Will the Syrian regime be able to recapture the liberated areas inside Syria? Are you better off with the regime returning to your area, or with the rule of the others, including those run by civilians, the Free Syrian Army or the al-Qaida-backed Islamic State of Iraq and Syria (ISIS)?

After all, many changes had taken place since my last visit, which was in early July. The elected president of Egypt, a patron of Syrian refugees in that country, was removed from power by military takeover. The Syrian government used chemical weapons against civilians and was threatened with the possibility of U.S.-led air strikes.

ISIS expanded its presence in rural Idlib, liberating parts of the city of Aleppo and few eastern provinces. In many areas, ISIS is now the de facto government and is in charge of civilian affairs.

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Abou Ahmad is an energetic 30-year-old medical activist who organizes first aid courses and teaches basic nursing skills to volunteer staff in field hospitals. He travels throughout liberated northern Syria, working with the groups who control each area.

In response to my question about the government’s ability to recapture this territory, he said: “The regime may only return to liberated areas if the foreign fighters leave or are driven out.” He felt that the local civilians are exhausted spiritually and physically, and would not be able to fight.

Abou Ahmad witnessed the ferocity of  foreign fighters during battles and said he noticed that most inexperienced volunteer fighters chose to stay behind them, on the “back lines.” He didn’t feel that those soldiers would be strong enough to fend off Bashar al-Assad’s forces.

As regards my second question, about governance, he said: “Syrians are definitely better off with any government entity other than the regime. The powers that control regions in liberated areas are establishing foundations for a nascent state: judiciary, education, a health system and reconstruction.”

Abou Ahmad was reserved but optimistic about the future. He admitted there were difficulties facing Syrian civilians, like re-entry after life in a refugee camp, the destruction of so much of the country’s infrastructure, threat of starvation and an entire generation of young Syrians facing illiteracy.

Later, I encountered a patient from ISIS who had shrapnel in his eye. The patient, a foreign fighter, needed retina surgery and had heard I was in the area. Dressed in black, he had a long dark beard and a shaven head. He came from Azerbaijan.

He spoke some Arabic, and proceeded to ask about my training and qualifications. Once assured of my surgical skills, we had an exchange. I asked him about his mission in Syria. “I came to defend Muslims who were being raped, burned, tortured and slaughtered,” he said. “I am here to assist in establishing an Islamic State in the land of Sham [Syria].”

He looked me in the eye. “If you seek democracy, then go to Turkey, Europe and America. But this land will have an Islamic state governed by Sharia law. Everyone is welcome in this land, and things will be tolerated, except Kufr,” which means disbelief in the one God, Allah.

ISIS commands the respect of locals in rural Idlib with its discipline, appearances of sincerity and a reputation for being incorruptible, or at least less corrupt than most.

It has a solid presence here, though other rebel factions in the area control certain checkpoints.

I was told that ISIS was setting up shops in the liberated villages of rural Idlib. They were recruiting professionals into their ranks to work as civil administrators. Being extremely religious was not a prerequisite to be part of ISIS’s new civil administration; teachers, doctors, engineers and nurses are welcome, though the group does have reservations about a mixed-gender workplace.

A nurse from al-Daana, a village of 40,000 in rural Idlib with a strong ISIS presence, said that since the group’s arrival, her town was “leaner, law-abiding and peaceful, with no crime. Schools are open, religious courts are ruling in disputes, and we feel safe.”

On the last day of my trip, I had discussions with local staff at our field hospital. The topics ranged from the future of Syria, the role of the foreign fighters, the loss of coexistence among ethnic groups and the potential for a protracted conflict, to who would govern Syria after the war.

They were all young, with differing ideologies. But they agreed that the conflict would last another five to eight years and foreign fighters would be influential in battle, but Syrian fighters would ultimately take over the leadership. They said there would be no coexistence between Sunnis and Alawites after the atrocities and massacres they said had been inflicted on Sunni civilians.

They all agreed that the majority in Syria should rule Syria, meaning a Sunni president and governing leadership, with participation by minority groups. And, they said, Syrians would not accept a minority president, even if he were to win an election. Old fears still hold here, and they’d automatically assume it had been rigged.