A year after the US first attacked Syria, what’s changed?

One year ago the US launched its first military assault against the Syrian regime, a move some thought would be a game-changer in that country’s gruesome civil war.

US warships pummeled a government airbase with missiles on April 6, 2017, a day after more than 80 Syrians died in a ghastly chemical attack.

This image released early Sunday, April 8, 2018 by the Syrian Civil Defense White Helmets, shows a child receiving oxygen through respirators following an alleged poison gas attack in the rebel-held town of Douma, near Damascus, Syria. Syrian rescuers and medics said the attack on Douma killed at least 40 people. The Syrian government denied the allegations, which could not be independently verified. The alleged attack in Douma occurred Saturday night amid a resumed offensive by Syrian government forces after the collapse of a truce. (Syrian Civil Defense White Helmets via AP)

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Photos surfaced of dead children, their eyes wide open. US President Donald Trump said he took action in response because that chemical attack “crossed a lot of lines for me.”

Fast forward one year, and the horrors inside Syria haven’t stopped. Children still fear death on a daily basis. And on April 7, another suspected chemical attack killed dozens of people in the rebel-held city of Douma.

Here’s what’s changed since the US assault last year, what hasn’t changed and what could happen next:

UN says Syrian regime was responsible for 2017 chemical attack

What’s happened: A joint report from the United Nations and international chemical weapons inspectors found that the Syrian regime was responsible for the April 2017 sarin attack that killed more than 80 people.

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Syrian President Bashar al-Assad’s regime maintains it had nothing to do with the attack. The government also insists it doesn’t even have chemical weapons.

In February, a State Department spokeswoman said the US was “extremely concerned about yet another report of the use of chlorine gas by the Syrian regime to terrorize citizens” in eastern Ghouta – the third reported incident in the region in the previous 30 days.

No one has claimed responsibility for the most recent attack, and the Syrian regime again denies any involvement. But anti-government activists say Syrian military helicopters dropped barrel bombs filled with chemicals on Douma, suffocating some residents and sending others into violent convulsions.

What’s next: On April 8, Trump warned there will be a “big price to pay” over the latest reported chemical attack. Six days later, the US and allies launched strikes against targets at three sites in Syria.

Assad regime makes gains

What’s happened: In the past year, the Syrian regime, supported by Russia and Iran, has gained more control over rebel-held areas, dampening the hopes of those who want to oust Assad and his autocratic rule.

Displaced Syrian residents wait to receive food aid distributed by the UN Relief and Works Agency at the besieged al-Yarmouk camp, south of Damascus, Syria, on January 31, 2014. According to the UN Envoy for Syria, an estimated 400,000 Syrians have been killed since an uprising in March 2011 spiraled into civil war. See how the conflict has unfolded.

An injured man lying in the back of a vehicle is rushed to a hospital in Daraa, Syria, on March 23, 2011. Violence flared in Daraa after a group of teens and children were arrested for writing political graffiti. Dozens of people were killed when security forces cracked down on demonstrations.

Anti-government protesters demonstrate in Daraa on March 23, 2011. In response to continuing protests, the Syrian government announced several plans to appease citizens.

Syrian children walk over bricks stored for road repairs during a spontaneous protest June 15, 2011, at a refugee camp near the Syrian border in Yayladagi, Turkey.

Jamal al-Wadi speaks in Istanbul on September 15, 2011, after an alignment of Syrian opposition leaders announced the creation of a Syrian National Council -- their bid to present a united front against Bashar al-Assad's regime and establish a democratic system.

Delegates from Arab League member states and Turkey discuss a response to the government's crackdown in Syria on November 16, 2011.

Supporters of al-Assad celebrate during a referendum vote in Damascus on February 26, 2012. Opposition activists reported at least 55 deaths across the country as Syrians headed to the polls. Analysts and protesters widely described the constitutional referendum as a farce. "Essentially, what (al-Assad's) done here is put a piece of paper that he controls to a vote that he controls so that he can try and maintain control," a US State Department spokeswoman said.

Syrian refugees walk across a field in Syria before crossing into Turkey on March 14, 2012.

Rebel fighters with the Free Syrian Army capture a police officer in Aleppo, Syria, who they believed to be pro-regime militiaman on July 31, 2012. Dozens of officers were reportedly killed as rebels seized police stations in the city.

A Free Syrian Army fighter runs for cover as a Syrian Army tank shell hits a building across the street during clashes in the Salaheddine neighborhood of central Aleppo on August 17, 2012.

Family members mourn the deaths of their relatives in front of a field hospital in Aleppo on August 21, 2012.

A Syrian man carrying grocery bags dodges sniper fire in Aleppo as he runs through an alley near a checkpoint manned by the Free Syrian Army on September 14, 2012.

Free Syrian Army fighters are reflected in a mirror they use to see a Syrian Army post only 50 meters away in Aleppo on September 16, 2012.

Smoke rises over the streets after a mortar bomb from Syria landed in the Turkish border village of Akcakale on October 3, 2012. Five people were killed. In response, Turkey fired on Syrian targets and its parliament authorized a resolution giving the government permission to deploy soldiers to foreign countries.

A Syrian rebel walks inside a burnt section of the Umayyad Mosque in Aleppo hours before the Syrian army retook control of the complex on October 14, 2012.

An Israeli tank crew sits on the Golan Heights overlooking the Syrian village of Breqa on November 6, 2012. Israel fired warning shots toward Syria after a mortar shell hit an Israeli military post. It was the first time Israel fired on Syria across the Golan Heights since the 1973 Yom Kippur War.

Smoke rises in the Hanano and Bustan al-Basha districts in Aleppo as fighting continues through the night on December 1, 2012.

The bodies of three children are laid out for identification by family members at a makeshift hospital in Aleppo on December 2, 2012. The children were allegedly killed in a mortar shell attack that landed close to a bakery in the city.

A father reacts after the deaths of two of his children in Aleppo on January 3, 2013.

Syrians look for survivors amid the rubble of a building targeted by a missile in the al-Mashhad neighborhood of Aleppo on January 7, 2013.

Rebels launch a missile near the Abu Baker brigade in Al-Bab, Syria, on January 16, 2013.

An aerial view shows the Zaatari refugee camp near the Jordanian city of Mafraq on July 18, 2013.

The UN Security Council passes a resolution September 27, 2013, requiring Syria to eliminate its arsenal of chemical weapons. Al-Assad said he would abide by the resolution.

Residents run from a fire at a gasoline and oil shop in Aleppo's Bustan Al-Qasr neighborhood on October 20, 2013. Witnesses said the fire was caused by a bullet from a pro-government sniper.

Syrian children wait as doctors perform medical checkups at a refugee center in Sofia, Bulgaria, on October 26, 2013.

An injured man is helped following an airstrike in Aleppo's Maadi neighborhood on December 17, 2013.

A man holds a baby who was rescued from rubble after an airstrike in Aleppo on February 14, 2014.

A US ship staff member wears personal protective equipment at a naval airbase in Rota, Spain, on April 10, 2014. A former container vessel was fitted out with at least $10 million of gear to let it take on about 560 metric tons of Syria's most dangerous chemical agents and sail them out to sea, officials said.

A Free Syrian Army fighter fires a rocket-propelled grenade during heavy clashes in Aleppo on April 27, 2014.

A giant poster of al-Assad is seen in Damascus on May 31, 2014, ahead of the country's presidential elections. He received 88.7% of the vote in the country's first election after the civil war broke out.

Rebel fighters execute two men on July 25, 2014, in Binnish, Syria. The men were reportedly charged by an Islamic religious court with detonating several car bombs.

Photographs of victims of the Assad regime are displayed as a Syrian army defector known as "Caesar," center, appears in disguise to speak before the House Foreign Affairs Committee in Washington. The July 31, 2014, briefing was called "Assad's Killing Machine Exposed: Implications for U.S. Policy." Caesar, apparently a witness to the regime's brutality, smuggled more than 50,000 photographs depicting the torture and execution of more than 10,000 dissidents. CNN cannot independently confirm the authenticity of the photos, documents and testimony referenced in the report.

Volunteers remove a dead body from under debris after shelling in Aleppo on August 29, 2014. According to the Syrian Civil Defense, barrel bombs are now the greatest killer of civilians in many parts of Syria. The White Helmets are a humanitarian organization that tries to save lives and offer relief.

Medics tend to a man's injuries at a field hospital in Douma after airstrikes on September 20, 2014.

A long-exposure photograph shows a rocket being launched in Aleppo on October 5, 2014.

Rebel fighters dig caves in the mountains for bomb shelters in the northern countryside of Hama on March 9, 2015.

Nusra Front fighters inspect a helicopter belonging to pro-government forces after it crashed in the rebel-held Idlib countryside on March 22, 2015.

A Syrian child fleeing the war gets lifted over fences to enter Turkish territory illegally near a border crossing at Akcakale, Turkey, on June 14, 2015.

A refugee carries mattresses as he re-enters Syria from Turkey on June 22, 2015, after Kurdish People's Protection Units regained control of the area around Tal Abyad, Syria, from ISIS.

A sandstorm blows over damaged buildings in the rebel-held area of Douma, east of Damascus, on September 7, 2015.

Members of a Syrian opposition group attack the headquarters of al-Assad regime forces in the Aleppo villages of Nubul and al-Zahraa on February 12, 2016.

This still image, taken from a video posted by the Aleppo Media Center, shows a young boy in an ambulance after an airstrike in Aleppo, Syria, on August 17, 2016. It took nearly an hour to dig the boy, identified as Omran Daqneesh, out from the rubble, an activist told CNN. The airstrike destroyed his home, where he lived with his parents and two siblings. Director of the Aleppo Media Center Yousef Saddiq said Omran's 10-year-old brother, Ali, died from his injuries.

Syrian men carrying babies make their way through the rubble of destroyed buildings following a reported air strike on the rebel-held Salihin neighborhood of the northern city of Aleppo, on September 11, 2016.

Smoke rises after an airstrike in Aleppo on October 4, 2016.

Arabic writing that reads "some day we will return" is seen on a bus window as civilians evacuate Aleppo on December 15, 2016. The evacuations began under a new ceasefire between rebels and pro-government forces.

This photo, provided by the activist Idlib Media Center, shows dead children after a suspected chemical attack in the rebel-held city of Khan Sheikhoun on April 4, 2017. Dozens of people were killed, according to multiple activist groups. The United States responded a few days later by launching between 50-60 Tomahawk missiles at a Syrian government airbase. US officials said the base was home to warplanes that carried out the chemical attack. Syria has repeatedly denied it had anything to do with the attack.

Members of the UN Security Council raise their hands on April 12, 2017, as they vote in favor of a draft resolution that condemned the reported use of chemical weapons in Syria.

Residents of the war-torn city of Douma break their Ramadan fast on June 18, 2017.

A member of the Syrian pro-regime forces fires a machine gun as a comrade holds his feeding ammunition belt on November 11, 2017. It was during an advance toward rebel-held positions west of Aleppo.

A child receives medical treatment after a village was attacked in the rebel-held Eastern Ghouta region on February 25, 2018. Several people were treated for exposure to chlorine gas, opposition groups said, as airstrikes and artillery fire from the regime continued. CNN was unable to independently verify claims that chlorine was used as a weapon.

Bodies lie on the ground in the rebel-held city of Douma, Syria, on April 8, 2018. According to activist groups, helicopters dropped barrel bombs filled with toxic gas on Douma, which has been the focus of a renewed government offensive that launched in mid-February. The Syrian government and its key ally, Russia, vehemently denied involvement and accused rebel groups of fabricating the attack to hinder the army's advances and provoke international military intervention.

Damascus skies erupt with anti-aircraft fire as the US and its allies launch an attack on Syria's capital early on April 14, 2018. US President Donald Trump announced airstrikes in retaliation for Syria's alleged use of chemical weapons. Trump says the strikes are part of a sustained military response, in coordination with France and the United Kingdom.

Women and children who fled the Islamic State group's embattled holdout of Baghouz wait in the back of a truck in the eastern Syrian province of Deir Ezzor, on February 14, 2019.

Members of the Syrian Civil Defence, also known as the "White Helmets," search the rubble of a collapsed building following an explosion in the town of Jisr al-Shughur on April 24, 2019.

Turkish-backed Syrian fighters take part in a battle in Syria's northeastern town of Ras al-Ain as Turkey and its allies continue their assault on Kurdish-held border towns in northeastern Syria on October 14, 2019.

A member of the Syrian Violet Organization carries an injured boy at a makeshift hospital following a regime air strike on a vegetable market in Syria's last major opposition bastion of Idlib on January 15, 2020.

A Syrian man mourns the death of family members next to the rubble of his house following a reported airstrike on the village of Kafr Nuran, in the northern province of Aleppo, on January 21, 2020.

A displaced boy carries a bag of bread as people queue for food distributed by a nonprofit in Idlib on February 19, 2020.

Members of Syrian Civil Defence and Turkish-backed Syrian forces search for victims in the aftermath of a car bomb explosion near a security checkpoint in the town of Azaz on March 19, 2020.

Health workers carry the body of a 62-year-old displaced Syrian man who died of Covid-19, to be buried in the town of Salqin, in Idlib province, on September 17, 2020.

An aerial picture shows Syrians waving the national flag during a gathering in the rebel-held city of Idlib on March 15, 2021, as they mark 10 years since the nationwide anti-government protests that sparked the country's devastating civil war.

In photos: Syria's civil war

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The bloody battles have raged since 2011, when civilians turned into rebels trying to end four decades of rule by the Assad family.

Rebels now control little territory in Syria. Eastern Ghouta has been under siege since 2012, but the Syrian military has moved through the area since February. That offensive has been carried out with the support of Russia and in defiance of a UN call for a ceasefire.

What’s next: Idlib is now the only remaining Syrian province fully controlled by rebel groups. But Idlib has also been bombarded, and its fate remains uncertain.

Death toll tops 400,000

This photo provided Tuesday, April 4, 2017 by the Syrian anti-government activist group Edlib Media Center, which has been authenticated based on its contents and other AP reporting, shows Syrian doctors treating a child following a suspected chemical attack, at a makeshift hospital, in the town of Khan Sheikhoun, northern Idlib province, Syria. The suspected chemical attack killed dozens of people on Tuesday, Syrian opposition activists said, describing the attack as among the worst in the country's six-year civil war. (Edlib Media Center, via AP)

Related article Why children get killed with barrel bombs and chemical attacks

What’s happened: More than 400,000 people have died since the civil war began in 2011, according to UN estimates. That’s more than the entire population of New Orleans.

And the suffering isn’t limited to victims of airstrikes and gruesome barrel bomb attacks. In 2018 alone, more than half a million people have been displaced in and around Eastern Ghouta, Idlib and Afrin, said the UN humanitarian adviser for Syria, Jan Egeland.

“This is the very wrong time to turn our back on Syria’s civilians,” Egeland said.

What’s the motivation for killing civilians?

Many of those killed are children. In March, UNICEF regional communications chief Juliette Touma said 432 children had been killed and 803 injured in the first two months of 2018.

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Inside look at the lives of displaced Syrians

02:13 - Source: CNN

What’s next: Aid agencies are struggling to meet the needs of wounded and dying civilians. This month, Doctors Without Borders (Medecins Sans Frontieres) said medical facilities supported by the group have received more than 1,000 dead and 4,800 wounded in Eastern Ghouta since the start of the renewed Syrian government assault from February 18 to March 4.

But the group acknowledges the numbers “underestimate” the casualties, since they don’t include data from all MSF-supported medical clinics in the area nor facilities outside of its scope.

ISIS suffers big losses

What’s happened: ISIS managed to gain a strong foothold in Syria during the early years of the civil war, while the country was in chaos. But more recently ISIS has suffered significant blows.

In October 2017, US-backed militias declared the “total liberation” of the Syrian city of Raqqa, which was ISIS’ de facto capital in Syria for three years.

What’s next: While Trump said the US would soon have total victory over ISIS, US defense officials have recently ackowledged that progress against ISIS has been largely halted due to Turkey’s recent military incursion into Afrin, Syria – an operation that has caused US-backed Kurdish fighters to divert from the ISIS fight.

Turkey, a NATO ally, launched an operation targeting Kurdish groups in Afrin province in January to clear the border area of militias it considers to be terrorist organizations.

Trump says he wants to get troops out of Syria

President Donald Trump speaks during a news conference with, from left, Latvian President Raimonds Vejonis, Estonian President Kersti Kaljulaid, and Lithuanian President Dalia Grybauskaite in the East Room of the White House, Tuesday, April 3, 2018, in Washington. (AP Photo/Evan Vucci)

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Related video Trump: I want to get out of Syria

What’s happened: The US announced in December that there are about 2,000 American troops in Syria, supporting local forces fighting ISIS.

What’s next: Trump said last month that after helping deal blows to ISIS, US troops will start coming home “very soon.”

“We’re knocking the hell out of ISIS,” he said on March 29.

“We’ll be coming out of Syria, like, very soon. Let the other people take care of it now.”