The Syrian-American Medical Society (SAMS) has published a grim report documenting the pattern of attacks on healthcare in Syria following the passage of UN Security Council Resolution 2286 on 3 May 2016 condemning attacks on medical facilities and personnel in conflict zones. The Resolution was a general one; several states drew attention to Israel’s assault on medical facilities in Gaza, and to the US airstrike on the MSF Trauma Centre in Kunduz (Afghanistan) (see here and here).
The Resolution had the urgent support of a host of humanitarian NGOs; it was co-sponsored by more than 80 member states, and it was adopted unanimously by the Security Council. At the time the UN Secretary-General Ban Ki-Moon described attacks on hospitals as a war crime, and declared:
When so-called surgical strikes are hitting surgical wards, something is deeply wrong… Even wars have rules… The Council and all Member States must do more than condemn such attacks. They must use every ounce of influence to press parties to respect their obligations.
And yet this is what SAMS found in Syria:
- In 2015, the rate of targeting of medical facilities and personnel was one attack every four days.
- In October 2015, following Russia’s intervention in support of the Syrian government, this rate doubled to one attack every 48 hours.
- In November 2016 the rate virtually doubled again to one attack every 29 hours.
SAMS estimates that there were 252 attacks on medical facilities and personnel in 2016; 199 of them took place after the passage of UNSC Resolution 2286.
Between June and December SAMS identified 172 attacks (all detailed in an appendix to the report): 168 of them were carried out by the Syrian government and its allies; one by non-state opposition forces; one by Islamic State; and two by unidentified parties. Aleppo and Idlib were the principal targets: eastern Aleppo alone received a numbing 42 per cent of all attacks.
In case you are wondering about the sources for these claims, the report explains:
SAMS maintains rigid documentation standards in collaboration with partners in the WHO Health Cluster in Turkey and the Johns Hopkins University Bloomberg School of Public Health’s Center for Health and Human Rights. Our reporters on the ground rely on rst- hand testimony and photo documentation from medical sta and record the date, time, location, damages, casualties, impact on service delivery, weapon(s) used, and perpetrator of each incident. Any other source of information is not considered.
Dr Ahmad Tarakji, President of SAMS, reaches this bleak and compelling conclusion:
The failure of the international community to hold the perpetrators of these attacks accountable sends a dangerous message: that there are no lines, no limits, and no boundaries to the atrocities that are being committed against the Syrian people.
You can find more details about the targeting of doctors and hospitals in my post on the weaponisation of healthcare in Syria here; there is also a response to the passage of UNSC Resolution 2286 and its implementation by the Safeguarding Health in Conflict coalition (in September 2016) here.
Syria’s civilians were under constant threat from Coalition air strikes throughout 2016, with 38% more casualty events reported in Syria than Iraq over the year. This may however reflect improved local reporting by Syrian monitors.
Overall, minimum likely civilian deaths in Syrian incidents graded by Airwars as Fair or Confirmed doubled in 2016. Across 136 incidents, between 654 and 1,058 civilians were claimed killed in total. Airwars estimates that a minimum of 818 civilians were likely injured in Fair and Confirmed events in Syria alone.
There were major spikes in February, in June and July (the Manbij campaign) and November the Raqqa campaign), all of them focused on areas held by Islamic State.
As for Syrian/Russian air strikes:
Airstrikes carried out by Moscow pummeled rebel-held areas of Syria throughout 2016, with many hundreds of civilians credibly reported killed.
Overall, there were 1,452 separate claimed civilian casualty events allegedly carried out by Russia during 2016. Between 6,228 and 8,172 civilians reportedly died in these events. Many of these incidents are likely to have been the result of actions by the Assad regime. Even so, civilian deaths from Russian strikes in 2016 far outpaced those from Coalition actions.
The pattern of civilian casualties from Russian air strikes:
But at least three caveats are necessary. First, these are provisional calculations: ‘With so many allegations to assess, Airwars has a significant case backlog’, and the team has so far only completed a detailed analysis of the first four months of 2016.
Second, the report provides no separate listing of air strikes carried out by the Syrian Arab Air Force. The Airwars team concedes a ‘very high level of confusion – especially between Russia and the regime’. Here is Kinda Haddad: ‘For many incidents we have some sources blaming the regime and others Russia – and we can’t really tell who is responsible as they use similar planes and weaponry.’ One major exception to that must be the use of barrel bombs dropped by the SAAF’s helicopters.
Third, these tabulations identify immediate casualties from the strikes: one of the reasons for attacking doctors and hospitals, as I explained previously, is to multiply subsequent and distant casualties – to deny those wounded (or simply sick) life-saving medical treatment. So these casualty lists are minima – and not only as a result of the general problems of casualty accounting in conflict zones.