Colonel General Alexander Sergeyevich Sorochkin
Vice-Chairman of the Investigative Committee of the Russian Federation
Head of the Main Military Investigation Department
Dear Colonel General Alexander Sergeyevich,
We are writing to request information about potential investigations your office may have conducted into a number of air strikes in Syria that have resulted in the destruction of, or damage to, several health facilities and disrupted in the provision of medical care. In particular, we seek information on whether investigations were conducted into these incidents; how they were carried out; and what they found. If no investigations were carried out, we ask that they be opened promptly and that conclusions be presented publicly.
Human Rights Watch is an international nongovernmental organization that promotes respect for human rights and international humanitarian law and monitors violations by both states and non-state actors. We work in more than 90 countries around the world, including in many conflict zones. We have long been concerned about the impact of armed conflict on healthcare and particularly the frequency with which military operations result in damage to or disruptions of medical facilities.
As you undoubtedly know, the Geneva Conventions, its additional protocols, and customary international humanitarian law grant hospitals and other medical facilities special protection in armed conflict. Parties to international and non-international armed conflicts must refrain from deliberately attacking these facilities or interfering with their functioning. They must also take precautions to avoid harm to them even when a military target is nearby. The Russian Federation’s Regulations on the Application of IHL of 2001 and Combat Manual of 2005 all reiterate the protections afforded to medical units.
In May 2016, the UN Security Council unanimously expressed deep concern about the increase in the number of violations of these obligations in resolution 2286, and urged countries around the world to take measures to prevent these incidents. The resolution also strongly condemned what it called the “prevailing impunity for violations and 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.” It noted that this impunity may in turn contribute to the “recurrence of these acts.” It strongly urged states to “conduct, in an independent manner, full, prompt, impartial and effective investigations within their jurisdiction of [relevant] violations of international humanitarian law … 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.”
In 2015 and 2016, Human Rights Watch and partner organizations in the Safeguarding Health in Conflict Coalition documented hundreds of incidents where medical facilities were attacked or the provision of healthcare was otherwise disrupted in more than a dozen armed conflicts or situations of civil unrest throughout the world. Human Rights Watch is currently collecting detailed information on a selection of these incidents from a variety of sources including eyewitness testimony, partner organizations, local media sources, as well as open-sources. The selection that Human Rights Watch has chosen for follow up include incidents in Syria, including incidents involving armed opposition forces and Islamic State, also known as ISIS, as well as incidents in 10 other countries including Afghanistan, Iraq, Yemen, and Ukraine. Human Rights Watch seeks to determine whether they were properly investigated by the appropriate authorities and if those responsible have been held to account.
As part of this project, we seek information about airstrikes that damaged or destroyed four hospitals and disrupted medical services in Syria. To date, no party has claimed responsibility for any of these incidents. We are writing you as a party to the conflict engaged in aerial combat operations in Syria to request information about potential investigations into these incidents.
We request that you provide information on potential investigations by Russia’s investigative committee into the following incidents in which the Russian Air Force may have been involved:
- Airstrike on the Second Field Hospital in al Latamneh town, Hama governorate on October 2, 2015. The facility suffered some structural damage and was put out of service while staff made repairs. Two nurses and a hospital guard were injured in the attack. The strike damaged the facility’s generator, ambulance, and medical supplies. The Russian Ministry of Defense later announced that the Russian Air Force had conducted strikes in al Latamneh on the same day.
- Airstrike on al-Mustaqbal Hospital in al-Ghariya al-Gharbiya village, Dara’a governorate on February 5, 2016. The attack severely damaged the facility’s structure, operating rooms, emergency wing, medicine storage room, fuel storage room, medical supplies and equipment, and an ambulance. The facility suspended services while staff searched for an alternative location. The Russian Ministry of Defense later announced that the Russian Air Force had conducted strikes in al-Ghariya al-Gharbiya between February 4 and 11, 2016.
- Multiple airstrikes on a hospital in al-Hamadiya village, near the city of Ma’aret al Nu’man in southern Idlib governorate on February 15, 2016 and on the Ma’aret al Nu’man National Hospital. Airstrikes hit the area next to the hospital in al-Hamadiya, the hospital itself, and emergency service personnel that had started to rescue the wounded. The attack destroyed the four-story building, killed at least 9 medical personnel and 16 patients and caretakers, and injured another 11 people. Less than two hours later, Ma’aret al-Nu’man National Hospital, located approximately six kilometers north of the hospital in al-Hamadiya, was hit in two airstrikes. The strikes hit just outside the hospital, killing at least four civilians, including two of the facility’s staff, damaging its generator room, and cutting off the oxygen supply to the incubator room.
- Multiple airstrikes on al-Sakhour Hospital in al-Sakhour neighborhood, Aleppo City on September 28, October 1, October 3, and October 14, 2016. The airstrikes damaged the hospital’s surgical ward, intensive care unit, laboratory, patient’s wing, the facility’s medical equipment and supplies, and destroyed generators. At least five people were killed and 14 were injured, including four medical staff members. At least two of the strikes involved Soviet/Russian-made cluster munitions.
We provide more detailed information on each of these incidents in the annex to this letter. We seek the following information regarding each of these incidents:
- Has the Main Military Department of the Investigative Committee or any other Russian investigative agency conducted investigations into these incidents to establish whether the Russian Air Force was involved in them?
- If so, what did these investigations find?
- If the Russian Air Force was involved in these incidents, did the investigation establish whether the attacks hit their intended targets or not and whether appropriate measures were taken to prevent damage to hospitals and civilian casualties?
- What steps will the Russian Federation take if its investigations determine that a violation of the laws of armed conflict by a Russian airstrike resulted in civilian casualties?
- Have any measures been taken to hold accountable those responsible for the strikes?
- Will Russia offer “condolence payments” to families of civilian victims in the event that an investigation determines that a Russian airstrike resulted in civilian deaths or injuries?
Human Rights Watch sent a letter to Minister of Foreign Affairs Sergey Lavrov on November 23, 2016 that included the following questions among others. We would also appreciate your office’s response:
- What criteria does the Russian Federation use to determine if it should open an investigation into Russian airstrikes in Syria?
- How many open investigations are underway? Have any investigations been completed? What was the outcome of those investigations? When do you expect pending investigations to be completed?
- Through what mechanism is information regarding investigations recorded, stored, and tracked?
- In general, will the Russian Federation make public the results of its investigations?
Thank you very much for your attention to this matter. We look forward to receiving your response.
Sincerely,
Diederik Lohman
Director
Health and Human Rights Division
Human Rights Watch
Annex – Detailed descriptions of relevant incidents
Incident involving the Second Field Hospital in al-Latamneh, Hama – October 2, 2015
On October 2, 2015, the Second Field Hospital in al-Latamneh village, located in northwest Hama governorate, was hit with at least one airstrike, according to multiple reports by the Hama Health Directorate and local media.[1] The hospital is reported to be underground, built into the side of a mountain and fortified by cement and sandbags.[2] In spite of this, the strike reportedly damaged the facility’s generator, ambulance, and medical supplies.[3] The facility also reportedly suffered some structural damage, two nurses and a hospital guard were injured, and it was forced to suspend services while staff made repairs.[4] Human Rights Watch was unable to determine exactly how long the facility remained out of service.
Hospital administrators told Human Rights Watch that while the facility regularly receives wounded fighters, they were not aware of any military targets in the immediate vicinity of the hospital.[5] All of the casualties reported by the Violations Documentation Center in al-Latamneh on October 2 were civilians.
The Russian Ministry of Defense published a press release on October 2, 2015, stating that the Russian Air Force had launched attacks on al-Latamneh, Hama: “In Al-Latmna district (Hamah), Su-34 bombers equipped with guided air bombs blew up a militants’ underground HQ. The command center and its ground facilities are destroyed according to the objective monitoring data.”[6] The release also reports attacks on two other locations in al-Latamneh.
The next day, on October 3, 2015, the Russian Ministry of Defense’s YouTube account published a video purportedly showing the bombing of an underground command post in Raqqa.[7] However, Human Rights Watch investigations indicate that the video was not recorded near Raqqa, but rather it was recorded over the southern end of the town of al-Latamneh (36°37'17.421"E 35°18'29.641"N) as confirmed by landscape feature matching with very high resolution, commercial satellite imagery (see images below). This location is consistent with documentation of the hospital reviewed by Human Rights Watch.[8]
The video shows the presence of two fire burn scars on the hillside above the al-Latamneh hospital entrance immediately before the detonation of three air dropped munitions. These two burn scars were not present in satellite imagery recorded on the morning of October 1, 2015, indicating the hospital facility had probably been hit also between October 1 and 3, 2015, by an air strike other than that depicted in the video.
The video shows the initial detonation of two munitions approximately 50 meters apart on the hillside slope immediately above the hospital entrance at 00:01.08 seconds, followed by the impact and detonation of a third munition at 00:01.72, approximately 50 meters from the first two.
Satellite imagery recorded on the morning of October 5, 2015 shows the impact craters and extensive fire burn scars resulting from this airstrike event as captured in the video.
There is no indication in the video, however, of any secondary detonation of munitions allegedly stored in the hospital resulting from the air strike as indicated in the video description. Further, satellite imagery recorded after the air strike on October 5, as well as later satellite imagery recorded April 24, 2016 shows no indication of structural collapse of the hillside, or any other signature consistent with underground secondary explosions. The fires shown in the video following the air strike are consistent with superficial brush fires on the hillside surface.
Human Rights Watch has reviewed numerous videos posted to the YouTube account associated with the Second Field Hospital in al-Latamneh, which corroborate the facility’s medical use since at least 2013.[9] Medical supplies and equipment are clearly visible in one video posted by the hospital’s YouTube account immediately following the alleged attack.[10]
According to the Hama Health Directorate’s Facebook page, this facility was hit again in strikes on October 24, 2015.[11] Multiple media reports corroborated the attack, reporting the deaths of five people, but Human Rights Watch was unable to confirm these reports.[12]
Incident involving al-Mustaqbal Hospital in al-Ghariya al-Gharbiya, Dara’a – February 5, 2016
At around 12:00 p.m. on February 5, 2016, at least one airstrike hit the compound of al-Mustaqbal Hospital in al-Ghariya al-Gharbiya, located in southern Dara’a governorate at 32°41'20.8" N 36°13'36.9"E, the hospital’s communications officer said in a statement.[13] The communications officer said that the strike severely damaged the facility’s structure, operating rooms, emergency wing, medicine storage room, fuel storage room, medical supplies and equipment, and an ambulance, causing the facility to suspend services while the hospital’s staff searched for an alternative location.[14]
Video and photo documentation posted by the hospital’s Facebook page shows extensive damage to the facility’s southern walls of the ground and second floors.[15] Scorch marks are visible on the walls of a small structure on the eastern side of the compound, verbally identified in the video as the fuel storage. A two-meter-wide crater is visible approximately five meters from the facility’s southern wall. In the assessment of Human Rights Watch’s Arms Division, the width and depth of the crater as well as the damage are consistent with the detonation of multiple 500kg-class impact fuzed general-purpose bombs.
Satellite imagery taken after the strike and analyzed by Human Rights Watch shows multiple impact craters on the southern courtyard of al-Mustaqbal Hospital (marked by red box in image below) and associated severe destruction to the building façade, consistent with both testimony and ground photos.
A media article reported that al-Mustaqbal Hospital was the only health facility in the village.[16] Hospital administrators and the facility’s Facebook page also reported that the hospital suffered minor damage from a separate strike the day prior, February 4, 2016.[17] Human Rights Watch was unable to verify the second attack.
A Russian Ministry of Defense press release issued on February 11, 2016 reported that between February 4 and 11, 2016, the Russian Air Force launched at least one airstrike on “an ISIS strong point” in al-Ghariya al-Gharbiya, a village with an area of approximately 4 km2.[18]
No weapons or military equipment are visible in footage taken immediately after the strike.
Incidents involving the hospital in al-Hamadiya, Idlib and the National Hospital in Ma’aret al-Nu’man, Idlib – February 15, 2016
On February 15, 2016, two of the largest hospitals serving Ma’aret al-Nu’man city were hit in at least four separate airstrikes within a period of three hours starting at around 9:00 a.m. according to the Idlib Health Directorate and the two organizations that provide medical support to the facilities.[19] According to Doctors Without Borders/Médecins Sans Frontières (MSF), which supports the hospital in the nearby village of al-Hamadiya, al-Hamadiya Hospital was first hit by two strikes in quick succession, which destroyed the four-story building, killed at least 9 medical personnel and 16 patients and caretakers, and injured another 11 people.[20] Less than an hour later, the National Hospital, located six kilometers north of the hospital in al-Hamadiya (see image below), was hit by two strikes, according to the Syrian American Medical Society (SAMS), which supports the facility.[21] Per SAMS, the strikes killed at least four civilians, including two of the facility’s staff.[22] Hospital administrators told Human Rights Watch via email that the facility did not receive advanced warning of the attacks.[23] Given that the attacks occurred within such a short timeframe, it is plausible that they were perpetrated by the same party in a coordinated attack. However, Human Rights Watch was unable to confirm this.
All three parties that could have potentially carried out these attacks—the Russian Air Force, the Syrian Arab Air Force, and US-led coalition forces—have denied responsibility.
Incident involving the hospital in al-Hamadiya, Idlib
According to MSF and the Idlib Health Directorate, starting at around 9:00 a.m. on February 15, 2016, at least three munitions in two separate strikes hit the hospital in al-Hamadiya, located four kilometers south of Ma’aret al Nu’man city in southern Idlib governorate at 35°36'44.5" N 36°39'34.3" E.[24] According to media reports citing eyewitnesses, the first munition hit the area next to the hospital and a second hit the hospital directly.[25] Once first responders had gathered and begun rescuing the wounded, a third munition reportedly hit the facility.[26] MSF reported that the attack destroyed the four-story building, injured 11 people, and killed at least 9 medical personnel and 16 patients or caretakers.[27]
Human Rights Watch reviewed seven videos posted on subsequent days by local journalists and the NGO Civil Defense of Idlib.[28] In each of these videos, the facility is verbally identified as the MSF hospital in Ma’aret al-Nu’man, and medical supplies are clearly visible in at least two of the videos, corroborating the facility’s medical use.[29] Satellite imagery from after the strike analyzed by Human Rights Watch (see below) shows the complete destruction of the hospital’s building and a large debris field, consistent with both testimony and photo and video documentation.
No weapons or military equipment were visible in any of the video or photo documentation reviewed by Human Rights Watch. All of the casualties in Ma’aret al-Nu’man on February 15, 2016 reported by the Violations Documentation Center were civilians.
MSF reports that this hospital had been previously hit three times in 2015, most recently in December 2015, when an airstrike damaged the hospital’s operating and emergency rooms.[30]
On February 16, 2016, President Vladimir Putin’s press secretary Dmitry Peskov rejected claims made by MSF that either the Russian Air Force or the Syrian Arab Air Force was responsible for the attack on the hospital in Ma’aret al Nu’man.[31] Similarly, Ambassador Bashar Jaafari, permanent representative of the Syrian Arab Republic to the United Nations, denied Russian responsibility for the attack in an interview with Russian television and claimed that the Syrian government is in possession of information that the US-led alliance struck a hospital in Syria on February 15, 2016.[32] Colonel John Dorrien, US Air Force spokesman for Operation Inherent Resolve, denied these allegations in a tweet.[33]
Incident involving the National Hospital in Ma’aret al-Nu’man, Idlib
Following the attack on the hospital in al-Hamadiya, emergency medical personnel began transporting the wounded to Ma’aret al-Nu’man National Hospital located six kilometers north at 35°39'35.1" N 36°41'15.1" E in Ma’aret al Nu’man city. At around 11:00 a.m., just two hours after the airstrikes on the hospital in al-Hamadiya began, reports from SAMS and the Idlib Health Directorate indicate that Ma’aret al-Nu’man National Hospital was struck by two munitions.[34] According to SAMS, which supports the hospital, the first munition hit about three meters from the facility.[35] Ten minutes later, another strike fell close to the hospital’s entrance, where the wounded from the hospital were being shuttled in.[36] The attack damaged the hospital’s generator room and killed at least four people, including two nurses in training, according to SAMS and media reports.[37] The Idlib Health Directorate reported four dead, including one nurse, and Human Rights Watch reviewed photo and video documentation uploaded by local media in which at least two bodies are visible.[38] A video posted on the Facebook page of a health professional also reports that the oxygen supply had been cut off by the strike.[39]
Satellite imagery from after the strike and analyzed by Human Rights Watch (see below) shows damage signatures in two distinct locations within the complex, consistent with both testimony and ground photos.
There is no sign of weapons or military equipment in the photo and video documentation, and all of the casualties in Ma’aret al-Nu’man on February 15, 2016 reported by the Violations Documentation Center were civilians.
Ma’aret al-Nu’man National Hospital is a well-known facility and was established prior to the start of the conflict. It is included on the list of hospitals published by the Ministry of Health of the Syrian Arab Republic.[40] The hospital is labeled on several publicly accessible maps, including Google Maps, and is easily identifiable from the air as it is located in the northern-most part of the city, is architecturally distinct as compared to its surroundings, and occupies a compound with an area of 60 thousand square meters (see below).
Incidents involving al-Sakhour Medical Center in al-Sakhour Neighborhood, Aleppo City, Aleppo – September 28, 2016 and October 1, 3, and 14, 2016.
Human Rights Watch determined that airstrikes hit al-Sakhour Medical Center on at least four days between September 28 and October 14, 2016. The strikes damaged the hospital’s surgical ward, intensive care unit, laboratory, patient’s wing, the facility’s medical equipment and supplies, and destroyed generators. According to medical staff interviewed by Human Rights Watch, at least 5 people were killed and 14 were injured, including 4 medical staff members.
Based on photographic evidence, a Human Rights Watch weapons expert determined that at least two of the airstrikes involved Soviet/Russian-made cluster munitions.
Al-Sakhour Medical Center’s staff told Human Rights Watch that they received no advanced warning of any of the strikes. Local residents and hospital staff said that opposition armed groups did not have any bases nearby and that there were no armed groups or weapons in the hospital at the time of the attacks. According to Physicians for Human Rights, the hospital was attacked at least seven times between 2014 and 2015.[41]
September 28, 2016
At least one airstrike hit the facility at about 4 a.m. on September 28. A medical worker reported that a munition struck the facility’s wall, partially damaging the surgery ward and the intensive care unit. The facility ceased services temporarily because of the damage from the attack. Human Rights Watch reviewed photos from local activists that clearly show structural damage to the western part of the facility.[42]
Human Rights Watch reviewed photographs of weapon remnants that were found at the site of the hospital after the attack and identified the remnants as two air-dropped Russian-made ShOAB-05 fragmentation submunitions.[43]
A week before this attack, on September 21, 2016, Russian Foreign Minister Sergey Lavrov told Russian media that the Syrian Air Force was not capable of flying at night.[44] If Lavrov's statement is correct, it follows that the Russian Air Force conducted the September 28 attack on al-Sakhour Hospital.
October 1, 2016
At 11 a.m. on October 1, 2016, two aircrafts launched strikes at the medical center again. Over the next hour and a half, several strikes hit on or near the facility. Medical staff said that one strike hit a secondary facility used for non-critical patients across a narrow street from the facility. The strike put that facility out of service. The same strike damaged an ambulance. Five to seven minutes later, a strike hit the street in front of the medical center, and a third strike hit near the front of the center.[45] The strikes damaged the facility’s structure and laboratory, as well as the intensive care unit, the patients’ wing, destroyed generators, and medical equipment and supplies.
Medical personnel interviewed by Human Rights Watch estimated that there were approximately 200 people inside the facility at the time of the attack. They told Human Rights Watch that the strikes killed at least two patients and injured another ten.
At least one of the strikes involved cluster munitions. Photographs and video documentation of weapon remnants from the attack that local journalists shared with Human Rights Watch conclusively show remnants from an air-dropped Soviet/Russian-made RBK-500 cluster bomb with PTAB-1M submunitions.
Media reports and medical staff interviewed by Human Rights Watch also said that they believed that aircraft dropped a bomb containing chlorine because they found yellow residue where the bomb had impacted.[46] Human Rights Watch was unable to confirm the use of chlorine in this attack.
October 3, 2016
At about 3:30 p.m. on October 3, an airstrike hit the street in front of the medical center. The facility was out of service at the time of the strike, but some staff members had stayed behind to make repairs after the October 1 incident. The strike killed at least three people and injured a nurse and an ambulance driver.[47]
October 14
On October 14, the medical center was hit again by multiple munitions, which fell near the facility’s entrance and penetrated the basement. Following this strike, a number of pressurized gas canisters that were stored in the basement exploded and ignited fires. A healthcare worker told Human Rights Watch that the medical center’s director and one other staff member suffered serious burns as a result of the fires.
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Following public allegations that the Russian air force had carried out these strikes, General-Lieutenant S.F. Rudskoy held a briefing on October 25, 2016 at which he presented two satellite images that he said were taken on September 24 and October 22 respectively and claimed that there were no differences between the two images.[48] He concluded that the accusations against the Russian Air Force were “plain forgeries.”
However, Human Rights Watch has reviewed several sets of satellite images, which clearly show that the medical center sustained significant damage between September 30 and October 10 (see below). The imagery shows a large crater in front of the facility where bombs struck on October 1, 3, and 14, as well as damage from the October 1 attack that destroyed the ambulance and put the outpatient facility out of service. The damage to the facility is consistent with being hit by airstrikes.
[1] Hama Health Directorate via Syrian Interim Government, “Report Published by the Hama Health Directorate on Russian Aggression in Syria,” October 6, 2015, http://syriaig.org/syr14/index.php/content-category-4/4400-2015-10-06-12-38-14 (accessed January 13, 2017) ; Hama Health Directorate Facebook Post, October 2, 2015, https://www.facebook.com/HamaHealthDirectorate/photos/a.491994577596716.1073741829.473950772734430/763018910494280/?type=3&theater (accessed January 13, 2017) ; Sham News Network YouTube Account, “Sham: Russian Warplane Destroys Field Hospital in Northern Rural Hama,” October 2, 2015, https://www.youtube.com/watch?v=gF99ej2gHSs (accessed January 13, 2017) ; Eye of the Homeland YouTube Account, “Meeting with the Official Spokesperson of the Second Field Hospital in Hama in al-Latamneh City,” October 7, 2015, https://www.youtube.com/watch?v=OanPsCgi3Z0 (accessed January 13, 2017) ; Sham News Network YouTube Account, “Sham: Northern Hama Countryside, Russian Warplane Destroys the Second Field Hospital in the Area, 2 10 2015,” October, 2, 2015, https://www.youtube.com/watch?v=J1x44Z-tBKk (accessed January 13, 2017).
[2] Leticia Miranda, “Syria’s Medical Clinics: Inside Caves, Basements, and Dirt,” Buzzfeed, December 10, 2015, https://www.buzzfeed.com/leticiamiranda/syrias-hospitals-go-underground-as-bombs-fly-overhead?utm_term=.eqEJmzGBGz#.pbzwaDdldD (accessed January 13, 2017) ; Syrian American Medical Society, “Press Release: SAMS Responds to Russian Airstrikes on 3 Medical Facilities,” October 7, 2015, https://www.sams-usa.net/press_release/press-release-sams-responds-to-russian-airstrikes-on-3-medical-facilities/ (accessed January 13, 2017).
[3] Syrian American Medical Society, “Press Release: SAMS Responds to Russian Airstrikes on 3 Medical Facilities,” https://www.sams-usa.net/press_release/press-release-sams-responds-to-russian-airstrikes-on-3-medical-facilities/.
[4] Ibid.
[5] Human Rights Watch phone interview with hospital administrators, September 28, 2016.
[6] “Su-25 attack aircraft completely destroyed a large workshop aimed for production of bombs and improvised explosive devices and disguised as a plant for gas cylinders,” Ministry of Defence of the Russian Federation, October 2, 2015, http://eng.mil.ru/en/news_page/country/more.htm?id=12059507@egNews (accessed January 13, 2017).
[7] Ministry of Defence of the Russian Federation YouTube Account, “Уничтожение подземного командного пункта отряда ИГИЛ в районе РАККА самолетами Су-34,” October 3, 2015, https://www.youtube.com/watch?v=H7fqew26a1A (accessed January 13, 2017).
[8] Al Jazeera Arabic YouTube Account, “The Opposition in Hama Countryside Prepares a Field Hospital in a Mountain,” May 22, 2014, https://www.youtube.com/watch?v=MJjYjecK0aQ (accessed February 8, 2017) ; Leticia Miranda, “Syria’s Medical Clinics: Inside Caves, Basements, and Dirt,” Buzzfeed, December 10, 2015, https://www.buzzfeed.com/leticiamiranda/syrias-hospitals-go-underground-as-bombs-fly-overhead?utm_term=.eqEJmzGBGz#.pbzwaDdldD ; Hama Health Directorate Facebook Post, October 27, 2015, https://www.facebook.com/HamaHealthDirectorate/photos/pcb.773486646114173/773486182780886/?type=3&theater (accessed February 8, 2017).
[9] “The Second Field Hospital in Rural Hama,” YouTube, https://www.youtube.com/channel/UCKwQwbUn0x5hy4W_o5e830A/videos?shelf_id=0&view=0&sort=dd (accessed January 13, 2017).
[10] The original video was uploaded to the hospital’s Youtube page but has since been taken down, a copy is on file with Human Rights Watch. The same video was uploaded by the Sham News Network see, Sham News Network YouTube Account, “Sham: Russian Warplane Destroys Field Hospital in Northern Hama Countryside,” October 2, 2015, https://www.youtube.com/watch?v=gF99ej2gHSs.
[11] Hama Health Directorate Facebook Post, October 27, 2015, https://www.facebook.com/HamaHealthDirectorate/posts/773486646114173 (accessed January 13, 2017).
[12] “The Opposition Takes Control of Two Villages, Russian Aviation Targets a Field Hospital in Hama Countryside,” Syria News Desk, October 24, 2015, http://syrianewsdesk.com/?p=7748 (accessed January 13, 2017) ; “Hospitals and Homes Targeted by Russian Strikes in Syria,” AlJazeera, October 30, 2015, https://goo.gl/8LqGg5 (accessed January 13, 2017).
[13] Statement from the communications officer of al-Mustaqbal Hospital, October 25, 2016, on file with Human Rights Watch. See also: al-Mustaqbal Hospital – al-Ghariya al-Gharbiya Facebook Post, February 5, 2016, https://www.facebook.com/hospitalfuturewesterngharryya/posts/987763831293845 (accessed January 13, 2017) ; al-Mustaqbal Hospital – al-Ghariya al-Gharbiya Facebook Post, February 5, 2016, https://www.facebook.com/hospitalfuturewesterngharryya/videos/987768367960058/ (accessed January 13, 2017) ; Yaqeen Media YouTube Account, “al-Ghariya al-Gharbiya: The Field Hospital After It Was Targeted by Russian Aviation, 5-2-2016,” February 4, 2016, https://www.youtube.com/watch?v=EDZ6bmEGC_c (accessed January 13, 2017) ; “Russian Bombardment Puts 7 Field Hospitals Out of Service in Dara’a Countryside,” al-Souriya, February 10, 2016, https://goo.gl/I199Gn (accessed January 13, 2017) ; “Russian Warplane Bombards al-Mustaqbal Hospital in Dara’a, Puts It Out of Service,” al-Hal, February 6, 2016, https://7al.net/2016/02/06/30022/ (accessed January 13, 2017) ; “Regime Forces Take Control of ‘Otman Village Near Dara’a,” All For Syria, February 5, 2016, http://all4syria.info/Archive/290850 (accessed January 13, 2017).
[14] Ibid.
[15] Al-Mustaqbal Hospital – al-Ghariya al-Gharbiya Facebook Post, February 5, 2016, https://www.facebook.com/hospitalfuturewesterngharryya/posts/987763831293845 ; al-Mustaqbal Hospital – al-Ghariya al-Gharbiya Facebook Post, February 5, 2016, https://www.facebook.com/hospitalfuturewesterngharryya/videos/987768367960058/ ; Yaqeen Media YouTube Account, “al-Ghariya al-Gharbiya: The Field Hospital After It Was Targeted by Russian Aviation, 5-2-2016,” February 4, 2016, https://www.youtube.com/watch?v=EDZ6bmEGC_c
[16] “Russian Warplane Bombards al-Mustaqbal Hospital in Dara’a, Puts It Out of Service,” al-Hal, February 6, 2016, https://7al.net/2016/02/06/30022
[17] Statement from the communications officer of al-Mustaqbal Hospital, October 25, 2016, on file with Human Rights Watch ; al-Mustaqbal Hospital – al-Ghariya al-Gharbiya Facebook Post, February 4, 2016, https://www.facebook.com/hospitalfuturewesterngharryya/posts/987413344662227 (accessed January 13, 2017).
[18] “In the course of the last week aircraft of the Russian aviation group in Syria have performed 510 combat sorties engaging 1,888 terrorists’ objects,” Ministry of Defence of the Russian Federation, February 11, 2016, http://eng.syria.mil.ru/en/index/syria/news/more.htm?id=12078017@egNews (accessed January 13, 2017).
[19] Idlib Health Directorate, “Report on Bombing,” February 16, 2016, on file with Human Rights Watch ; Médecins Sans Frontiers/Doctors Without Borders (MSF), “At least seven killed and eight missing in another MSF-supported hospital attack in Idlib province-Syria), February 15, 2016, http://www.msf-me.org/en/news/news-media/news-press-releases/at-least-seven-killed-and-eight-missing-in-another-msf-supported-hospital-attack-in-idlib-province-s.html (accessed January 13, 2017) ; SAMS, “Statement from SAMs President, Dr. Ahmed Tarakji Following Aerial Attacks on Hospitals in Aleppo and Idlib on 15 February,” http://www.sams-usa.net/press_release/statement-from-sams-s-president-dr-ahmed-tarakji-following-aerial-attacks-on-hospitals-in-aleppo-and-idlib-on-15-february/ (accessed January 13, 2017).
[20] MSF, “At Least 25 Killed in Attack on MSF-Supported Hospital in Northern Syria (Updated),” February 15, 2016, http://www.doctorswithoutborders.org/article/least-25-killed-attack-msf-supported-hospital-northern-syria-updated (accessed January 13, 2017).
[21] SAMS, “Press Release: Deadly Missile Attacks on Hospitals and School in Aleppo and Idlib,” February 16, 2016, http://www.sams-usa.net/press_release/press-release-deadly-missile-attacks-on-hospitals-and-school-in-aleppo-and-idlib/ (accessed January 13, 2017).
[22] Ibid.
[23] Email to Human Rights Watch from SAMS hospital administrators, September 22, 2016.
[24] MSF, “Syria: At least 11 killed in another MSF-supported hospital attack in Idlib province,” February 15, 2016, updated February 18, 2016, http://www.msf.org/en/article/syria-least-11-killed-another-msf-supported-hospital-attack-idlib-province (accessed January 13, 2017) ; Idlib Health Directorate, “Report on Bombing,” February 16, 2016, on file with Human Rights Watch.
[25] Francis Whittaker, Borzou Daragahi, Sarah Dadouch, and Alicia Melville-Smith, “50 People Killed in Airstrikes on Hospitals in Syria including Doctors Without Borders Facillity,” BuzzFeed, February 15, 2016, https://www.buzzfeed.com/franciswhittaker/doctors-without-borders-facility-in-syria-destroyed-in-airst?utm_term=.mbGW7W7EqQ#.lmXy0y0243 (accessed January 13, 2017) ; Orient News YouTube Account, “Russian Aggression Bombards Doctors Without Borders Hospital in Ma’aret al-Nu’man), https://www.youtube.com/watch?v=7IIG_pyyF50 (accessed January 13, 2017).
[26] Francis Whittaker, et. al., “50 People Killed in Airstrikes on Hospitals in Syria including Doctors Without Borders Facility,” February 15, 2016, https://www.buzzfeed.com/franciswhittaker/doctors-without-borders-facility-in-syria-destroyed-in-airst?utm_term=.mbGW7W7EqQ#.lmXy0y0243.
[27] MSF, “Syria: At least 11 killed in another MSF-supported hospital attack in Idlib province,” February 15, 2016, updated February 18, 2016, http://www.msf.org/en/article/syria-least-11-killed-another-msf-supported-hospital-attack-idlib-province.
[28] Almarra Today YouTube Account, “The Moment that the MSF Hospital in Ma’aret al-Nu’man Was Targeted by Two Russian Strikes While [Rescuers] Search for Survivors Under the Rubble,” February 15, 2016, https://www.youtube.com/watch?v=OISn8swp9B4 (accessed January 13, 2017) ; Orient News YouTube Account, “Russian Aggression Bombards MSF Hospital in Ma’aret al-Nu’man,” February 15, 2016, https://www.youtube.com/watch?v=7IIG_pyyF50 ; Moaath al-Shami YouTube Account, Russian Aviation Destroys MSF Hospital, Bombards the National Hospital in Ma’aret al-Nu’man,” February 15, 2016, https://www.youtube.com/watch?v=321-NNdBnUY (accessed January 13, 2017) ; al Ma’ara Alaan Network YouTube Account, “MSF Hospital in Ma’aret al Nu’man City, Idlib Countryside Targeted,” February 15, 2016, https://www.youtube.com/watch?v=EURnNCpgJs0 (accessed January 13, 2017) ; SMART News Agency YouTube Account, “12 Civilians Killed and 30 Injured in Russian Bombardment of Hospital Close to Ma’aret al-Nu’man,” February 15, 2016, https://www.youtube.com/watch?v=Oc84fvJwaD4 (accessed January 13, 2017) ; al Hadath YouTube Account, “Syrian Doctors Confirm Targeting of Ma’aret al-Nu’man Hospital in Russian Strike # Doctors Without Borders,” February 16, 2016, https://www.youtube.com/watch?v=EjWb2ZIeRDU (accessed January 13, 2017) ; Maara Media Center YouTube Account, “Maara Media Center – Damage at MSF Hospital After It Was Bombarded by Russian Missiles,” February 15, 2016, https://www.youtube.com/watch?v=tvlQaehBybk https://www.youtube.com/watch?v=tvlQaehBybk
[29] Orient News YouTube Account, “Russian Aggression Bombards MSF Hospital in Ma’aret al-Nu’man,” February 15, 2016, https://www.youtube.com/watch?v=7IIG_pyyF50 ; Moaath al-Shami YouTube Account, Russian Aviation Destroys MSF Hospital, Bombards the National Hospital in Ma’aret al-Nu’man,” February 15, 2016, https://www.youtube.com/watch?v=321-NNdBnUY.
[30] MSF, “At Least 25 Killed in Attack on MSF-Supported Hospital in Northern Syria (Updated),” February 15, 2016, http://www.doctorswithoutborders.org/article/least-25-killed-attack-msf-supported-hospital-northern-syria-updated.
[31] “Kremlin dismisses claims Russian planes destroyed hospital in Syria as unacceptable,” TASS, February 16, 2016, http://tass.com/politics/857027 (January 13, 2017).
[32] “Bashar Ja’afari (Syria) on Syria – Security Council Stakeout (16 February 2016), UN Web TV, https://goo.gl/1SDmmR (accessed January 13, 2017).
[33] @OIRSpox Tweet, February 15, 2016, https://twitter.com/OIRSpox/status/699291597117267968
[34] Idlib Health Directorate, “Report on Bombing,” February 16, 2016, on file with Human Rights Watch.
[35] SAMS, “Press Release: Deadly Missile Attacks on Hospitals and School in Aleppo and Idlib,” February 16, 2016, http://www.sams-usa.net/press_release/press-release-deadly-missile-attacks-on-hospitals-and-school-in-aleppo-and-idlib/ ; Francis Whittaker, et. al., “50 People Killed in Airstrikes on Hospitals in Syria including Doctors Without Borders Facility,” February 15, 2016, https://www.buzzfeed.com/franciswhittaker/doctors-without-borders-facility-in-syria-destroyed-in-airst?utm_term=.mbGW7W7EqQ#.lmXy0y0243.
[36] Ibid.
[37] SAMS, “Statement from SAMs President, Dr. Ahmed Tarakji Following Aerial Attacks on Hospitals in Aleppo and Idlib on 15 February,” http://www.sams-usa.net/press_release/statement-from-sams-s-president-dr-ahmed-tarakji-following-aerial-attacks-on-hospitals-in-aleppo-and-idlib-on-15-february/ ; ; Francis Whittaker, et. al., “50 People Killed in Airstrikes on Hospitals in Syria including Doctors Without Borders Facility,” February 15, 2016, https://www.buzzfeed.com/franciswhittaker/doctors-without-borders-facility-in-syria-destroyed-in-airst?utm_term=.mbGW7W7EqQ#.lmXy0y0243.
[38] Idlib Health Directorate, “Report on Bombing,” February 16, 2016, on file with Human Rights Watch.; al-Ma’ara Alaan Network YouTube Account, “Pulling Martyrs from Inside the National Hospital in Ma’aret al-Nu’man City in Idlib Countryside,” February 15, 2016, https://www.youtube.com/watch?v=xXmdMuDkhDU (accessed January 13, 2017) ; “In Photos: Martyrs Inside the National Hospital in Ma’aret al-Nu’man City After Warplane Bombardment,” al-Ma’ara Alaan Network, February 15, 2016, https://goo.gl/5iGAVM (accessed January 13, 2017).
[39] Video on file with Human Rights Watch.
[40] “Distribution of Ministry of Health Hospitals,” Ministry of Health of the Syrian Arab Republic, http://www.moh.gov.sy/Default.aspx?tabid=201&language=ar-YE (accessed January 13, 2017).
[41] “Anatomy of a Crisis: A Map of Attacks on Health Care in Syria,” Physicians for Human Rights, https://s3.amazonaws.com/PHR_syria_map/web/index.html (accessed January 13, 2017).
[42] Photos were sent to Bellingcat by local activists, see Bellingcat, “Fact-Checking Russia’s Claim that It Didn’t Bomb Another Hospital in Syria,” November 9, 2016, https://www.bellingcat.com/news/mena/2016/11/09/fact-checking-russias-claim-didnt-bomb-another-hospital-syria/ (accessed January 13, 2017).
[43] Mac William Bishop and Ammar Cheikh Omar, “At a Hospital in Aleppo, Evidence of a Detested Weapon,” NBC News, October 3, 2016, http://www.nbcnews.com/storyline/aleppos-children/hospital-aleppo-evidence-detested-weapon-n657621 (accessed January 13, 2017).
[44] “Syrian Jets Unable to Fly at Night, Not Behind Attack on Aid Convoy Near Aleppo,” Sputnik News, September 21, 2016, https://sputniknews.com/middleeast/201609211045538182-syria-russia-attack-convoy/ (accessed January 13, 2017).
[45] SMART News Agency YouTube Account, “Regime and Russian Aerial Bombardment Puts al-Sakhour Hospital in Aleppo Out of Service,” October 1, 2016, https://www.youtube.com/watch?list=PLq6cQ--4f90hoHQO7m1oMpc5-Skul7sPq&v=haUL9SD0nTo (accessed January 13, 2017) ; Aleppo Media Center YouTube Account, “Al-Sakhour Hospital Went Out of Service After Being Targeted in Series of Airstrikes, 4 Dead and 15 Wounded, 1-10-2016,” October 1, 2016, https://www.youtube.com/watch?v=mqKI-esPTfk (accessed January 13, 2017) ; OGN TV YouTube Account, “7 Airstrikes Pound Aleppo Hospital,” October 1, 2016, https://www.youtube.com/watch?v=bDOlY1xYBBg&feature=youtu.be (accessed January 13, 2017).
[46] Al Jazeera Arabic YouTube Account, “Seven Strikes Target al-Sakhour Hospital in Aleppo,” October 1, 2016, https://www.youtube.com/watch?v=sdI2Gg_P82c (accessed January 13, 2017).
[47] Bellingcat analyzed several videos and photos of the strike and found that it caused additional damage to the facility’s north, east, and west sides as well as the facility’s basement, see Bellingcat, “Fact-Checking Russia’s Claim that It Didn’t Bomb Another Hospital in Syria,” November 9, 2016, https://www.bellingcat.com/news/mena/2016/11/09/fact-checking-russias-claim-didnt-bomb-another-hospital-syria/.
[48] Ministry of Defence of the Russian Federation, “Брифинг НГОУ ГШ ВС РФ генерал-лейтенанта С.Ф. Рудского (25.10.2016),” October 25, 2016, https://www.youtube.com/watch?v=3BGQeYf2t6w&feature=youtu.be&t=295 (accessed January 13, 2017).
