Syria’s three-year war has taken a devastating toll on children’s health, according to a new report by international charity Save the Children. The report, A Devastating Toll, details the impact of three years of war on the health of the country’s children and adds that more than 10,000 children have been lost as a direct result of the violence.

At least 1.2 million children from Syria have fled to neighboring countries, and 4.3 million need humanitarian assistance.

The extent of the decline in Syria’s health system is demonstrated in many horrific ways, including children having limbs amputated because the clinics they present to don’t have necessary equipment to treat them according to the report, which paints a gruesome picture of the dire health care crisis.

“Newborn babies [are] dying in their incubators due to power cuts; in some cases, patients [are] opting to be knocked out with metal bars for lack of anesthesia; parents [are] arriving at hospital to find no medical staff and hooking up children themselves to intravenous drips,” said one health worker.

Increasing numbers of children are dying from diseases that would have previously either been treated or prevented from taking hold in the first place. The report stated that several thousand children had died because of greatly reduced access to treatment for diseases including cancer, epilepsy, asthma, diabetes, hypertension, and kidney failure. There has been a revival of polio, which had previously been eradicated in Syria.

The humanitarian crisis has impacted every corner of the country to some degree, but certain rebel-held towns and neighborhoods have been especially devastated by the regime’s stranglehold tactic of cutting off the delivery of food and medical aid entirely. In one reflection of the doctor shortage, the report cited examples of doctors barely out of medical school performing hundreds of operations. In one case, the only practitioner available to treat children was a dentist.