The picture went viral on social media networks: two dust-covered Syrian girls, trapped in rubble, grab their baby sister from her shirt as she dangles from a bombed-out building.
Behind them, a man slaps his hand against his forehead, his mouth gaping in horror as he looks on amid the mangled wreckage.
The picture was captured on Wednesday by Bashar al-Sheikh, a photographer working with local news website SY24, moments after warplanes pummelled the town of Ariha in Syria's northwestern province of Idlib.
The jihadist-run region has been the target of regular attacks by Damascus and its ally Russia since the end of April.
Of the three girls shown in the photo, one is dead and two are fighting to stay alive, after regime airstrikes hit their home, said Dr. Ismail, who treated the victims in a nearby hospital but asked that his last name not be revealed.
Riham al-Abdullah, 5, who appears in the photo gripping her younger sister's green shirt, died shortly after the strikes on Wednesday, the doctor said.
Her seven-months-old sister Touka, who is shown dangling from the rubble, is in intensive care after suffering wounds to her head, he added.
"She has been receiving respiratory support for 24 hours" Dr. Ismail told AFP, adding that her condition was stable.
Dalia, the third sister in the photo, is stable after undergoing chest surgery, according to another doctor at the same facility.
The girls are part of a family of eight, consisting of two parents and six sisters.
In addition to Riham, the mother and another daughter not shown in the photo also died following Wednesday's raids, according to Dr. Ismail.
The other daughter, Rowane, died on Friday after succumbing to wounds on her chest and stomach, he added.
Tawfik Kattan, a rescue worker from Ariha, was pulling people from beneath the rubble the day of the raids.
After evacuating one of the victims, he returned to the battered building.
"When I came back, I was surprised to find that, unfortunately, the girls had fallen," he said, referring to the sisters.
The jihadist-run Idlib region is supposed to be protected by a months-old international truce deal, but it has come under increased bombardment by the government and its ally Russia since late April.
Aid groups have decried a "nightmare" that has slain an alarming amount of children, in the latest bloody episode of Syria's eight-year civil war.
Save the Children said the number of children killed in Idlib over the past four weeks had exceeded the number slain in the same region in the whole of last year.
The war in Syria has killed more than 370,000 people and displaced millions since it started in 2011 with a brutal crackdown on anti-government protests.