In Assad’s mind, his presence and control are the only protection from mass killings for his Alawite clan — a Shiite sect that makes up about 12 percent of Syria’s population.

“He has no illusions about how he is perceived around the world,” said Father Patrick Henry Reardon, pastor of All Saints’ Antiochian Orthodox Church in Chicago, who met with Assad for 90 minutes in December. “But he sees it as an almost metaphysical necessity that he must hold his country together and to do so, he’s got to knock a few heads.”…

Even as Assad’s government denies any role in a series of mass killings of villagers, Assad addressed Syria’s parliament this month, offering a muscular defense of harsh responses to what he views as an existential assault on his country.

“No rational human being likes blood,” he said. “But when a surgeon goes into the operation room, cuts a wound, the wound bleeds, the surgeon cuts and amputates. Do we condemn the surgeon because his hands are bloodstained or do we praise him for saving a human being’s life?”