Scores of Syrians, many of them women and young children, were killed Tuesday in one of the deadliest chemical attacks of the country's six-year war, according to doctors, rescue workers and witnesses.
Airstrikes on the northwestern town of Khan Sheikhoun began just after daybreak, delivering an unidentified chemical agent that killed at least 58 people and filled clinics across the area with patients foaming at the mouth or struggling to breathe.
President Donald Trump blamed the attack, which he said was carried out by the Syrian government, on former president Barack Obama, calling it a "consequence" of Obama's "weakness and irresolution." The reference was to Obama's decision not to follow through with a threat to use military force against Syrian President Bashar Assad after a 2012 chemical attack.
In a statement released by the White House - just days after the administration said action against Assad was not a U.S. priority - Trump called the Tuesday attack "reprehensible" and said that it "cannot be ignored by the civilized world." At the United Nations, U.S. Ambassador Nikki Haley called for an emergency meeting of the Security Council.
The Syrian Observatory for Human Rights, a Britain-based monitoring network, put the death toll at 58, including at least 11 children. Doctors at the scene cited higher figures, saying entire families were killed in their sleep.
Three doctors said in interviews that the symptoms they saw were far more serious than they would expect from chlorine, which Syrian government forces have used as a chemical weapon in the past. The Hague-based Organization for the Prohibition of Chemical Weapons expressed "serious concern" and said it was investigating.
Images from the area showed the bodies of at least a dozen men, women and children splayed across the ground between two houses. It was not possible to independently verify the reports, but video footage showed lifeless bodies wrapped in blankets and packed on the back of a truck. The youngest were wearing diapers.
In another video, several children were seen slumped on hospital beds, apparently unresponsive to the medics and chaos around them.
Syrian government warplanes in recent months have launched heavy attacks across northern Idlib province, where hundreds of thousands of civilians - many having fled other battle zones - are squeezed together among much of what remains of the armed opposition to Assad.
Syria's Foreign Ministry denied involvement in Tuesday's attack, saying the government was committed to its obligations under the international Chemical Weapons Convention. Syria joined the convention in 2013 after launching sarin attacks on several Damascus neighborhoods - strikes that killed hundreds of civilians and pushed the United States to the brink of military intervention.
"Assad calculates, reasonably, that military dynamics play in his favor. By using chemical weapons and other weapons, he is demonstrating the powerlessness of international actors," said Emile Hokayem, a Middle East analyst at the International Institute for Strategic Studies.
Congressional refusal to vote in favor of U.S. military action after Assad's use of sarin, a nerve agent, in 2012 provided Obama with cover to withdraw his ultimatum, although he continued to call for Assad to leave power. The United States and Russia, Assad's main backer, then negotiated a plan for the internationally supervised removal of Syria's chemical weapons stocks.
Throughout his presidential campaign, Trump criticized Obama for what he said was a waste of attention and resources on Syria's internal struggle at the expense of the fight against the Islamic State. Late last week, Haley said the U.S. priority was no longer to "focus on getting Assad out," while Secretary of State Rex Tillerson said the Syrian people should decide Assad's future.
A senior State Department official told reporters Tuesday that Assad has committed "war crimes" and blamed his Russian and Iranian backers for failing to control him. Those two countries are "guarantors" of a cease-fire they negotiated, the official said, but "clearly, they are not able to deliver."
"That's a very significant problem. Obviously that'll be something that we'll be looking at and discussing and reviewing," said the official, who noted that Tillerson will visit Moscow this month. The official spoke on the condition of anonymity under rules set by the State Department.
The attack came as European diplomats gathered in Brussels for a flagship conference aimed at pledging billions of dollars for Syria's reconstruction, six years into a civil conflict that has shattered much of the country and prompted refugees to pour out across the Middle East and Europe.
Photographs of lifeless bodies in Khan Sheikhoun were passed from phone to phone in the Brussels conference hall, attendees said, a stark reminder of the limitations of European power in a war now heavily driven by Iranian and Russian influence.
In Washington, Senate Foreign Relations Committee Chairman Bob Corker, R-Tenn., echoed Trump's criticism of Obama, saying that the former president had "figuratively jumped in [Russian President Vladimir] Putin's lap" to agree on the weapons withdrawal.
Sen. John McCain, R-Ariz., said that "Assad believes he can commit war crimes with impunity," and he challenged Trump to take action. The question now confronting Washington, he said, "is whether we will take any action to disabuse him of this murderous notion."
Doctors and activists in rebel-held areas have accused the government of sharply increasing chemical attacks across Idlib, Aleppo and Hama provinces since the end of last year.
In the Khan Sheikhoun attack, Samer al-Youssef, a resident, described watching people running toward the homes of relatives, then wrenching open the doors to find them dead inside.
"We did our best, but we couldn't save people. Around 30 percent of those who were brought to us were dead on arrival," said Usama Darwish, a doctor.
Although a nationwide cease-fire has technically been in place across Syria since late December, civilians and rebel groups now say it exists in name only.
"People are terrified. They don't know where to go," said Ahmad Rahhal, a 22-year-old activist. "They can't cross into Turkey because the borders are closed, but if they stay in their houses, they will be attacked by bombs. What can they do?"
As a displacement crisis burgeons on its southern border, Turkey has limited new Syrian arrivals to those seeking medical treatment, often in the wake of attacks. Reports Tuesday suggested that ambulances were lined up at the border crossing, ready to bring the next wave of casualties to Turkish hospitals.
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