The last operating hospital in east Aleppo has been destroyed by airstrikes, leaving up to 250,000 residents without access to surgery or specialist care, and rebel-held districts at the point of collapse.

Another four hospitals were hit and forced to close on Friday, before the Omar bin Abdul Aziz facility was struck just after 8.30pm, capping the most deadly day yet for the medical system in Syria’s second city, which has been systematically targeted by Russian and regime jets over the past year.

“They have all been repeatedly attacked over the last few days,” said David Nott, a surgeon with decades of experience working in war zones, who has been supporting the Aleppo doctors.

“I don’t think in all my years of doing this I’ve seen such dreadful pictures of injuries, of people lying on the floor in an emergency room, the dead mixed with the living,” said Nott. At least two doctors were among the dead, he said, and he feared hospitals that had kept operating under attack and with dwindling supplies might now have been shut down permanently.