, which has been ravaged by fighting.

The brief was rare also in its effectiveness. Another, much broader cease-fire adopted by the United Nations Security Council on Feb. 24 has had little influence on the combatants on the ground. In eastern Ghouta alone, in a two-week span from Feb. 18 through March 3, Doctors Without Borders says more than 1,000 people were killed and nearly 5,000 more were wounded.

"Daily, we hear an increasing sense of hopelessness and despair, as our medical colleagues reach the limits of what a person can be expected to do," the group's general director, Meinie Nicolai, said in a statement last week. Of the 20 medical facilities in the region supported by the international humanitarian group, Nicolai said 15 were hit with bombs or shells in recent weeks.

"They are trying their best to keep some semblance of a medical service operating, but everything is overwhelmingly stacked against them," she added. "The situation, and the unrelenting trampling of the rules of war by the fighting parties, are pushing them to do the impossible."

Beyond the capital

The region around Damascus is not alone in its recent spasm of violence, despite international attempts at admonishment.

To the north, on the country's border with Turkey, the Turkish military and its allies are nearly two months into an operation aimed at clearing Kurdish fighters from the cities of the borderlands — and they appear to be succeeding. The Turkish-led forces have surrounded Afrin, which remains for the moment in the hands of the besieged Kurdish YPG militia.

Shells poured down on the city center Wednesday, according to The Asssociated Press, and the Syrian Observatory says more than 30,000 civilians have escaped Afrin for nearby cities ahead of an expected offensive against the remaining YPG fighters.

Turkey views its military intervention in northwest Syria, which it calls Operation Olive Branch, as vital to its national security interests. Ankara asserts that the YPG is an extension of the PKK, a Kurdish separatist group operating within its own borders. Turkey and its Western allies, including the U.S., consider the PKK a terrorist organization — but that's where their agreement ends. The U.S. not only has refrained from labeling YPG terrorists, it has even armed and supported the group as a partner against the Islamic State in Syria.

On Thursday, far from Syria, that dispute between Turkey and the West again spilled into view. The European Parliament passed a non-binding resolution calling on Turkey to withdraw its troops — a move that Turkish President Recep Tayyip Erdogan brushed off.

"Don't get your hopes up. We will only leave Afrin once our work is done," Erdogan said in a speech Thursday. "There is nothing the European Parliament can tell us on this. Your statement will go in one ear and out the other."

'I screamed, but no one came'

In these weeks of warring factions, as in the seven years that preceded them, civilians have borne the brunt of the brutality. Rarely has that been more evident than in a report released Thursday by the Human Rights Council, which details the integral role sexual violence has played in the years of fighting.

The report, which draws on 454 interviews with survivors, lays out what it describes as the Syrian government's systematic campaign of rape, torture and other "outrages upon personal dignity" during the war.

"Sexual violence against females and males is used to force confessions, to extract information, as punishment, as well as to terrorise opposition communities," says the U.N. commission that compiled the report.

"Rapes and other acts of sexual violence carried out by Government forces and associated militias during ground operations, house raids, at checkpoints, and during detention formed part of a widespread and systematic attack directed against a civilian population, and amount to crimes against humanity," according to the report.

The commission said rebel groups had also engaged in incidents of female rape, but that those incidents were "considerably less common." ISIS also stoned female victims to death for claims of adultery and forced them into marriage, according to the commission.

"My home was invaded in December," one female rape survivor told the commission of her encounter with Syrian regime forces in 2012. "One security officer told me to go to my room and he followed me in. He began insulting me and telling me he would 'do me' and that I would 'never be clean again.'

"I screamed," she said, "but no one came."

As the war enters its eighth year, there are few signs the war will end soon. Rather, with factions fracturing and multiplying, the complexities behind the violence only appear to grow.

The Islamic State has lost its principal strongholds in the country, but where the group's influence has diminished, other countries have stepped up their own involvement in the war: Besides Assad's regime, the many rebel groups and Turkey, others exerting varying levels of pressure include Russia, Iran, the U.S., the U.K. — among others.

"It's almost like a mini-world war now, which means that it's not really something that Syrians can solve or sort out between themselves now," Bowen, the BBC editor, told Here & Now. "There are big powers involved — and in the end, they will be sorting out the future."

This brutal anniversary is passing. But as Bowen suggests, for the civilians in the basement in eastern Ghouta, the years that went into reaching that anniversary will stay with them — if they can stay alive.

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