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Airstrikes rained down on al-Iman Specialized Hospital for Women and Children on Aug. 31 in the battered Aleppo province of Syria. Six consecutive attacks injured three people and forced the evacuation of newborn babies – still in their incubators.

This type of grim scene has played out again and again during the eight-year-long Syrian conflict, a conflict defined by Syrian and Russian government attacks on civilian targets like hospitals and schools.

And while Syria has largely faded from the headlines, Syrian President Bashar Assad and his allies in Moscow are escalating their brutal assault on Idlib, the last opposition-held area. More than 540,000 women, men, and children are internally displaced and 3 million civilians are now trapped in this so-called deescalation area, according to the United Nations. An estimated 1,089 civilians have been killed amid the violence in Syria’s northwest region over the past four months.

The courageous medics who remain in what’s left of Idlib’s health facilities can expect more strikes on their surgical units.

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This is because the vast majority of attacks on health centers in Syria are not accidents, not “collateral damage,” nor terrorist propaganda. The Syrian and Russian government bombing of hospitals represents their deliberate, inhumane, and illegal strategy of war. As much as Syria and Russia try to obfuscate or cry “fake news,” they cannot escape the facts.

Our researchers at Physicians for Human Rights have rigorously corroborated and documented violations by all combatants since the beginning of the Syrian conflict. From March 2011 through August 2019, PHR corroborated 583 attacks on at least 350 separate health facilities as well as the killing of 912 medical personnel. And these are conservative estimates — the true scale of the slaughter is likely greater. Our documentation indicates that 525 attacks — 91 percent — were perpetrated by the Syrian government and its allies.

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Every attack on a functioning health facility is a war crime. Taken together, these assaults constitute crimes against humanity.

Since the Syrian government’s escalation on Idlib began in late April, PHR has received reports of 57 attacks on health facilities in that province. So far, we have confirmed 23 of them and are still counting.

Desperate to spare civilians from the carnage, 12 humanitarian organizations worked with the United Nations on an agreement in 2018 through which those operating health facilities would share their location with the UN, as part of its “deconfliction mechanism.” The coordinates were then shared with parties to the conflict, including Syria and Russia. This would prevent hospitals from accidentally being attacked, the thinking went.

Barely a year after its implementation, this arrangement has backfired spectacularly. Those who dared to share their coordinates with the UN have been bombed.

We’ve seen health workers forced to go to extraordinary lengths to continue providing care. One group in northern Hama established a “cave hospital” some 55 feet into a mountain to escape the attacks. It, too, was bombed repeatedly.

In response to the intensified violence and blatant disregard of the humanitarian agreement, UN Secretary General António Guterres announced last month a new investigation into the failure of the deconfliction mechanism. While the UN is right to examine what went wrong, human rights groups are deeply concerned that the probe will not actually assign responsibility for the attacks. “The hospital was bombed” is very different from “the Syrian Air Force knowingly bombed the hospital.”

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The United Nations should name and shame those who flout the most fundamental principles of humanitarian law and show such callous disregard for human life. The investigation should be public, transparent, and rapidly executed.

But regardless of how the investigation plays out, it is unclear that new condemnation will do anything to change the barbaric behavior of Syria and Russia. Their violent takeover of Idlib may already be complete by the time the UN investigation announces its findings. This is a sad reflection of how impotent the UN Security Council has become, hamstrung by its own structure and the permanent veto threat from Russia. Regional neighbors and world powers alike have repeatedly failed the Syrian people, and now risk one of the worst humanitarian disasters of the 21st century unfolding before our eyes.

Above all else, Syria and Russia should stop the onslaught on civilians in Idlib. All groups should cooperate fully with the UN investigation. Since Russia has vetoed the referral of war crimes to the International Criminal Court, national governments should aggressively pursue accountability through “universal jurisdiction” options, which would allow for war crimes committed in Syria to be tried in the courts of other countries.

Continued inaction sends a message of abandonment and erosion of humanitarian law not only to those in Syria, but also to all people subjected to crimes against humanity.

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Whether in Syria or elsewhere, we must never allow the bombing of hospitals, doctors, and patients to become normal. Hospitals — the places of safety, refuge, and life — should never become death traps.


Susannah Sirkin is director of policy and a senior advisor at Physicians for Human Rights, based in Boston.