PRESS RELEASE
3 March 2016
Syrian and Russian forces targeting hospitals as a strategy of war
Even underground hospitals have been destroyed with attacks designed to empty the area ahead of Aleppo offensive
‘Hospitals have become the new front line’ - Tirana Hassan
Russian and Syrian government forces appear to have deliberately and systematically targeted hospitals and other medical
facilities over the last three months to pave the way for ground forces to advance on northern Aleppo, an examination of
airstrikes by Amnesty International has found.
Even as Syria’s fragile ceasefire deal was being hammered out, Syrian government forces and their allies intensified
their attacks on medical facilities.
“Syrian and Russian forces have been deliberately attacking health facilities in flagrant violation of international
humanitarian law. But what is truly egregious is that wiping out hospitals appears to have become part of their military
strategy,” said Tirana Hassan, Crisis Response Director at Amnesty International.
“The latest string of attacks on health facilities north of Aleppo appears to be part of a pattern of attacks on medics
and hospitals, a strategy that has destroyed scores of medical facilities and killed hundreds of doctors and nurses
since the start of the conflict.”
The organisation has gathered compelling evidence of at least six deliberate attacks on hospitals, medical centres and
clinics in the northern part of the Aleppo Countryside governorate in the past 12 weeks. The attacks, which killed at
least three civilians including a medical worker, and injured 44 more, continue a pattern of targeting health facilities
in various parts of Syria which amounts to war crimes.
Amnesty International researchers spoke to medical workers from the six medical facilities and several humanitarian
organizations in Turkey and Syria, who described their struggle to cope with the high number of civilians in need of
medical treatment following the recent escalation of airstrikes on the area in February 2016.
Several medical workers from Anadan and Hreitan, two towns north-west of Aleppo, told Amnesty International that the
Syrian government’s strategy is to empty an entire town or village of residents by targeting hospitals and
infrastructure to facilitate the ground invasion.
A doctor from Anadan said: “Hospitals, water and electricity are always the first to be attacked. Once that happens
people no longer have services to survive. This is what happened in Anadan. By mid-February most of the residents had
fled the city after the field hospital and medical centre were attacked on 2 February. The field hospital is barely
operating and the centre closed. The problem is that not everyone is able to leave the city. The ones who stayed behind
are elderly people who are in desperate need of medical treatment.”
“Hospitals in opposition-controlled areas around Aleppo became a primary target for the Russian and Syrian government
forces. This eliminated a vital lifeline for the civilians living in those embattled areas, leaving them no choice but
to flee,” said Tirana Hassan.
All of the people interviewed by Amnesty International said that there were no military vehicles, checkpoints, fighters
or front lines near the hospitals that were attacked and that the hospitals were exclusively serving their humanitarian
function.
Deliberate attacks on civilians not directly participating in hostilities and on civilian objects, including hospitals
and other medical facilities, violate international humanitarian law (also known as the laws of war) and amount to war
crimes. Under the laws of war, hospitals and medical units enjoy special protection. They only lose their protection
from attacks if they are being used outside their humanitarian function to commit “acts harmful to the enemy” such as to
store weapons.
Even in the case of such misuse, a warning has to be issued setting a reasonable time limit and an attack can only take
place after such a warning has remained unheeded.
“We have repeatedly called on the Syrian and Russian governments to abide by international humanitarian law and have
urged Russia to conduct credible, independent investigations into its forces’ attacks on hospitals and other serious
violations,” said Tirana Hassan.
“All medical workers and all health facilities should be respected and protected instead of being targeted. The injured
and sick people are stranded at the Turkish border or dying inside Syria because hospitals have become the new front
line in the offensive on the northern part of the Aleppo Countryside governorate. There is no excuse for a government to
prevent people from accessing medical care. There is no excuse for deliberately targeting hospital after hospital.”
New Zealand must provide leadership
Amnesty International is calling on New Zealand to continue providing leadership on aid access into Syria and the
protection of health workers and facilities.
New Zealand, as an elected member of the UN Security Council, has a key role to play in continuing to push for an end to
all unlawful attacks against civilians in Syria and ensure that all parties to the conflict lift sieges and allow
unfettered humanitarian access.
The organisation also encourages New Zealand to start working towards accountability for these war crimes; independent
monitors need access to Syria and the UNSC must refer the situation to the International Criminal Court.
Background and testimonies
According to the Syrian Network for Human Rights, a local monitoring group, at least 27 hospitals, including eight in
Aleppo governorate, have been targeted by Russian and Syrian government forces since September 2015. The Syrian American
Medical Society (SAMS) told Amnesty International that since December 2015 at least 13 hospitals had been targeted in
Aleppo by airstrikes and one by a surface-to-surface missile on 15 February. A total of four medical staff workers and 45 civilians were killed in these 14 attacks.
Physicians for Human Rights has reported that, since the conflict began, at least 346 attacks on medical facilities have been carried out by
parties to the conflict, with 705 health workers killed. Syrian government forces and their allies have been responsible
for the overwhelming majority of these.
Amnesty International’s researchers focussed on six attacks in northern Aleppo between December 2015 and February 2016.
The offensive on the northern part of Aleppo Countryside
During the last week of January 2016, Syrian government forces supported by Russian airstrikes began a ground offensive
in the northern part of the Aleppo Countryside governorate to break the siege imposed by non-state armed groups on the
towns of Nubul and Zahraa. This cut off the supply route from both this area and Turkey to Aleppo city. On 1 February,
the Syrian government forces and the Syrian Democratic Forces, which include Kurdish, Arab and Assyrian groups,
continued their offensive in the same area.
Civilians who fled the northern part of the Aleppo Countryside governorate to the Bab al-Salam border crossing into
Turkey told Amnesty International that Russian and Syrian government airstrikes escalated in the first week of February,
forcing thousands of people to flee. With no functioning hospitals left in the area, many of those injured in the
airstrikes were forced to drive for hours to obtain medical help. Interviews with doctors and medical workers in and
around Aleppo indicate that health facilities were among the first buildings targeted in a series of airstrikes at the
start of the offensive, which they believe were intended to reduce the capacity of health facilities and prevent the
injured from receiving medical treatment.
Tel Rifaat
Two doctors and an activist from Tel Rifaat who left two days before the People’s Protection Unit (YPG), part of the
Syrian Democratic Forces, took control of the town on 15 February told Amnesty International that all three health
facilities, including a field hospital, a rehabilitation centre and a kidney dialysis centre were directly targeted by
missiles during the week beginning on 8 February, just as the ground offensive on the town began. The attacks injured
six members of the medical team and three civilian patients and left the population with no working medical facility.
Doctor “Faraj” (his real name has been withheld for security reasons), who manages the field hospital, rehabilitation
and kidney dialysis centre, told Amnesty International:
“The Kurds started gaining control of some villages in the northern part of Aleppo Countryside at the beginning of
February and they were advancing towards Tel Rifaat. As they approached, Russian and Syrian forces targeted medical
facilities. As a result, the civilians injured from the indiscriminate shelling had to be transferred to the
Syrian/Turkish border because the hospitals were no longer operational.”
Several weeks before the current offensive, on 19 December 2015 at 2.45pm, a direct airstrike destroyed a centre in Tel
Rifaat which provided medical care for children with special needs. According to the centre’s manager, it had been set
up in 2014 and received 250 children per month from all over the northern part of Aleppo Countryside.
Maskan village
A doctor from the Independent Doctors Association (IDA) in Turkey told Amnesty International that the field hospital
they support in Maskan, a village in the northern part of Aleppo Countryside, had to be evacuated on 1 February because
of intensifying airstrikes and an imminent ground invasion of the village. A day after the medical staff and patients
evacuated, the IDA received images of the field hospital destroyed by an airstrike.
The Syrian government gained control of the deserted village on 15 February. Amnesty International reviewed the images
of the destruction and a video of government forces inside the field hospital claiming that the facility was used by terrorists to treat the war
wounded. International humanitarian law protects hospitals and health facilities carrying out their humanitarian
function, including providing medical treatment to wounded fighters.
Anadan
Doctors and a medical worker in Anadan told Amnesty International how two airstrikes on 27 January and 2 February by
Russian or Syrian warplanes partially destroyed a field hospital and rendered a rehabilitation centre out of service. A
physiotherapist at the rehabilitation centre said:
“The airstrikes intensified on 1 February. The next day at 8.30am the centre was targeted by a missile. I was on my way
to work when I saw and heard the explosion. When I arrived I saw the driver’s body at the entrance, two patients and
five from the medical team severely injured. We had to transfer them outside of Anadan. Now the centre is out of
service. We lost a lot of expensive equipment. We provided treatment to whoever is in need and we have been operating
since 2014.”
Hreitan
Baghdad Hospital in Hreitan was directly targeted on 25 December 2015 and severely damaged. A doctor and another medical
worker at the hospital told Amnesty International that a Russian or Syrian warplane fired missiles directly at the
hospital, injuring 10 medical staff and at least 20 civilian patients, and leaving the facility in ruins. Medical worker
Ali Hamedo was killed by the strike. The hospital has been unable to function since.
Doctor “Abdullah” (his real name has been withheld for security reasons) from Hreitan said: “Not even underground
hospitals are safe. We moved the hospital underground a year ago assuming that it will be protected from the airstrikes.
But the missiles were able to penetrate the underground levels. We have spent hundreds of thousands of dollars to equip
the hospital and provide treatment to the injured and sick but now Hreitan has no more hospitals.”
A family from Hreitan who fled the attacks on 6 February told Amnesty International that they were the last ones to
leave. The father said, “I have lived in Hreitan all my life and I have never seen it deserted. Very few families
remained because they can’t leave the city. The airstrikes destroyed the city’s infrastructure including hospitals so
there are no more services for us to be able to survive.”
According to the Russian Ministry of Defence, Russian warplanes carried out strikes on “terrorists’ objects” in Aleppo between 4 and 11 February but denied targeting civilians. The Russian authorities
continue to deny killing any civilians or damaging any civilian infrastructure in Syria, despite strong evidence
indicating many hundreds of such deaths and multiple attacks on civilian buildings. On 11 February, the Russian Ministry
of Defence accused the US-led coalition of being responsible for the attacks on the northern part of Aleppo Countryside, an accusation
denied by the USA. According to the US Central Command (CENTCOM), the US-led coalition carried out strikes on the armed
group calling itself Islamic State in Mar’a in the northern part of Aleppo Countryside between 1 and 4 February.
ENDS/