“To be able to understand accurately the damage, threat and the devastation of the disaster in Syria, [it is like] we are having a 7.6 earthquake 50 times a day,” writes Ammar al-Salmo, leader of Syrian Civil Defense in Aleppo, on the agency’s website.

To operate in the most dangerous of environments, members of the Civil Defense – also known as the White Helmets – have adapted technically and emotionally. “Before the war, I hated funerals and the sight of blood,” says Ammar al-Salmo, leader of Syria Civil Defense in Aleppo. “But now I feel like I’m drugged, like my heart has become hardened. Killing and massacres have become commonplace, and we’re all now sick and in need of a hospital. When the war ends, I’ll go back home and sleep forever.” The absence of feeling is undoubtedly a sign of shock in response to the sights of war, but it is also what protects the White Helmets from a nervous breakdown, and enables them to work in the worst of conditions. Since they were founded in 2013, they have been able to save about 70,000 civilians, and 148 members of the White Helmets have been killed in the line of duty, according to Khaled Khatib, one of the officials responsible for connecting Syria Civil Defense in Aleppo with the outside world.

According to Khatib, the White Helmets are active in eight provinces in Syria and have 120 centers in these areas, which face targeted bombings from the Syrian regime and its Russian allies. Several centers in Atarib (west of Aleppo), in Aleppo itself and in Idlib and Daraa have been bombed and destroyed. The danger does not stop these men from working or searching for civilians under the rubble to rescue them.

The White Helmets have changed significantly since they were founded, both as an organization and in terms of their work. Their staff have gained more experience and therefore a heightened ability to cope and adapt to new situations, especially the increased bombings that started after Russia’s intervention in September 2015. Russian weaponry is more destructive than that of the Syrian regime, making the need to adapt more difficult but also more important.

Aleppo in northern Syria, for example, has been subjected to continuous bombings from a variety of weaponry, including the infamous barrel bombs that cause significant damage. Many White Helmets have lost their lives while searching for victims and rescuing survivors due to repeated bombings and the so-called “double tap” strategy. To continue their work, they relied on observatories in the countrysides in Idlib and Latakia to monitor air traffic, maintaining constant contact with each other and avoiding grouping together during rescues. They began to use quick mobilization tactics during rescues and when performing first aid, dividing into small groups to avoid larger formations.

The observatories scattered throughout opposition territory in Syria are an early warning mechanism, designed to listen in on wireless means of communications used by regime forces. To communicate with each other, monitoring stations rely on wireless handsets, which provide links among opposition fighters, civilians, the Civil Defense, medical units and first aid teams. The monitoring teams are independent but work frequently with the White Helmets. Civil Defense members carry wireless handsets to communicate with monitoring stations and inform their colleagues of any warplane movement.

The Civil Defense’s range of activities has expanded, especially in Aleppo. According to Fadi al-Halabi – a photographer who works in opposition territory in Aleppo – the White Helmets take their awareness campaigns to schools to explain to children how to act during bombings. They have also taken their outreach campaigns to the mosque, when people are gathered at prayer time, and distributed written awareness-raising materials, as well as illustrated ones to inform people who cannot read.

Members of the Civil Defense have gained broad experience in this field; many activist journalists depend on them to cover the bombings by photographing and documenting the events. “When the bombing happens, we head to the Civil Defense and go out with them to cover it, that’s how most journalists work,” says al-Halabi.

The humanitarian group’s activities are not only limited to rescuing civilians – they are also active in providing other services. The Civil Defense clears roads when they are obstructed with rubble and clears roads and helps residents when snow builds up and there is flooding in the winter.

One of the most significant changes in the Civil Defense is that it is no longer only men. In 2015, Syrian women joined the group to rescue people and provide first aid. According to Khatib, about 80 women volunteers have joined. They work alongside the men, wearing white helmets in opposition territory in southern Syria’s Daraa, Idlib and Aleppo.

Sarah al-Hourani, a journalist working in Daraa, is one of these women. When her brother was injured by a sniper, she did not know how to provide first aid or help him in any other way, so she decided to join the White Helmets to learn first aid and how to treat people. In terms of women’s tactics for this kind of work, she says, “We follow proper conduct during events, and are not reckless or impulsive. We wear protective clothing, like helmets, but unfortunately, defense stations are often specifically targeted by the bombing.”

Women are best known for their work providing first aid to the injured – accompanying them to hospitals to do the work of doctors and nurses. Many women in the Civil Defense do rounds of civilians’ homes to educate people about what to do during bombings, in addition to their work in medical campaigns to help the injured and tell people how to take care of injured family members. According to al-Hourani, they also take care of much of the administrative work.

For the men and women working with the Civil Defense, their challenges do not end with the bombing. Many work as volunteers, and others for very low pay. Alongside their work in rescuing people, some White Helmets continue their original professions as tailors, carpenters, laborers and journalists in order to maintain their livelihood and meet their children’s needs.

After one air raid in a neighborhood in western Aleppo, the Civil Defense recovered several people who had been killed in one house. They confirmed that there were no more bodies, but then noticed more blood, and kept digging until they found a dog under the rubble. They dug him out and tended to his injuries, but he did not survive due to the severity of his injuries.

This year, the White Helmets gained international attention for their work. Sweden awarded them a Right Livelihoods Award – the “alternative Nobel Prize” – in September and they were also nominated for this year’s Nobel Peace Prize, which was ultimately awarded to Colombian president Juan Manuel Santos.

“Once when the area of Hellok, in Aleppo, was bombed, about 13 members of the Civil Defense went to rescue people at 9 a.m.,” says Fadi al-Halabi. “In one house was a man and his son. They were able to rescue the man first, and others took him to the hospital.” Al-Halabi adds that the child was still under the rubble and asked the White Helmets about his father. When they told him he was at the hospital, the boy was upset that his father went without waiting for him, and refused to get out from under the rubble. The White Helmets ended up staying there for hours, trying to convince the boy to get out from under the rubble so they could save him.

The story may seem odd, but it is one local residents will remember – the rescuers’ efforts to treat and rescue people will clearly not be forgotten.

This article was originally published by the Atlantic Council and is reprinted here with permission.

The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Syria Deeply.