The earthquake hit war-scarred northern Syria.

On Monday morning, Syrians in the war-ravaged north of the country woke up to scenes familiar to them for years: collapsed buildings and people pulled from the rubble.

The 7.8 magnitude earthquake, centered in southeastern Turkey but felt as far away as Israel and Cyprus, brought back painful recent memories of Syria’s civil war.

Much of Syria still bears the scars of the conflict, which has been in a fragile ceasefire since early 2020. In the face of sanctions, the lack of reconstruction aid from international donors and its own economy in ruin, reconstruction was fragmentary and limited.

The toll of the war – massive destruction, an acute economic crisis, a collapsing currency – will make the earthquake response even more difficult for all parties.

At least 237 Syrians have been killed and 639 injured in Aleppo, Hama, Latakia and Tartous, according to the Syrian Ministry of Health.

Aleppo, the country’s largest city, is a shadow of its former self, strangled by power outages, a fuel crisis and high unemployment.

The government figures do not include the hard-hit northwest corner of Syria, which is under the control of the Turkish-backed opposition. There, the White Helmets, the civil defense which operates in areas beyond government control, killed dozens and declared a state of emergency. The region is home to some 4.2 million people, more than half of whom were displaced from other parts of the country during the war, many living in large tent camps.

“The organization calls on the international community to take responsibility for this disaster and to take urgent measures to prevent the situation from worsening,” the White Helmets said in a statement on Monday morning. “He also urges the international community to support the rescue of civilians in Syria and to pressure the Assad regime and its Russian ally not to bomb the affected areas.”

In the early years of the conflict, members of the White Helmets were trained in rescue operations by Turkish rescue teams who had honed their craft responding to earthquakes.

The White Helmets used this knowledge to rescue Syrians trapped inside buildings brought down by airstrikes and barrel bombs, launched by the Syrian government and Russia.

In the province of Idlib, near Aleppo, a hospital, supported by the Syrian American Medical Society, was damaged and had to be evacuated.

The Assad government has been so cash-strapped in recent years that it has forced wealthy businessmen to help fund government salaries and services.

Syria’s GDP has more than halved between 2010 and 2020, according to the World Bank. Syria was reclassified as a low-income country in 2018 due to a massive drop in its gross national income. Then the coronavirus pandemic hit in 2020, causing more economic hardship and straining the country’s healthcare system.