The earthquake struck war-scarred northern Syria.

On Monday morning, Syrians in the country’s war-ravaged north awoke to scenes that had been familiar for years: collapsed buildings and people being pulled from the rubble.

The magnitude 7.8 earthquake, centered in southeastern Turkey but felt as far away as Israel and Cyprus, brought back painful recent memories from Syria’s civil war.

Much of Syria still bears the scars of the conflict, which has been in a fragile ceasefire since early 2020. Faced with sanctions, no reconstruction aid from international donors and its own economy in shambles, rebuilding has been piecemeal and limited.

The war’s toll — massive destruction, an acute economic crisis, a collapsing currency — will make responding to the quake even more difficult for all sides.

At least 237 Syrians were killed and 639 injured in Aleppo, Hama, Latakia and Tartous, according to the Syrian health ministry.

Aleppo, the country’s largest city, is a shadow of its former self, throttled by power outages, a fuel crisis and high unemployment.

The government’s figures do not include the hard-hit northwest corner of Syria, which is under the control of the Turkish-back opposition. There, the White Helmets, the civil defense which operates in areas outside of government control, reported dozens dead and declared a state of emergency. The region is home to some 4.2 million people, more than half of them displaced from other parts of the country during the war, with many living in large tent camps.

“The organization calls on the international community to take responsibility in the face of this catastrophe and to take emergency measures to prevent the situation from worsening,” the White Helmets said in a statement Monday morning. “It also urges the international community to support the rescue of civilians in Syria and to put pressure on the Assad regime and its Russian ally to ensure that there is no bombing in the affected areas.”

In the early years of the conflict, members of the White Helmets were trained in rescue operations by Turkish rescue crews who had honed their craft responding to earthquakes.

The White Helmets used that knowledge to rescue Syrians trapped inside buildings felled by airstrikes and barrel bombs, launched by the Syrian government and Russia.

In the province of Idlib, next to Aleppo, one hospital, supported by the Syrian American Medical Society, was damaged and had to be evacuated.

The Assad government has been so strapped for cash in recent years, it has forced wealthy businessmen to help fund government salaries and services.

Syria’s GDP shrank by more than a half between 2010 and 2020, according to the World Bank. Syria was reclassified as a low-income country in 2018 because of the massive decline in its gross national income. Then the coronavirus pandemic hit in 2020, causing more economic pain and straining the country’s healthcare system.