The last two functional ambulances in Al-Marj neighbourhood (in the East Ghouta besieged area near Damascus) were destroyed beyond repair in an aerial bomb attack on Monday 05 December 2016. They were parked in the hospital’s warehouse/garage, very near to the makeshift hospital’s location. Two hospital cars, used to transporting supplies and medical personnel, were also destroyed in the blast. The lack of ambulances will have an impact on the ability to quickly treat wounded when there is bombing or shelling in the area, but above all it will affect the capacity to refer the most sick patients to larger secondary referral hospitals. The makeshift hospital in Al-Marj is not equipped for complex or long-term in-patient hospital care, and this could have a big impact on the ability to refer patients for appropriate secondary care.