HAREM: After more than a decade of bombardment, dwindling international support, and a crippling economic crisis, Syria's opposition-held northwest was already barely hanging on when calamity struck.

Instead of bombs from the sky, the earth rumbled from below early on the morning of Feb. 6 – sending multi-storey cinderblock houses tumbling onto the heads of residents.

The earthquake left more than 35,000 people dead in Turkey, where international help could easily flow in. But the complex politics of humanitarian assistance in Syria's opposition-held northwest left many war-weary citizens there fending for themselves.

Walid Ibrahim lost more than two dozen of his family members – among them his brother, his cousin, and all their children. He only managed to remove their bodies from under the rubble two days after the quake.

"We were removing rock after rock and finding nothing underneath. People were under the concrete screaming, 'Get us out! Get us out!' But we'd come up with empty hands," he said.

"Your hands alone aren't enough."

Parts of the provinces of Idlib and adjacent Aleppo held by Turkey-backed rebels suffered the bulk of the quake's casualties in Syria: over 4,000 of the entire Syrian death toll of more than 5,800, according to the United Nations and government authorities.

Four Syrian towns in a stretch bordering Turkey were among the hardest hit: Salqin, Harem, Jinderis and Atareb.

On an organised press tour on Tuesday, Reuters saw around 20 men and boys trying to salvage what they could from pulverized homes in Harem and its outskirts, without protective gear or uniforms.

Only some wore work gloves, covered in the grey-white dust of smashed cinderblocks. Even their eyelashes, cracked lips and beards were coated in the chalky substance.

One man prayed among the rubble as a lone excavator cleared debris. Children chased each other around mounds of ruins and twisted rebar.

'HARDEST WEEK'

The frontlines had become relatively quiet over a decade into the conflict - which erupted in 2011 with protests against President Bashar al-Assad that ended up carving the country into competing cantons.

Raed Saleh, who heads the 'White Helmets' rescue force operating in opposition-held areas, is more accustomed to rescuing victims of bombardment.

He said rescuers had been allowed to go home to see their families for the first time on Tuesday, after round-the-clock operations for the last eight days that required every volunteer and every piece of equipment.

"It was the hardest week of our lives," he said.

"What happened to us – it's the first time it's happened around the world. There was an earthquake and the international community and the U.N. don't help," he said.

Saleh and others in the northwest said more lives could have been saved in Syria if the outside world had acted faster.

The earthquake hit Turkish cities where major humanitarian organisations running aid operations in Syria are based and the single border crossing from Turkey was closed for days.

Dozens of U.N. aid trucks later brought food and medicine through that crossing, authorized by a 2014 Security Council resolution that allowed aid into Syria without Assad's approval.

On Tuesday, eight days after the quake, a second border crossing for aid delivery was opened after Assad gave his assent, marking a shift for Damascus which has long opposed cross-border aid deliveries to the rebel enclave.

But the move was met with scepticism and even anger by many residents of Idlib, where a bulk of the 4 million residents hail from other bombed-out provinces.

"If Assad wanted to help these poor people, then he wouldn't have displaced them to begin with," said Joumaa Ramadan, a day labourer.

The trucks included none of the heavy equipment and machines that rescuers say they need to remove rubble faster – and that could have helped with reconstruction.

Syria's economic crisis may also hinder rebuilding, with 77% of households already unable to secure their basic needs, according to a U.N. assessment.

Those in Idlib have no choice but to rebuild, with Turkey, which hosts 3.6 million Syrians, no longer accepting others, while many fear to cross the frontline into areas controlled by Assad's forces. But resources are scarce.

"The situation is really tragic," said Abdulrahman Mohammad, a displaced Syrian originally from the neighbouring province of Aleppo.

"Anyone who is working as a labourer and renting a house... If you need $10 a day in expenses and you can barely get that – how are you supposed to rebuild?" he said.

Hospitals used all of their reserves of medical equipment treating the quake victims, said Abdulrazzaq Zaqzouq, a local representative for the Syrian-American Medical Society.

Health Minister Hussein Bazar, of the self-declared Salvation Government in northwest Syria, said that the displacement of tens of thousands could lead to a "massive" surge in the cholera outbreak already ravaging the water-stressed zone, as well as a spike in other diseases.

"This is not about a tent or a bite of food. That's not the essential thing for people," he said.

"People want to feel that they're seen as human beings who deserve to live in dignity in this area."