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The United Nations Security Council, during its debate on July 16, 2013, should call for the Syrian government and armed opposition groups to grant humanitarian organizations access to civilians and wounded trapped by fighting in Syria. The government and opposition groups should ensure safe passage for civilians and medical treatment for all those wounded.

Denial of humanitarian access and safe passage to civilians trapped in fighting in violation of the laws of war has been a recurring issue during the Syrian armed conflict, Human Rights Watch said. A recent Human Rights Watch investigation into the government and Hezbollah attack on al-Qusayr, near Homs, found that the government’s refusal to allow humanitarian organizations access to the town appears to have contributed to several dozen deaths because no safe evacuation routes were available to civilians, and wounded people were denied adequate medical care.

“Many lives in al-Qusayr might have been saved if the Syrian government had allowed aid organizations to do their job,” said Ole Solvang, senior emergencies researcher at Human Rights Watch. “When people are dying every day, Security Council members should be calling for humanitarian access, not hiding behind political negotiations.”

Several governments and high-level UN officials called on the Syrian government to grant humanitarian access to al-Qusayr during the fighting in May and June. But the Security Council did not issue a statement on access until the fighting was over due to obstruction by Russia. Russia also blocked a subsequent Security Council statement on Homs where the government is imposing a siege on opposition-controlled areas. The Security Council is due to hold a briefing on the humanitarian and human rights situation in Syria on July 16.

Since June 28, the Syrian government has intensified its offensive to retake the opposition-controlled old city of Homs, as well as the Khaldiyeh and Baba Houd neighborhoods in Homs. The spokesman for the UN Office of the High Commissioner for Human Rights, Rupert Colville, estimated that as of the first week in July, 2,500 to 4,000 people were trapped amid the fighting. Opposition activists told Human Rights Watch that many of the people were civilians, though Human Rights Watch has no means to independently verify.

Both the Office of the High Commissioner for Human Rights and UN Secretary General Ban Ki-moon have called on the parties to allow civilians to leave the besieged areas safely, and to allow immediate humanitarian access to the areas. On July 12, the International Committee of the Red Cross (ICRC) issued a statement saying it is “alarmed” by the situation in the old city of Homs and that it would like to bring in humanitarian assistance and enable the evacuation of civilians, but that it did not yet have consent from all sides.

Government forces have also besieged opposition-controlled towns in Eastern Ghouta in the Damascus suburbs since early 2012. Residents there are suffering from electricity, water, fuel, and food shortages, opposition activists say. The area is currently home to approximately one million people, according to people in the area.

Opposition forces have imposed sieges on the Shia towns of Nubul and Zahra in Aleppo governorate, limiting access for approximately 70,000 people to food, fuel, and medical supplies, according to the UN Commission of Inquiry. In June, the commission reported that residents had begun to suffer from malnutrition and that wounded and sick could not get medical treatment.

“Both government and opposition forces have besieged towns with little regard for the lives of civilians and wounded trapped inside,” Solvang said. “Both sides need to stop punishing civilians immediately.”International humanitarian law, or the laws of war, prohibits attacking or destroying objects indispensable to the survival of the civilian population. It also requires parties to a conflict to allow and facilitate the rapid and unimpeded passage of impartially distributed humanitarian aid to the population. Starvation of the civilian population as a method of warfare is prohibited.

Parties must allow the free passage of food relief to civilians at risk. They must consent to allowing relief operations to take place, but may not refuse such consent on arbitrary grounds. They can take steps to control the content and delivery of humanitarian aid, such as to ensure that consignments do not include weapons. A deliberate refusal to permit access to aid in response to military action can constitute collective punishment or an illegal reprisal against the civilian population.

Under the laws of war, warring parties must also ensure the freedom of movement of humanitarian relief personnel. This movement can be restricted only temporarily for reasons of imperative military necessity. Medical facilities, transport, and medical personnel may never be deliberately attacked.

The Human Rights Watch investigation into the government capture of al-Qusayr found that while many civilians managed to leave the town through government checkpoints during the battle, a well-founded fear of abuses by government forces led a significant number to attempt dangerous escape routes, often accompanied by armed opposition fighters.

Human Rights Watch interviews with witnesses from al-Qusayr, including three doctors who had reached Lebanon, indicates that several dozen civilians and wounded may have died from lack of medical treatment in the town and during the evacuation, or during possibly unlawful government attacks on those trying to escape.

One case concerned the death of a 13-year-old boy who had shrapnel wounds to his chest and abdomen. “It would have been easy to treat him if we had access to any medical equipment,” a doctor told Human Rights Watch. “But under the circumstances there was nothing we could do to even stop the bleeding. We didn’t even have any water to give him to drink.”

Humanitarian Access Denied During Battle of al-Qusayr
On May 19, Syrian government forces, supported by a significant number of Hezbollah fighters from Lebanon, began a major offensive to retake al-Qusayr, a Syrian town of about 30,000 people on the border with Lebanon. Opposition forces had largely controlled the strategically important town since July 2012.

For two weeks, government forces subjected the town to intensive bombardment and enforced a siege, preventing food, medical supplies, and other necessities from reaching civilians who remained in the town.

In the months leading up to, and particularly during, the two week battle for al-Qusayr, government forces maintained a siege on the town, preventing food, water, fuel, and medical supplies from entering. The lack of electricity and potable water in the town exacerbated the situation.

“There was no food or water. We were starving,” a mother who was trapped in the town with several children during the battle told Human Rights Watch.

Dr. Qassem al-Zeyn, one of the few remaining medical staff in the town during the siege, said:

The food situation was very bad during the battle. We didn’t have the main food items such as milk, bread, or eggs. People were mostly eating bulgar. We had some food distribution in the beginning, but after five days we ran out – we were not able to bring anything more in.

A local resident trying to coordinate relief efforts told Human Rights Watch that it was very difficult to smuggle humanitarian relief into the town, because government forces had encircled the town and used landmines in surrounding areas. “It seemed like every week one or two cars exploded from hitting mines,” he said.

Local residents told Human Rights Watch that the water supply had been intermittent in the town for months, but that it was completely cut off in mid-April when pro-government Hezbollah fighters took control of the local water plant west of al-Qusayr. Residents told Human Rights Watch that they managed to survive by reopening a couple of old wells in the town, but that it was difficult because lack of fuel meant that they had to draw water manually.  

It is not clear whether turning off the water supply was a deliberate tactic, or a consequence of the fighting. At least some local residents told Human Rights Watch that the complete cut-off of the water might have been due to lack of electricity and fuel to run the water plant, and because the water plant employees ran away when it was taken by Hezbollah fighters, leaving nobody to keep it running.

The lack of medical supplies such as oxygen, antibiotics, and anesthetics became particularly critical as the number of wounded increased, medical personnel said. Dr. al-Zeyn told Human Rights Watch that they tried to bring medical supplies into town through the government checkpoints, but that the government forces always confiscated the supplies. Cars attempting to smuggle in supplies were attacked on several occasions, he said.   

An employee of an international humanitarian organization told Human Rights Watch that the group had attempted to get medical supplies into al-Qusayr on several occasions through a local contact, but the man said it was impossible to get the supplies through.

The government’s bombardment of the national hospital in al-Qusayr, and strikes on several improvised field hospitals, made it more difficult to provide adequate medical help, medical staff told Human Rights Watch.

Fleeing Civilians and Wounded Endangered and Attacked
The government’s refusal to allow access to the town by the International Committee of the Red Cross, or other independent humanitarian actors who could have facilitated evacuation of civilians and treated the wounded, appears to have contributed to several dozen deaths. 

As government forces and Hezbollah fighters gradually encircled al-Qusayr, civilians and wounded wanting to leave the town increasingly faced the option of leaving through government checkpoints, or of taking significant risks by fleeing on smaller roads or through the fields.

While many civilians left al-Qusayr through government checkpoints, including during the two week battle, a significant number of civilians, in particular men of fighting age, dismissed this option because they were convinced that they would be detained, mistreated, or killed. “They would have killed me immediately,” said one fighter who had been injured during the battle. Several people told Human Rights Watch that they knew of civilians who had been detained at the checkpoints.

The residents disputed media reports that the government had dropped leaflets with instructions for civilians to leave the town safely. Three people told Human Rights Watch that they had seen a leaflet telling fighters to surrender or face death – a demand prohibited by the laws of war. A photograph of leaflets dropped in al-Qusayr, the only one Human Rights Watch found, contained no evacuation instructions.  

Fear of government forces led many civilians to attempt escape through orchards and using smaller roads with no government checkpoints. Some sought to escape this way with armed opposition fighters, which increased their risk of being attacked by government forces. One woman with several children told Human Rights Watch that opposition fighters had tried to evacuate them twice, but that they had returned each time because it was too dangerous.

Several witnesses told Human Rights Watch about a failed attempt to evacuate 50 wounded civilians and fighters by car in the evening on May 25, for example. About five kilometers north of the town government forces opened fire from a checkpoint, killing 13 people. Those killed included a father whose child lost both legs in the attack.

The laws of war prohibit deliberate attacks on civilians or wounded fighters no longer participating in the hostilities. Attacks on fighters trying to evacuate may be lawful, so long as the attacks are not indiscriminate or likely to cause disproportionate harm to civilians present. At the same time, it is unlawful for fighters to place civilians at unnecessary risk or to deliberately use civilians to protect themselves from enemy attack.

The landmines the government forces planted also made the evacuation of wounded a dangerous undertaking. One 20-year-old local resident told Human Rights Watch that he was assigned to be a lookout while opposition fighters tried to evacuate several wounded and civilians in five cars in mid-May. The man, who observed the incident from a distance, said that the first car hit a landmine between Husseniyeh and Shamsin, killing the driver. The military captured those who were unable to run away.

In a separate incident, a local resident active in evacuating wounded told Human Rights Watch that Ayoub al-Shidadeh, a civilian, who also transported wounded out of al-Qusayr, was wounded by an antipersonnel landmine while traveling by foot outside of the town. He returned to receive treatment and then, 10 days later, while being driven out of al-Qusayr, was killed by an antivehicle mine in late May. The local resident gave Human Rights Watch the names of five other men who worked with him who had been killed on the road while trying to evacuate wounded from al-Qusayr.

The Syrian government rejected many international calls for the evacuation of civilians and refused to grant access to independent observers who could have facilitated an evacuation. On June 2, Syria’s foreign minister, Walid al-Moualem, said that Syria would grant the ICRC access only after the fighting ended. On June 3, the ICRC said publicly that it had requested access, but that it was still waiting for permission.

The Final Evacuation
Information from witnesses indicates that hundreds, perhaps thousands, of civilians and wounded remained in al-Qusayr on June 4, the day before government forces took control of the town.

An activist helping to transport the wounded from several towns to places where people were fleeing to told Human Rights Watch that about 1,500 to 1,800 civilians, 3,000 to 4,000 fighters, and about 800 wounded fighters and civilians had arrived from al-Qusayr in the days following the town’s capture.

Dr. al-Zeyn told Human Rights Watch he believed the group fleeing al-Qusayr and neighboring villages consisted of at least 10,000 people altogether, including 1,300 wounded. Others put the total number as high as 15,000.

After rumors started circulating in al-Qusayr that opposition forces would soon have to abandon the town, civilians started leaving in large numbers on the afternoon of June 4. One member of the al-Qusayr civilian council told Human Rights Watch that 90 percent of the civilians and wounded had left the town by that evening, heading north on secondary routes. By morning, the vast majority of civilians, the wounded, and fighters had left the town.

Throughout the afternoon and evening of June 4, opposition authorities in al-Qusayr and Hezbollah attempted to negotiate the safe evacuation of civilians and wounded through doctors on both sides. The two doctors involved in the negotiations gave Human Rights Watch divergent accounts of the final agreement. But apparently the opposition military council in al-Qusayr rejected a proposal for fighters to disarm and leave the town safely, for civilians to remain under Hezbollah protection, and for Hezbollah to evacuate the wounded to Lebanon.

One person present at the meeting of the military council on the evening of June 4 told Human Rights Watch: “The option proposed by Hezbollah meant that fighters would have to leave their families behind in the hands of Hezbollah. There was no way that they would do that.”  

For the next several days, groups of evacuating civilians, wounded, and fighters moved by car and then by foot north to Dabá'a and Eastern Buwayda, then east to cross the Homs-Damascus highway near the village of Husayniyah. Local residents who evacuated on June 4 and 5 said that government forces attacked the evacuating groups.

The groups of fleeing civilians, wounded, and fighters came under intensive attacks as they tried to cross the Homs-Damascus highway between the Husayniyah and Shamsin checkpoints during the night of June 7.

The number killed during the evacuation is unknown and estimates vary widely. An activist who is collecting names of those killed during the evacuation provided Human Rights Watch with a list of the names of 29 people killed at the crossing alone. Dozens are still missing, however, according to the activist.

According to medical staff and others, at least 13 people who had been wounded previously died due to lack of medical care, food, and water during the evacuation.

In one case, Walid Khaled Charouf, an 18-year-old who was wounded in al-Qusayr by shrapnel in his chest during an airstrike in May died while attempting to flee because he did not get a needed blood transfusion.

Witnesses told Human Rights Watch about two incidents in which convoys evacuating wounded, civilians, and fighters struck antivehicle landmines that government forces planted on secondary routes. One man who was helping to evacuate people to the hospital in Yabroud on June 9 told Human Rights Watch:

There were about 30 cars in our convoy. This was the only road that the FSA [opposition Free Syria Army] could use to evacuate wounded. When the first car exploded on a landmine, the drivers in the other cars panicked, trying to turn around their cars. Two more cars hit landmines. A fourth was hit by a tank shell. All the people in the cars died, both wounded and fighters. 

“Mahmoud,” who had been coordinating efforts to bring humanitarian assistance into al-Qusayr, told Human Rights Watch about a second incident in which the first car in an 11-vehicle convoy of fighters, wounded, and civilians hit a landmine a couple of kilometers south of Dibeh, killing four people in the car on June 12:

We had been evacuating people using the same road for two nights already. Suddenly, on the third night, the front right wheel of the first car in the convoy hit a landmine. The three people sitting next to the driver in the cabin and one person on the pickup plane were killed. There were women and children in some of the other cars, but luckily, none of them were killed.

While international law’s prohibition on the use of landmines only applies to antipersonnel landmines, the use of antivehicle landmines is governed by common principles of legal warfare such as the need to distinguish between civilians and combatants and not to carry out attacks that will lead to disproportionate civilian casualties.  

Syrian government forces frequently attacked fleeing civilians, wounded civilians, and fighters, including by planting landmines along secondary routes to the town. However, it is difficult to determine to what extent these attacks were violations of the laws of war because the convoys were frequently accompanied by opposition fighters, who are lawful military targets. 

As such, opposition fighters might have placed civilians and wounded at greater risk of attack by accompanying or evacuating with them. Civilians, wounded, and fighters interviewed by Human Rights Watch believed, however, that government forces would have killed many more civilians and wounded people had opposition fighters not been there to protect them

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