The red and white Lebanese flag, of course, was everywhere, but so too were makeshift black flags, waved side by side with the national flag. I know the bearers intended their banners to be symbols of mourning, but I couldn’t help thinking they could have just as well been the black flag of anarchy — since that’s what many fear Lebanon is on the verge of slipping into.

When the bomb went off on Monday, I was walking with my girlfriend, Tara, a little less than a mile away. Nonetheless, we could both feel the explosion reverberate in our ribcages, which was the first sign that what we had just heard was not just a demolition charge from a nearby construction site. Still, we had no idea just how big the bomb was until we arrived on the scene 10 minutes later.

I had felt explosions reverberate in my body before, and it’s an eerie feeling, like someone has just shocked you with a heart resuscitator or punched you full force in the solar plexus. Once, as an Army Ranger on a mission in Iraq, I had ordered the use of fragmentary grenades to clear a room in the midst of a firefight. The resulting concussion bounced off the walls and shook those of us in the adjacent rooms; I could imagine what it had done to the people inside before we even entered.

By contrast, the bomb in Beirut had done the same thing from almost a mile away, and unlike the grenade, it wasn’t even in a confined space where it could reverberate off anything. So I shouldn’t have been shocked when I arrived and saw how big the crater caused by the bomb was, but I was.

Later that afternoon, I discussed the blast with a friend, a former United Nations official who lived in Lebanon during the 15-year civil war that ended in 1990 (a war that Hariri helped mediate from abroad before he returned to his native Lebanon and became prime minister). We both estimated the explosive charge to have been massive, over 300 kilograms in weight. The crater it left in the middle of the Corniche was at least three meters deep and 20 wide, astonishing given all the asphalt and rock it had to blast through.

The first culprit on everyone’s minds was Syria. Hariri had resigned as prime minister in protest of Syria’s meddling in Lebanese affairs, and those opposed to the current pro-Syrian prime minister, Omar Karami, had been courting him of late. (Syrian troops’ presence in Lebanon was legitimized by the Arab League after Lebanon’s civil war, but U.N. Security Council Resolution 1559, which calls for the troops’ withdrawal, has emboldened Lebanese opposed to their presence.) Later in the day the groups opposed to Karami would issue a statement placing the blame squarely on the shoulders of Damascus.

For the rest of the day on Monday, Beirut remained in a state of shellshock. Without even being told, shops and restaurants shuttered their businesses midafternoon. People went home to their families, city residents back to their villages in the mountains and the south. Many of those who remained dressed up in their best dark suits and made the drive to Qoreitem to pay their respects to the Hariri family.

Tuesday was much the same. All stores and restaurants remained closed for the duration of the mourning period. Tara, a photographer, sent her pictures back to New York, and then we both headed out of town, up north to the coastal town of Byblos in search of a good restaurant still open.

When we arrived back in town that night, Beirut remained a ghost town — the streets still empty, the stores all still shuttered. The only signs of life were the glossy pictures of Hariri that had suddenly sprouted up everywhere — on apartment buildings, on billboards, on windows and on cars.

An American friend called me once we arrived back in town. A group of resourceful expatriates had gathered up enough groceries and liquor for an “end of the world” dinner before the next day’s funeral, where anything seemed likely to happen. I contributed a fifth of bourbon, and we all crowded around the dinner table, exchanging our best guesses late into the night as to what might happen next. We laughed at one another’s gallows humor and the sad state of affairs in tiny, hapless Lebanon. Halfway through, however, one of our Lebanese friends excused herself, and I quickly realized how callous we had been. For us, as Westerners, everything that happened in Lebanon took place in the third person. For us, a trip out of the country was just a passport away. For her, however, this was the only country she had — and she was smart enough to know in what awful direction it appeared to be heading.

Wednesday morning, as the crowds began to gather around Hariri’s mansion in Qoreitem for the funeral procession into downtown, I ran into my same group of friends standing by a busy intersection not two blocks from my apartment. The Lebanese friend I was worried we had offended had copies of all the day’s newspapers in her hand, and I asked to see them. On the front page of one, I saw a remarkable photograph that filled me with both a sense of hope for the country and at the same time fear.

Hariri’s two sons, Sunni Muslims, stood together in the photograph side by side with the Druze chieftain, Walid Jumblatt, and the Maronite Christian patriarch, Nasrallah Boutros Sfeir. They were all receiving mourners, together, inside the Hariri residence.

To someone with little background knowledge of Lebanon and the Middle East, such a photograph would seem unremarkable. But for anyone with even a passing understanding of the sectarian conflict that engulfed Lebanon from 1975 until 1990, the image of the four men standing united under the headline “Hariris Snub Government Overtures” was nothing short of amazing. For now, the leaders of once bitter rivals have put aside their differences in united contempt toward the current regime, widely dismissed as puppets of the Syrian government.

And as one of the keenest longtime observers of the Middle East, David Hirst, noted in the Guardian, Syria “is on the defensive. So are its Lebanese allies, inside and outside the regime.”

For that reason a friend of mine felt the attack on Hariri was a “message” — meant to remind those calling for Lebanese independence to remember who really remains in charge of the country.

The day of the funeral, however, belonged to Hariri and the opposition. Tara and I followed the procession for a while through the crowded, crazy Beirut streets until we had had enough and took a shortcut to the unfinished mosque that was being built by Hariri downtown, where the funeral was to be held. Already, tens of thousands of people had gathered, and we worked our way down to the VIP seating section just in time to snap pictures of the American ambassador arriving.

I chatted with one of the men on his security detail for a while and asked him if he had ever seen such a mess as far as security was concerned. The crowd had by now grown to hundreds of thousands, and I kept one arm around Tara to keep her from getting swept away in the flood of shouting, chanting men and women. The Boy Scouts of Lebanon, of all people, kept a semblance of order, linking their arms to hold back the crowd. I tried to imagine the Boy Scouts doing the same thing in America, out there in their uniforms with their merit badges, and the ambassador’s security man and I chuckled as — against all odds — the scouts managed to keep people from killing one another outside the mosque.

Tara and I traded her camera back and forth, me holding it high above my head in an effort to get some pictures of the wild crowd as they pushed against one another for space.

The two of us then spent 15 minutes fighting our way through the crowd to get another angle, and we saw several people being led away on stretchers by the Red Cross, most of them casualties of the heat. Once again, the Boy Scouts, together with the Red Cross and a phalanx of Druze clerics, managed to keep some sort of order outside the mosque. We narrowly avoiding being trampled as bearers started unloading the coffins carrying Hariri’s security detail killed in the blast.

We then crept around the corner, where we saw a group of boys climbing over the walls of the unfinished mosque. We followed them in and then followed a smaller group of people to the roof of the mosque, where we looked down on the crowd as the service came to a close.

Forty feet below, in the street, one of the valiant scouts was bleeding from the head as the result of some unseen blow. He would be OK, though, and as his mates helped him to the Red Cross station, I watched his fellow scouts attempt to put his bloody blue beret back on his head as he limped away. I didn’t know whether to laugh or cry. The whole scene was just so awful and beautiful and confusing and hopeful.

And that, I realized, is the city of Beirut and the country of Lebanon in a nutshell. Now perhaps more than ever. In a time of mourning and fear, there is also a sense that this horrible tragedy really might change things for the better, that somehow this will force the last cards left in Syria’s hand, that although the death of a man as financially powerful as Rafik Hariri might mean the start of a long night for Lebanon’s economy, it might also signal the start of something else, perhaps even the long-awaited independence of the Lebanese people.

The majority of the predictions, of course, have been far more negative. Most prognosticators never even bothered to imagine a Lebanon without Hariri because it was just too awful to comprehend. Most people fear Lebanon is about to slip back into the abyss of open warfare. But in a country that has already survived 15 year of brutal civil war, the greatest natural resource left in Lebanon is hope. And maybe, just maybe, that will be enough this time.

“The big question today is to implement the Libyan or Yemeni scenario in Syria,” the head of a Damascus-based think tank told GlobalPost, requesting anonymity to speak without fear of reprisal.

“The United Sates will discuss the Yemeni scenario with Russia to implement it in Syria, but if Russia refused then the Libyan scenario is coming for sure.”

US President Barack Obama is already actively seeking Russian cooperation on removing Assad from power while retaining the structure of the state, according to a report last week in the New York Times.

Yemen’s Vice President Abdu Rabbu Mansour al-Hadi ascended to the top job backed by both the opposition and by powerful remnants of former President Ali Abdullah Saleh’s regime — including his own family members still running the security forces.

But analysts say Syria’s vice president, Farouk al-Sharaa, who has been all but absent from the public sphere since the start of the uprising in March last year, has neither the trust of the opposition nor the support of the regime, making any such transition of power highly problematic.

“Sharaa is very weak and has no power and popularity among either pro- or anti-regime Syrians. The army and senior security officers don’t respect Sharaa, who spends his days between his house and his office doing nothing,” the analyst said.

“He doesn’t even hold meetings with visitors to Syria or key local figures. So the Yemeni scenario is going to fail, even if Russia supports it.”

Amid the international outcry that followed the killing by Assad’s security forces of at least 108 people in the villages of Houla, in northwest Syria, on March 25, Russia repeated its refusal on Wednesday to sanction any international action that could lead to military force used against Assad’s regime.

The continued diplomatic deadlock came as details emerged that the massacre, one of the worst in the 14-month uprising, was sectarian in nature, leading to fears that the conflict was shifting from an uprising to a civil war.

Moreover, the conflict appears to have sharper consequences than previously believed: According to a report co-authored by the Syrian Network for Human Rights and the Damascus Centre for Human Rights Studies, more than 14,000 people have died, well above the widely quoted but outdated UN estimate of 9,000.

UN monitors in Syria, whose accounts were corroborated with other sources, found that most of the 108 Syrians killed in Houla appeared to have been shot at close range in “summary executions of civilians, women and children.”

Fewer than 20 people were killed by government artillery fire, UN High Commissioner for Human Rights spokesman Rupert Colville told a news conference in Geneva on Wednesday.

Speaking to GlobalPost from Houla, a resident said that the attacks began after security forces had opened fire on a large anti-regime protest on Friday afternoon.

In response, local rebel fighters from the Free Syrian Army, which he said had been largely in control of Houla for the past three months, stormed military checkpoints set up around the villages and launched a coordinated attack against a nearby army base, using rocket-propelled grenades and machine guns.

That triggered the army to launch a barrage of rocket fire on the four villages, using similar weapons as the assault that devastated Homs’ Baba Amr district. Previously, the resident said, Houla had suffered bombardment, but from tank fire, not the heavier rockets and mortars used in the May 25 attack.

Houla is a collection of four Sunni-majority villages some 20 kilometers northwest of Homs. It is surrounded by villages that are home to Allawites, a sect of Shiite Islam, to which the Assad family and a majority of the regime’s ruling elites belong.

An opposition activist in Houla told GlobalPost that as shelling intensified around 6:30 p.m., he saw what he believed were Allawite militiamen, known as shabiha, arriving on five buses protected by soldiers.

“The bombing began as usual and there were numerous injuries. But this Friday the bombing was more severe. During the shelling, buses with shabiha arrived at the village of Houla from the surrounding villages of Fulla, Al Qabu and Al Shinnea.”

The activist did not witness the killings himself, but said that when members of the Free Syrian Army returned to Houla after battling the military late on Friday night, he and other activists entered the homes that had been raided.

“We entered the houses after the departure of the shabiha and found families had been slaughtered with knives. Almost all the women and children had been stabbed and the men had been shot,” he said.

“Frankly, what I felt when we were dragging the bodies of women and children out of their homes is only that I want to take revenge against the other sect which has committed this massacre. Unfortunately this is how the regime has made us think.”

Thirty-four women and 49 children, by the UN’s count, were stabbed or shot dead at point-blank range.

Most of those killed belonged to the large Abdel Razzak family. Local activists provided Human Rights Watch with a list of 62 dead members from the family. According to survivors, the Abdel Razzaks own the land and farms next to the national water company and the water dam of Taldou, one of the villages of Houla, and lived in eight or nine houses next to each other, two families to a house.

“[The killers] were wearing military clothes. I couldn’t see their faces. I thought they wanted to search the house,” an elderly woman from the Abdel Razzak family told Human Rights Watch.

“After three minutes, I heard all my family members screaming and yelling. The children, all aged between 10 and 14, were crying. I heard several gunshots. I was so terrified I couldn’t stand on my legs. I heard the soldiers leaving. I looked outside the room and saw all of my family members shot. They were shot in their bodies and their head.”

Syria’s state news agency SANA said Assad told Annan today that “terrorist groups” had stepped up their actions recently, and it was up to the states that arm, finance and harbor them to abide by Annan’s plan to end the violence engulfing Syria.

Civilians are cynical about the negotiations.

“Syrians don’t want words on paper and meetings in offices or five-star hotels. Syrians want practical solutions to stop the killing and massacres,” Osama, a 30-year-old civil engineer who said he supports neither the opposition nor regime, told GlobalPost in Damascus.

“The Annan plan and 300 UN monitors couldn’t prevent massacres in Houla, Hama and Homs in the last three days. Syrians began to believe there is no hope from the UN and the international community. If the people of Houla had weapons, then Assad’s Allawite Shabiha could not have slaughtered those women and children in cold blood.”

A correspondent in Damascus, Syria, contributed to this report. Hugh Macleod contributed from Beirut, Lebanon.

However, there was no indication that Russia, one of the veto-wielding permanent members of the Security Council, was changing its position on Syria.

Dmitry Peskov, President Vladimir Putin’s spokesman, was quoted as saying by the ITAR-Tass news agency Wednesday that “there can be no talk” about a shift in Russia’s stance on Syria under foreign pressure.

Russia, along with China, has twice shielded Syrian President Bashar Assad’s regime from the U.N. sanctions over his crackdown on protests. Syria is Russia’s last ally in the region, providing Moscow with its only naval base outside the former Soviet Union and a top customer for Russian weapons industries.

Guehenno, the Annan deputy and a former U.N. peacekeeping chief, also warned of the possibility of outside groups and terrorists taking advantage of the violence. “In any situation where there is a risk of civil war you have opportunistic actors, if one can say that, that can try to exploit that,” he said.

Guehenno said he told the closed session of the 15-nation council that Annan’s six-point peace plan to end the 15-month conflict must be fully implemented and that political process must include talks between the Syrian government and the opposition.

“It<s very important that the Security Council be united in pushing for a political process,” Guehenno said.

Annan held talks with Assad in Damascus on Tuesday following the weekend massacre in Houla of more than 100 people, many of them women and children.

At the U.N. headquarters in New York, Germany’s U.N. Ambassador Peter Wittig said Guehenno told the council that while Annan was in Damascus he appealed to the Assad<s government “to take bold steps forward” to end the violence immediately and implement the peace plan.

U.S. Ambassador Susan Rice said the worst but most probable scenario in Syria is a failure of Annan’s peace plan and a spreading conflict that creates “a major crisis” not only in Syria but also region-wide.

“And members of this council and members of the international community are left with the option only of considering whether they are prepared to take actions outside of the Annan plan and the authority of this council,” she told reporters.

The best scenario would be for the Syrian government to immediately start complying with the plan, she said, but that doesn’t seem to be “a high probability.”

And if Assad refuses to implement it, Rice added, then the Security Council should set aside its differences and up the pressure on Syria with added sanctions.

Minutes after she spoke, Russia<s U.N. Ambassador Vitaly Churkin told reporters that “our attitude to sanctions frankly continues to be negative.”

But Rice, Churkin and other council members agree the best scenario is full implementation of the Annan plan, with talks between opposing sides, despite the increasing worry that will never happen.

They also agree on the need for all sides to immediately halt the violence and for Syrian troops and heavy weapons to be withdrawn from towns and cities, with the government also providing access to detainees, journalists and humanitarian workers.

Annan said in Damascus that the situation has reached “a tipping point” and many council ambassadors agreed, including Rice.

“I think we may be beginning to see the wheels coming off this bus,” she said.

Britain’s U.N. Ambassador Mark Lyall Grant said Guehenno and one of his French successors, the current U.N. peacekeeping chief Herve Ladsous, provided a grim briefing.

Lyall Grant said there was a sense of “revulsion” at the weekend massacre and the increase in extremist attacks with a new sectarian element, all of which are throwing up roadblocks to Annan<s peace plan.

“The key thing is unity of the council,” he said, calling for discussion at the U.N. and in world capitals on how to avoid a civil war in Syria.

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Lederer reported from the United Nations. Eileen Powell contributed from New York.

(This version CORRECTS Corrects British ambassador’s surname on second reference to Lyall Grant.)

Survivors of the Houla massacre blamed pro-regime gunmen for at least some of the carnage as the killings reverberated inside Syria and beyond, further isolating Assad and embarrassing his few remaining allies.

“It’s very hard for me to describe what I saw, the images were incredibly disturbing,” a Houla resident who hid in his home during the massacre told The Associated Press on Tuesday. “Women, children without heads, their brains or stomachs spilling out.”

He said the pro-regime gunmen, known as shabiha, targeted the most vulnerable in the farming villages that make up Houla, a poor area in Homs province. “They went after the women, children and elderly,” he said, asking that his name not be used out of fear of reprisals.

Assad’s government often deploys fearsome militias that provide muscle for the regime and carry out military-style attacks. They frequently work closely with soldiers and security forces, but the regime never acknowledges their existence, allowing it to deny responsibility for their actions.

U.N. peacekeeping chief Herve Ladsous said there are strong suspicions that pro-Assad fighters were responsible for some of the killings, adding that he has seen no reason to believe that “third elements” — or outside forces — were involved, although he did not rule it out.

The Syrian regime has denied any role in the massacre, blaming the killings on “armed terrorists” who attacked army positions in the area and slaughtered innocent civilians. It has provided no evidence to support its narrative, nor has it given a death toll.

Following his meeting with Assad, Annan called on the government and “all government-backed militias” to stop military operations and show maximum restraint. He also called on the armed opposition to stop all violence.

“We are at a tipping point,” Annan told reporters in Damascus. “The Syrian people do not want the future to be one of bloodshed and division.”

Cranking up the pressure on Assad, the Obama administration gave Syria’s most senior envoy in Washington, the charge d’affaires at the Syrian Embassy, 72 hours to leave the United States. Britain, Canada, Australia, France, Germany, Italy, Spain and Bulgaria also expelled Syrian diplomats.

“We hold the Syrian government responsible for this slaughter of innocent lives,” State Department spokeswoman Victoria Nuland said in Washington. “This massacre is the most unambiguous indictment to date of the Syrian government’s flagrant violations of its U.N. Security Council obligations.”

The massacre in Houla could prove to be a watershed moment in the Syrian crisis, which began in March 2011 with peaceful protests inspired by the wave of uprisings sweeping the Arab world.

Nearly 15 months later, the country is in many ways unrecognizable from the days before the revolt. Assad, once considered a potential reformer in a region filled with aging dictators, is a global pariah. A country that once boasted it was the safest in the Middle East is riven with violence, some of it reminiscent of the worst days of the Iraq war. The economy is in tatters. Syrians are facing price increases for basic goods and endure regular power cuts.

And in some haunting cases, neighbors who have lived side by side for years are turning on each other, driven by sectarian hatred that so many months of violence is laying bare.

According to witnesses, the massacre, which began late Friday in an area about 40 kilometers (25 miles) northwest of the city of Homs, had dangerous sectarian overtones.

The victims lived in the Houla area’s Sunni Muslim villages. But the shabiha forces allegedly behind many of the killings came from an arc of nearby villages populated by Alawites, an offshoot of Shiite Islam.

Most shabiha fighters belong to the Alawite sect, to which the Assad family and the ruling elite also belong. This ensures the gunmen’s loyalty to the regime, built on fears they will be persecuted if the Sunni majority gains the upper hand.

Sunnis make up most of Syria’s 22 million people, as well as the backbone of the opposition. Even as much of the opposition insists the movement is entirely secular, disturbing reports from the ground suggest religious tensions are boiling over.

The volatile sectarian divide makes civil war one of the most dire scenarios.

Activists say as many as 13,000 people have been killed in the uprising. The U.N. put the toll at 9,000 as of March — one year into the revolt — but many hundreds more have died since.

On Tuesday, the U.N.’s human rights office said most of the 108 victims of the Houla massacre were shot at close range. The U.N. report indicated that most of the dead were killed execution-style, with fewer than 20 people cut down by regime shelling.

Deaths from heavy artillery can be blamed on regime forces with relative confidence because rebel fighters do not have such weapons. But it is more difficult to determine who is behind the close-range killings — particularly as Syria sharply restricts media access.

Still, the U.N. cited survivors and witnesses blaming the house-to-house killings on shabiha. Witnesses also told the AP that shabiha were behind the attacks.

“What is very clear is this was an absolutely abominable event that took place in Houla, and at least a substantial part of it was summary executions of civilians, women and children,” said Rupert Colville, spokesman for the U.N. High commissioner for Human Rights.

“At this point, it looks like entire families were shot in their houses,” he said.

It is not clear what touched off the convulsion of violence. Houla activists reached by Skype said government troops shelled the area after anti-government protests on Friday and clashed with local rebels. Later, shabiha from nearby villages swept through the area, stabbing residents and shooting them at close range.

Videos posted online by anti-regime activists show explosions in Houla and dismembered bodies in the streets, then row upon row of the dead laid out before being buried in a mass grave. Some videos showed dozens of dead children, some with gaping wounds.

According to the state-run news agency, SANA, Assad on Tuesday blamed terrorists and weapons smugglers for scuttling the peace plan, which called for a cease-fire and dialogue with the opposition. The regime denies there is any popular will behind the country’s uprising, saying foreign extremists and terrorists are driving the unrest.

Although Damascus has remained largely impervious to international condemnation over the course of the uprising, Tuesday’s diplomatic squeeze will increase pressure on Syria’s remaining allies, including Russia.

Russia has provided a key layer of protection for the Syrian government in the uprising. Russia and China have used their veto power to block U.N. resolutions against Assad. But Russia has grown increasingly critical of Damascus in recent months, and the Houla massacre has prompted some of the strongest condemnations yet from Moscow.

Russian President Vladimir Putin is traveling to Germany and France this week and is likely to come under even greater criticism for his support of the regime.

“We have to continue our work with the Russians,” British Foreign Secretary William Hague said. “We will continue to discuss this with Russia. Russia has particular leverage on the regime and therefore has a particular role in this crisis.”

Despite some shift in Russia’s stance recently, Russian Foreign Minister Sergey Lavrov said Tuesday the Houla massacre must not be a pretext to push for military intervention from outside. Instead, he urged all sides to focus on the Annan plan.

Hague said that the situation in Syria is more complicated than what international powers faced in Libya last year, when a U.N. resolution ushered in NATO military intervention against dictator Moammar Gadhafi’s regime.

White House spokesman Jay Carney said the Obama administration remains opposed to military action, reasoning that it would lead only to more carnage. He said the U.S. will continue offering non-lethal assistance to the Syrian people and said Tuesday’s coordinated move to expel Syrian diplomats was a signal of the international community’s “absolute disgust” with Assad’s rule.

Assad still commands a strong army that has proven largely unwilling to turn on him. The entire structure of the state has been built to preserve Assad’s power, with the military, the police and security services — even the economy — tied up with the survival of his presidency.

But as the violence engulfs the country, many see Assad’s departure as the only way out.

Fawaz Zakri, a member of the opposition Syrian National Council, urged action by the U.N. Security Council, saying the world body “must do something to save the Syrian people’s souls.”

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Associated Press writers Zeina Karam and Ben Hubbard in Beirut, Angela Charlton in Paris, Frank Jordans in Geneva, Edith M. Lederer at the United Nations, Albert Aji in Damascus, Syria, and Selcan Hacaoglu in Ankara, Turkey, contributed reporting.

There were many hospitals much closer to the scene, but these are government run, and the risk of execution or arrest, particularly for those arriving with battle wounds, is so high that citizens throughout the area endure these dangerous journeys every day.

“Most of the death cases we see are because of the distance,” said Dr. Mohammed, a neurosurgeon who treated the Deersonpol cases at his clinic in Deir Alsharky. “Most bleed to death along the way. Today we lost three from injuries that could be treated if we’d got to them in time.”

Many doctors and patients asked to be referred to only by their first names for fear of authorities. Dr. Mohammed was no exception. After his home and his practice in Damascus were raided by authorities, he became wanted on the charge of treating injured demonstrators and members of the Free Syrian Army. He was forced to flee the city with nothing.

“The soldiers would come into the hospitals and kill and arrest patients, especially after the Friday demonstrations,” he said of his work in Damascus before he fled the city in January. “Even in the intensive care units, the soldiers would come in and kill the patients in their beds or drag them into the streets. I have seen this many times.”

Due to the risks, secret hospitals have sprung up across the country. Some are manned only by untrained nurses. Volunteer doctors and surgeons working in primitive conditions run others, like Dr. Mohammed’s clinic. Immediately after surgery, the patients are sent to safe houses protected by the Free Syrian Army, where their condition is monitored.

Doctors Without Borders, an international nongovernmental organization, confirmed the government practice of targeting medical workers and patients in a report released earlier this month.

“We saw militarized health care facilities, meaning that access to medical care depends on which side you belong,” said Brice de le Vingne, the organization’s director of operations in Brussels. “Health facilities are being targeted, thus endangering patients and preventing health care workers from doing their jobs. Health facilities and pharmacies are looted and destroyed.”

Dr. Mohammed said most of his equipment is donated and smuggled in from Turkey. He shows a respirator, two new surgical sets and a radio that just arrived. Medical supplies and medications are always in short supply.

For some patients, the treatment they need is simply not available in these makeshift secret clinics.

In Maarat Al-Numaan, a government checkpoint stands by the city hospital. A few blocks away in a narrow alley is the door to the secret clinic. The doctor here, Ahmed Rawin, said they are afraid to keep patient records in case of a raid. They list only those who need follow-up treatment in the safe houses in a small notebook. Dr. Ahmed told the story of one recent patient in desperate need of life support.

“We moved him to the international hospital under a fake name,” he said. “Within days the soldiers came and killed him. They threw his body into the street.”

Many seek treatment in Turkey, but the journey is difficult. Rowad, 22, said he just returned from surgery across the border. As a member of the Free Syrian Army, he was injured by shrapnel during a clash with government forces. Nerve damage caused him to lose feeling in his right leg. After surgery performed by Dr. Mohammed, members of the Free Syrian Army snuck him across the Turkish border for follow-up surgery.

“Most of the way we managed to go by car, but they had to carry me for about three kilometers,” said Rowad, who still has no feeling in his leg, but can now walk with the help of crutches.

Dr. Mohammed said in the past week he has sent three urgent cases across to Turkey. Two died en route.

Activist Abdul Aziz Agini, who works with the Free Syrian Army near the Turkish border, said he receives requests to arrange transport for patients almost daily.

“We suffer a lot to get them there. We must carry them on our backs,” he said.

There isn’t enough manpower for everyone, however, and many in desperate need of medical treatment must wait to find a safe passage.

In Ariha, another town in Idlib province, the smell was nauseating as a 60-year-old man removed a bandage from his infected feet — most of the skin and flesh was gone. The man, who works as a butcher, was arrested at a checkpoint. His court papers say he is accused of “participating in demonstrations.” He was held and tortured for 45 days.

“They hit my foot with a wire cable telling me to confess,” he said, adding that he was released 10 days earlier. “When they took me to court, they had to carry me. When the judge saw me, he didn’t even question me. He ordered my release.”

So far, the route through Turkey has been too dangerous for someone in his condition. Until now he has been unable to get any treatment.

“We are in a large concentration camp called Syria,” he said. “My fate is in God’s hands.”

Volunteer doctors say they receive many cases of torture by authorities. Treating these patients often leads to their own arrest. Dr. Najib Aledel has been imprisoned twice for his work in a secret hospital in Ariha. Ten days after his last release, Dr. Aledel said he was back on the wanted list.

“There was no injury for me,” he said in reference to his two months of total prison time. “But I saw very bad deeds happen to others, and there is no [medical] treatment inside the prisons.”

Dr. Aledel said the cease-fire agreement between the government of Bashar al-Assad and the Free Syrian Army is in name only. The patient number has dropped, but not significantly, he said. And medical supplies, he said, are so low he and his staff often give their own blood to patients in need of transfusions. He said there are no humanitarian groups or overseas aid, and the only supplies come through private donations, both local and international. In all clinics, doctors said they desperately need more support from abroad.

Mohammed, an activist and pharmacist that secretly supplies these underground clinics in Ariha, believes these attacks on the medical system are yet another way to instill fear into the people.

“The government is aiming for social chaos so people will get desperate and ask for the government to come back,” he said. “But now we have started. There is no going back.”

Britain and France had proposed issuing a press statement condemning the massacre, but Russia told Security Council members it could not agree and wanted a briefing first by Norwegian Maj. Gen. Robert Mood, the head of the U.N. observer team inside the country. Russia has been Syria’s most powerful ally during the uprising, and along with China has used its veto power to shield Damascus from U.N. sanctions.

The massacre in Houla on Friday cast fresh doubts on the ability of an international peace plan put forward by envoy Kofi Annan to end Syria’s 14-month-old crisis.

The brutality of the killings became clear in amateur videos posted online that showed scores of bodies, many of them young children, in neat rows and covered with blood and deep wounds. A later video showed the bodies, wrapped in white sheets, being placed in a sprawling mass grave.

The U.N. counted at least 32 children under the age of 10 among more than 90 dead and said its observers found tank and artillery shells at the site, suggesting the regime’s well-equipped forces were to blame.

Activists from the area said the army pounded the villages with artillery and clashed with local rebels after protests Friday. Some activists said pro-regime thugs later stormed the area, doing the bulk of the killing.

The Syrian government rejected that narrative Sunday, painting a vastly different picture.

Speaking to reporters in Damascus, Foreign Ministry spokesman Jihad Makdissi said Syrian security forces were in their local bases Friday when they were attacked by “hundreds of heavily armed gunmen” firing mortars, heavy machine guns and anti-tank missiles, staring a nine-hour battle that killed three soldiers and wounded 16.

The soldiers fought back, but didn’t leave their bases, he said.

“No Syrian tank or artillery entered this place where the massacres were committed,” he said. “The security forces did not leave their places because they were in a state of self-defense.”

He blamed the gunmen for what he called a “terrorist massacre” in Houla and accused the media, Western officials and others of spinning a “tsunami of lies” to justify foreign intervention in Syria.

Makdissi did not provide videos or other evidence to support his version of events, nor did he give a death toll. He said the government had formed a committee to investigate and share its findings with Annan, who is due to visit Damascus in the coming days.

Throughout the uprising, the government has deployed snipers, troops and thugs to quash protests and shelled opposition areas.

A video released by the U.N. team in Syria on Sunday showed observers in Houla the day after the attack, meeting with local rebels and watching residents collect more bodies for burial. It also showed two destroyed armored personnel carriers — suggesting that local rebels put up more of a fight than the activists acknowledged.

At U.N. headquarters, Russia’s deputy U.N. ambassador Alexander Pankin told reporters as he headed into the closed-door Security Council meeting that “there is substantial ground to believe that the majority of those who were killed were either slashed, cut by knives, or executed at point-blank distance.”

“We have to establish whether it was Syrian authorities … before we agree on something,” he said.

Annan’s peace plan for Syria, sponsored by the U.N. and the Arab League, is one of the few points of agreement among world powers about Syria’s crisis, which began in March 2011 with protests calling for political change. As the government violently cracked down on the uprising, many in the opposition took up arms to defend themselves and attack government troops.

The U.N. put the death toll weeks ago at more than 9,000. Hundreds more have been killed since then.

Daily violence has marred the plan since a cease-fire was supposed to begin April 12. The Houla attack made Friday the deadliest day since the truce was announced, and has cast a shadow over Annan’s visit.

In another defiant move, Syria on Sunday denied permission for Annan’s deputy to travel to Damascus with his boss, a senior Arab League official said. The rejection of former Palestinian Foreign Minister Nasser al-Kidwa was intended as a slap to the Arab League, which suspended Syria’s membership and approved sanctions against it last year.

The official spoke on condition of anonymity because of the sensitivity of the issue. Annan’s spokesman declined to comment.

The Houla attacks caused outrage among American and international officials that Makdissi’s comments Sunday failed to assuage.

British Foreign Secretary William Hague said he would summon Syria’s most senior diplomat in the U.K. on Monday so the Foreign Office could “make clear our condemnation of the Syrian regime’s actions.”

Kuwait, which currently heads the 22-member Arab League, called for an Arab ministerial meeting to “take steps to put an end to the oppressive practices against the Syrian people.”

Switzerland’s Foreign Ministry urged that an international inquiry be convened, saying the killings “could constitute a war crime.”

In Paris, the head of the exile Syrian National Council also condemned the killings.

“The kids of Houla are the kids of all of Syria,” Burhan Ghalioun told reporters. “Killing the kids of Houla is like killing the kids of all of Syria.”

Anti-regime activists scoffed at the government’s version of events. One Houla activist said via Skype that the area had at most 300 fighters, but that none had more than rifles and that they often lacked ammunition.

“If we had anti-tank missiles, there would be no tanks left in the area,” said Mohammed, declining to give his full name for fear of retribution.

Activists reported shelling, gunfire and arrest raids in opposition areas throughout the country Sunday as well as clashes between regime forces and rebels in a number of areas. The Britain-based Syrian Observatory for Human Rights said security forces killed at least 14 civilians, while rebels killed nine soldiers.

Activist claims could not be independently verified. The Syrian government bars most media from operating in the country.

Annan’s plan calls for eventual talks between all sides on a political solution to the crisis.

The U.S. hopes Russia can use its influence with Damascus to press for a political transition similar to that seen in Yemen. In February, longtime Yemeni President Ali Abdullah Saleh passed power to his deputy in exchange for immunity from prosecution.

U.S. officials say Russia does not oppose a political transition in Syria in theory, but has not agreed to specific terms.

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Associated Press writers Edith M. Lederer at the United Nations, Adam Schreck in Dubai and Hamza Hendawi in Cairo contributed to this report.