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Six Months On – Medical Facilities Still Under Fire

February 19, 2018

By Syrian Archive

Translations: Русский


In July 2017, the Syrian Archive, in partnership with Syrians for Truth and Justice, Justice for Life, Bellingcat and a flight observation organisation, published a report titled Medical Facilities Under Fire: Systemic Attacks during April 2017 on Idlib Hospitals. Detailed reports of eight hospitals or medical facilities targeted within one month in one province (Idlib) were provided.

Findings in this previous report suggest that in April 2017 Syrian and Russian armed forces were responsible for the eight attacks on Syrian hospitals and healthcare centres – facilities in Idlib serving a combined 1.3 million people (a beneficiary group larger than the population of Brussels), as reported in witness statements as well as by the managers of those medical facilities. Subsequently, the United Nations’ Commission of Inquiry presented findings of a fact-finding mission confirmed the systemic targeting of medical facilities by the Syrian government in April 2017, as well as the illegal use of chemical weapons.

De-escalation zone

On 4 May 2017, the sponsoring states of Astana Talks (Russia, Turkey, and Iran) signed a memorandum of understanding for the establishment of de-escalation zones in Syria for at least six months, which was extended at Astana 7 on 31 October 2017. The Russian Ministry of Defense published a map showing the locations included in this memorandum as shown below (de-escalation zones in blue, ISIS in grey, Syrian army in orange). See below:

These areas included Idlib province, some parts of northern Homs province, as well as some parts of adjacent provinces (Latakia, Hama, and Aleppo), Eastern Ghouta in Damascus countryside and some parts of southern Syria.

Just four days after the Astana International meeting establishing Syria’s De-Escalation Zones in many parts of the country, three Idlib medical facilities serving a combined more than 100.000 people yearly were allegedly attacked in airstrikes attributed to Syrian or Russian forces on a single day.

Now, six months later, little has changed. Hospitals remain at the frontlines of the Syrian conflict, and attacks against medical facilities are regular. Within a four week period, four additional Idlib hospitals, well within the De-Escalation Zones, were attacked by airstrikes that visual, witness statements, and flight observation data attributes to Syrian or Russian forces. Three of these hospitals were attacked within the span of a week.

Russian Ministry Statement of Denial

The first week of February 2018 has shown a flurry of media attention focused on potential Russian involvement in the bombing of civilians in Syria. In response, the Russian Embassy to the United Kingdom published a press release on 15 Feb. 2018 claiming a misinformation campaign by “Western media.” The press release claims “the misinformation comes down to allegations that the Russian Aerospace Forces are striking rebel strongholds in Idlib, killing civilians and damaging civilian infrastructure, including medical institutions.” See below:

This statement, implies (though does not outrightly deny) that Russian airforces are not responsible for the bombing of civilian infrastructure, including hospitals and medical facilities. Later, the same press release states that “on February 3 the Russian Su-25 assault aircraft piloted by Major Roman Filippov…was monitoring compliance with the ceasefire in the Idlib de-escalation zone” at the time his plane was shot down.

That four Idlib hospitals were targeted by airstrikes within a four week period indicates that regardless of whether or not Russian aircraft are targeting medical facilities and other protected persons and objects (deliberately or not), Russia, Turkey and Iran have failed in their compliance enforcement of the de-escalation zones. Through analysis of flight observation data for 4 Feb. 2018 bombing of Maarat al-Numaan National Hospital, for example, several flights were tracked as having taken off from Hmeimim airbase (controlled by Russian forces), flown north, turned around and bombed the National Hospital at 20:40.

In a previous statement by Russian Foreign Minister Sergey Lavrov regarding the 2016 attack on a humanitarian aid convoy near Aleppo, the Foreign Minister stated: “The Syrian aircraft could not have operated [there], because the attack against the convoy was conducted in the night time and the Syrian Air Force does not perform flights in this time, it has no such capabilities.”

As the Maarat al-Numaan National Hospital was attacked at night, Lavrov’s statement can be interpreted as: 1) inaccurate, as the Syrian Airforce does in fact have the capacity to fly at night, potentially involving them in the 2016 attack on a humanitarian aid convoy; 2) the Syrian Air Force has vastly improved its capabilities since 2016, allowing flights to operate at night and operates out of a Russian airbase, in addition to airbases controlled wholly by the Syrian airforce; 3) Russian aircraft were involved in the attack of Idlib medical facilities; or 4) A third-party operating Russian aircraft from Russian airbases was involved in the attack of Idlib medical facilities, and Russian forces are failing to enforce compliance within their own airbases.

Protected status of medical personnel

Under International Humanitarian Law, medical personnel enjoy a protected status. As part of their protected status, they cannot be targeted by any party to the armed conflict. The law defines medical personnel as, “Personnel assigned, by a party to the conflict, exclusively to the search for, collection, transportation, diagnosis or treatment, including first-aid treatment, of the wounded, sick and shipwrecked, and the prevention of disease, to the administration of medical units or to the operation or administration of medical transports.” Moreover, persons performing medical duties who do not fall within this legal definition but are attacked when providing similar medical services enjoy the same protection under International Humanitarian Law.

The principle of proportionality also prohibits parties to an armed conflict from launching attacks that might incidentally harm medical personnel, creating excessive harm in relation to any concrete military advantages gained. Article 3 of the Geneva Conventions further requires that the wounded and the sick be collected and cared for during armed conflict.

About this report

The Syrian Archive and its partners (Syrians for Truth and Justice, and Bellingcat) analysed and verified this pattern of attacks by cross referencing a combination of open-source visual content, flight observation data, and witness statements. Findings regarding these attacks were characterised by repeated bombardments, lack of warnings, and an absence of active military hostilities in the vicinity of the attack. Through collecting, verifying and reporting investigative findings from these incidents, the authors hope to preserve critical information that may be used for advocacy purposes or as evidence in future proceedings seeking legal accountability.

This report includes damage identification, cross referencing and contextualising visual content (50 verified videos) with witness statements (10 people) and with flight observation data (1696 observations) provided by a spotter organisation of aircraft in the immediate vicinity of hospitals at the time of attacks. Geolocation of visual content was done in collaboration with the Bellingcat Investigation Team.

By examining a variety of sources of information for each attack, the Syrian Archive was able to corroborate and strengthen the findings from their visual content dataset. Visual content gathered and verified by the Syrian Archive is extensively analysed – including in-depth geolocation and, when relevant, munition identification.

To cross-reference findings from visual content, flight observation data was provided to the Syrian Archive by an organisation employing a well-developed network of spotters. Following an analysis of the visual content and flight observation data, the Syrian Archive identified excerpts of statements from witnesses and victims collected by Syrians for Truth and Justice combined them with findings from their earlier analysis to provide corroborating witness statements for each attack.

Detailed overviews of each incident are provided in the following pages. An overview of the visual content is provided first, followed by an overview of the corroborating flight observation data and witness statements. All times provided are in Damascus local time, and in 24-hour format. Prior to publication, consent was acquired with those interviewed (e.g. medical workers, facility managers, and Civil Defense volunteers) regarding the public sharing of information regarding attacks.

View link to full report here. 

Syrian Archive is a open source platform that collects, curates, verifies, and preserves visual documentation of human rights violations in #Syria | Twitter: @syrian_archive

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  1. Andrea

    I think that they are really following the ambulances from a bombed hospital towards the next one in order to find new targets…

    But let me guess… it’s all a conspiracy: SCD is just demolishing the buildings by themselves, destroying in the meantime equipment worth million dollars…

    • Mad Dog

      Andrea, you are correct and I am sure the dudes in St. Petersburg will back you up on this. Somehow, the rebels have found a way to bomb their own hospitals and make it seem like it was an airstrike. They also get people to act dead and maimed. Then the White Hats, getting their pay from Western gov’ts video everything in order to paint the Russians and those oh so nice Syrians as bad guys. Nefarious!

  2. Thomas Peterson

    Tiger Force is on their way to East Ghouta. Rot in pieces, jihadists.

    Glory to Syria and Assad.

  3. Mad Dog

    Yep, let’s root for the Brute of Damascus, a real hero in his prolific use of guns and gas on civilians, a man of principle and shining honor. Yep. He has done so much for his country, what is left of it. So, how is the weather in St. Petersburg Thomas old boy.

  4. Francesca

    Frankly, I have seen some pretty disturbing videos of the aftermath of attacks in my time, but they’re from the Donbass.
    Military strikes on civilians.Believe me, they are not pretty
    And they don’t feature otherwise undamaged people dusted in flour as most of the videos from the WH do.
    They show dismembered bodies, raw meat and missing limbs, not a huge amount of blood, but far more representative of the aftermath of an artillery attack.They are far more convincing to me than anything on this site

    • DDTea

      So what are you saying: that Assadist forces are launching this extraordinary offensive on a densely populated urban area and there are no civilian casualties?

      • Francesca

        The White Helmet videos certainly aren’t showing anything like what happens in Donbass
        I’m sure there are civilian casualties, just as there were in Fallujah, Mosul and Ragqa. Incidentally , where were you when there was a humanitarian crisis happening in those places?
        We didn’t hear from you
        It seems the White Helmets only film themselves running with children hanging on for dear life, dusted with flour, and old men being helped , also coping with the indignity of a thorough dousing with flour
        The only civil defence I have ever heard of equipped with head cameras while on the job
        The difference between the footage in Ghouta and the Donbas is staggering.Makes the WH look very amateurish

        • DDTea

          You literally have no idea about me.

          I’ve been commenting for over 15 years denouncing atrocities committed in Gaza, Iraq (including Fallujah from when the 82nd airborne gunned down all those demonstrators to present), Afghanistan, Syria..

          And everywhere, i encounter people just like you who try to cover up crimes against humanity or justify them.

          Dusted with flour? You’re just sick.

          • Francesca

            So Raqqa, Mosul……
            Nada from you
            you’re a lying hack
            So what pseudonym have you been denouncing with
            and where?
            Talk is cheap, and so are the WH videos. They all look the same. How credible is that?
            What kind of person reaches for his head camera before responding to an emergency?
            None of it rings true.
            I am quite sure there are many citizen casualties, but the WH aren’t there to help them

        • Mad Dog

          dusted with flour? Gee, that is a new one. I guess if the WH posted ghoulish vids without flour you would be happy?

        • frank

          I tend to agree with Francesca. Lying homophobic hack. Based on the above links to those pics.

  5. DDTea

    Anyone would predict it, because Assad’s forces routinely use chlorine in Eastern Ghouta. It’s not even remarkable anymore. 8th time this year at least.

  6. DDTea

    No it isn’t. Neither Jaysh al Islam or FSA Faylaq Rahman are internationally proscribed terrorist organizations.

    Hezbollah is, though.

  7. kraaiiii

    well there not hospitals and sadly a legit target if their not marked as hospital and their location is not shared and know tot the enemy side as a hospital, also weapons at the location it losses it safe status as a hospital. the geneva convention is clear on this.

    • Mad Dog

      Hahahaha, that is pretty good. Put a red crescent on it to save the day. Gee, all the hospitals known before this tragedy began have been hit. What about that targeting prowess. Ambulances have been followed to the hospitals that took the place of the ‘legit’ ones bombed by Syria and Russia. And them bombed. Do you really think Syria is concerned about the Geneva Convention? Any proof that they are? Firing on unarmed civilians started this madness and that was against the Geneva Conventions.

        • DDTea

          Your questions are fundamentally wrong. The default assumption is that, in an urban and residential area, is that every location is civilian. The presence of combatants does not change the civilian nature of an urban area.

          So let’s turn your questions around. Do you have proof that the locations bombed were legitimate military targets or had military function?

          • kraaiiii

            ”The presence of combatants does not change the civilian nature of an urban area. ” Welcome to urban warfare the times that army’s would face each other, face to face on a field are sadly for the civilians sake long gone. Your opinion does not match the reality of today’s ( raqqa, Mosul ) or past warfare.

            ”So let’s turn your questions around. Do you have proof that the locations bombed were legitimate military targets or had military function? ”. No i don’t, but neither do you that the were not/did have military function. Al we got for sure is the risk a pilot life, spend jet fuel and money on ordnance, and got in return sh*t load of bad PR.

          • DDTea

            So kill ’em all, let God sort ’em out?

            In other words, you have no meaningful rebuttal to the claim–and evidence–that the SyAAF and RuAF are willfully bombing civilians and medical centers, or at least not taking reasonable measures to avoid doing so. You’re just trying to justify it with the fallacious, “appeal to irrational fear of Al-Qaeda.”

            We can’t disregard almost a century of international law because we’re facing new conditions on the battlefield. Those who do so are still monsters, war criminals, and the worst of humanity.

          • radu

            I am so sure that those Russian cowboys do not have access to satellite imagery, drone intelligence and some humint from spies. I mean, what do I know? Especialyy on the sarin attack on Khan Sheykhoun, when they did not bomb obvious military targets, like HTS or any other Syrian faction position, but All medical facilities.
            Try not to insult our intelligence and choose another argument. Stray bomb or carpet bombing…ups, that is forbidden too, indiscriminate attack not justified by military necessity or lack of proportionality, Protocol 3 of the Geneva Convention.
            DDTEa, in my opinion you are right. Juridical norms set out in the Geneva Conventions are , in most part, imperative. The mere presence of opposition forces in a town does not encompass that town is a legitimate military target. Battlefield is fluid, we get that, but, to be on the right side of the laws of war, the target must be military, must be identified as such and the attack on it must be proportionate and justified by military necessity.
            To give an example, towns in East Ghouta bombarded relentlessly are not military targets. The attack on them – mjust the towns, not the people – is a clear violation of lwas and customs of war, it is called devastation not justified by military necessity. The attack on the defensless civilians is a double crime: extermination, as a crime against humanity, and willful killing, as a violations of laws and customs of war. If the mens rea is to exterminate in total or in part on various reason, then is genocide or act of genocide – Srebrenita precedent.
            Russians, Iranians, Palestinians and Syrians commanders bare command responsibility – the Yamashita standard.
            Of course, the aattackers genuinely knew they are attacking hospitals, ambulances etc.
            As for White Helmets fake videos and camera on helmets…it is a standard practice, in many countries, that emergency personnel to have body cameras, for obvious reasons.
            Syria Civil Defence , by uploading their videos, take a stance, anti assad and anti Russian. It is only normal they are attacked. I have seen a fair amount of videos on shelling and bombing from different wars and there is not a lot of difference.
            The fact that a lot of the victims are children…it is a demographical fact that sirian population is numerous, young and families are large and have a lot of children; plus, statistically speaking, approximately 50000 children were killed or maimed so far, about 10 % ; the rest of Syrian war dead are soldiers and adult civilians.

  8. DDTea

    Yup. I’m among the first 3% of members on sciencemadness, a site that has grown to become one of the premier places online to discuss amateur chemistry. You can even find some of my childhood/teenage conjecture and experiments–including proof that I’ve been fascinated by chemical agents as long as I’ve been a member there. I’m not so active anymore. As a professional chemist, I don’t need to divert chemicals from consumer products to run experiments in my garage anymore. But occasionally I log in to offer my expertise to a new generation of chemistry kids.

    Funny how you’ve called me a “liar” and a “fake chemist” when you’ve independently verified a part of my background that I’ve mentioned previously. Open source investigation at its finest!

    • Mad Dog

      Liar! Fake Chemist! I should know as I failed HiSchool Chem and I distrust all scientists after that experience. The class did get me a date or two with a young lady who be later be one of our Homecoming Princesses!

  9. Peter

    These are not hospitals, but empty husks devoid of any medical personnel, who have long ago evacuated to the safety of the Syrian Arab Government controlled areas.

    No sane person would remain under the control of armed criminals, racketeers, Jihadists and terrorists parading under the metaphoric Western designation of “rebels”.

    The White Helmets media production company were not quick enough in producing disaster pornography for presentation to the West, since the armed bandits of Ghouta routed quickly under the firepower of Syrian combined arms shock troops and Russian air power.

    Zionists, Jihadists, Russia-haters etc. You lose this round.


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