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(New York) – Syrian and Russian military attacks on hospitals in recent weeks during the government air campaign in the Aleppo region are causing deaths and injuries and shutting down medical facilities. The United Nations Security Council should ask the secretary-general to conduct an independent inquiry into the attacks.
A medic inspects the damage inside Anadan Hospital, sponsored by Union of Medical Care and Relief Organizations (UOSSM), after it was hit by an airstrike in the rebel held city of Anadan, northern Aleppo province, Syria on July 31, 2016.  © 2016 Reuters

Human Rights Watch documented six airstrikes by Syrian government or Russian planes on health facilities in Idlib and Aleppo over the past two weeks, all of which forced the medical facilities to temporarily shut down. The airstrikes also killed 17 civilians and wounded at least six people. According to the Syrian American Medical Society, which operates clinics and field hospitals in opposition-controlled areas, there were 43 such attacks in July, the worst month for attacks on medical facilities since the conflict in Syria began.
“Airstrikes on hospitals are becoming routine in Syria, but we have yet to see any investigation or accountability for these criminal acts,” said Nadim Houry, deputy Middle East director. “With heavy bombing continuing relentlessly in Aleppo especially, hospitals and clinics need to be treated as the sacred life-saving places they are, not as additional bombing targets.”
Human Rights Watch spoke by Whatsapp messaging to administrators of four hospitals and of a blood bank, as well as of two facilities hit on August 6, the Medecins Sans Frontiers-supported Amal Hospital in Millis, a village in Idlib province, and the hospital in Sarmin village in Idlib. All said that the facilities were clearly marked as medical facilities and that there were no armed combatants in the vicinity of the facilities at the time of the attacks.
Under international humanitarian law, medical facilities are afforded special protection, while also retaining the general protections applied to civilians and civilian structures. They should never be attacked unless they are being used for military purposes to commit acts harmful to a party to the conflict. Absent these conditions deliberate attacks on medical facilities are violations of the laws of war and could be prosecuted as war crimes.

The attacks on medical facilities also have a direct impact on the right to health for residents of northern Syria, Human Rights Watch said. A UN inquiry should identify the attackers, collect and preserve evidence for future prosecutions, and take measures to sanction those responsible.

On July 23, 2016, airstrikes struck four clinics – al-Hakim Children’s Hospital, al-Daqaq Hospital, al-Zahra’ Hospital and al-Bayan hospital – and the Central Blood Bank in Aleppo’s al-Sha`ar densely populated neighborhood. All are clearly marked as hospitals. There was no claim of responsibility from either the Syrian or Russian government.
Men and civil defence members look for survivors after an airstrike on a hospital in the town of Meles, western Idlib city in opposition armed forces-held Idlib province, Syria on August 6, 2016.  © 2016 Reuters

“The rocket fell right on top of the building,” said Abu al-Motassim, head of al-Zahra’ hospital, a 24-hour medical facility for gynecological and maternity needs in Aleppo. “I can’t describe the feeling when it hit – I thought the whole building was going to collapse on our heads. It was chaos.”

The World Health Organization had said that there was only one hospital in East Aleppo still offering obstetric services, with two gynecologists handling a caseload of 30–35 deliveries per day.

According to Physicians for Human Rights, 750 medical personnel have been killed in Syria since the beginning of the conflict, 698 of them by Syrian government forces or the Russian military. According to the organization, there were 373 attacks on 265 medical facilities between March 22, 2011 and May, 2016. They said that the majority of the attacks deliberately targeted the medical facilities.

On May 3, the UN Security Council passed Resolution 2286, condemning “abuses committed against medical personnel and humanitarian personnel exclusively engaged in medical duties, their means of transport and equipment, as well as hospitals and other medical facilities in armed conflict.” The Security Council urged member countries to protect “the wounded and sick, medical personnel and humanitarian personnel exclusively engaged in medical duties, their means of transport and equipment, as well as hospitals and other medical facilities in armed conflict, and, where appropriate, take action against those responsible in accordance with domestic and international law, with a view to reinforcing preventive measures, ensuring accountability and addressing the grievances of victims.”

Shrapnel flew into the hospital and tore the wire leading to the oxygen tank of Mohamad Shebli, a two-day-old baby, who died instantly. The smoke and dust also caused by the strike caused the death of three other ICU babies.

Dr. Hatem Abu Yazen

Head of al-Hakim children’s hospital

Security Council Resolution 2254, adopted on December 18, 2015, called on all parties to the conflict in Syria to “immediately cease any attacks against civilians and civilian objects as such, including attacks against medical facilities and personnel, and any indiscriminate use of weapons, including through shelling and aerial bombardment.”

In December 2014, the UN General Assembly passed a resolution that urges countries to take specific actions to prevent attacks on health services.

“For the doctors and nurses in Syria as well as to the sick and wounded, the words of the Security Council are empty promises,” Houry said. “The world powers may not be able to agree on a solution to the Syrian conflict, but surely they must be able to agree on steps to ensure that those who attack hospitals will one day face justice.”

The July 23 Attacks
Human Rights Watch spoke to heads of the four hospitals hit on July 23 as well as an administrator at the Aleppo Central Blood Bank.

Abu al-Motassim, head of al-Zahra’ hospital said the hospital was hit at 1 a.m.

Some doctors were in the middle of an open-stomach operation when the strike happened, and they had to quickly use fans to blow away the dust and smoke out of the operating room so they could tie up the patient and move her out of the operating room. The doors, windows, the walls were all damaged, and some equipment was destroyed.

We were just so happy that we were alive. We didn’t have any deaths or injuries and the hospital staff was fine, but the building is badly damaged and now we are not operational anymore.

Dr. Hatem Abu Yazen, the head of the nearby al-Hakim children’s hospital, said that the hospital was struck later that day, at 1 p.m. and again at 11 p.m. with shrapnel and damage, causing the deaths of four newborns in the intensive care unit:

The missile fell seven to eight meters away from the hospital in the residential building nearby. The impact of the strike destroyed the hospital’s windows, doors, and a corrugated ceiling. It also destroyed three incubators, and some hospital equipment was damaged. Shrapnel flew into the hospital and tore the wire leading to the oxygen tank of Mohamad Shebli, a two-day-old baby, who died instantly. The smoke and dust also caused by the strike caused the death of three other ICU babies – Rahaf Mohamed, 3 days old, Taha Sabah, 4 days old, and Hassan Makhzoum, 3 days old.

Dr. Ahmad Yaseen, head of al-Bayan hospital, a general surgery facility, said that his hospital, which had first been hit on June 8, was hit at 12 a.m. on July 23. Video posted on YouTube showed smoke billowing into the area where babies slept in incubators. Outside the doors of the hospital, much dust and smoke and rubble could be seen. He said:

The missile fell in the street just 10 meters outside the hospital and we suffered a huge amount of damage to the hospital walls and doors and windows and infrastructure in general. Luckily there were no injuries or deaths because it was very late at night and not many people were at the hospital. I was in the hospital at the time of the strike and all I heard was a plane circling in the sky and within seconds we were all thrown to the floor along with a huge explosion and the sounds of breaking glass and smoke and dust everywhere and women and neighbors screaming. We are in a very residential area and there are no headquarters of any security or military anywhere close by.

Abu Kamel, an administrator at the Central Blood Bank in Aleppo, said that a missile fell in the building across from the blood bank at 4 p.m., causing much damage to his building, and that another fell on the street in front of the facility, but did not explode. He said there was one injury but no deaths. Another strike occurred at 11 p.m. the same day.

The destruction was material, including doors, windows, and equipment. The second strike at night hit the building behind the blood bank and the impact of the strike blew out all the doors and windows of our building. I was in the building during the 4 p.m. strike and it was terrifying. The sound was very loud, and you could hear the shrapnel hitting walls all around us, and no one knew whether or not to leave the building or to stay put. al-Sha’ar is a residential area and we are part of a complex of medical facilities which agreed with all the military and security personnel in Aleppo to stay away from our buildings. Now we are closed completely and we are not operational.

The administrators of all four medical facilities said that there are no military or security headquarters or offices anywhere near the hospitals. Yaseen said the area is a “very residential area with many shops and restaurants.”

The August 6 Attacks
On August 6, airstrikes hit the Medecins Sans Frontiers-supported Amal Hospital in Millis, a village in Idlib province, at 2 p.m. The attack killed four medical staff and nine civilians, including five children and two women, and injured six others from the medical staff, according to the head of the hospital, Dr. Taher Abdelbaqi, who spoke to Human Rights Watch, and a statement from MSF. MSF said the bombing destroyed “most of the hospital building, including the operating theater, intensive care unit, pediatric department, and around 80 percent of the medical devices, the ambulances and the generator.”

Video posted on YouTube of the aftermath of the attack shows people clearing rubble, smoke rising from the charred hospital building, and firefighters putting out fires from what seems to be the hospital. Rescue workers are also shown pulling out a young boy with a bloodied face from underneath the concrete. Photos showed the building barely standing with a collapsed ceiling and interior walls.

Dr. Abdelbaqi said that 250 to 300 people are served by the hospital on a daily basis. He said that he was in the doctor’s rest area when the attack came:

The electrical generators are so loud that we can’t hear any planes or other sounds before the attack. All we felt was a huge explosion and all of a sudden smoke and dust filled the hospital. There is a building nearby that used to be used by armed groups but they abandoned it a year ago and it is empty now.

Also on August 6, at 9:30 a.m., airstrikes hit the hospital in Sarmin village in Idlib, said a hospital administrator and a nurse who spoke to Human Rights Watch. Photos posted on Twitter show a large crater in the ground near the hospital where the rocket fell, another photo shows the rubble collapsing in the middle of what seemed to be a children’s section of the hospital. Villages in Idlib have been the target of intensive aerial attacks by Russian and Syrian jets, particularly after armed groups shot down a Russian Mi-8 helicopter in Saraqeb, 10 kilometers from Sarmin on August 1. Two Russian officers and three crew members were killed in the attack.

Omar Jajouk, an administrator with Sarmin Hospital, said that the attack came at about 9:30 a.m. He said there were no injuries or deaths but that the building was damaged:

The hospital is made up of three buildings next to each other – the physical therapy center, the clinics section, and the hospital itself. The rockets fell in the middle of the three buildings, only about 10 meters away from each one. The hospital is out of commission at the moment until we finish maintenance on the damaged doors, windows and other parts of the hospital. The hospital is in the middle of a residential quarter of the village and there is a school nearby… There are no military or Free Syrian Army presence in the village or near the hospital.

Mustafa Khalil, a nurse at Sarmin hospital said he was in the ground floor in the operating area when the attack came:

The explosion was very strong and one of the walls collapsed into a room in front of me. All the doors and windows were completely broken. The dust and smoke entered into the hospital and affected the patients in the rooms and they were very frightened.

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