Since the beginning of the Syrian conflict, there had been 599 medical workers killed in 224 attacks on medical facilities by February 2015. Médecins Sans Frontières (MSF) supported-facilities were subjected to 94 aerial and shelling attacks in 2015 alone. These attacks killed or wounded 81 medical staff. Attacks on medical facilities and personnel in Syria have become so common that MSF gave a statement to the UN Security Council declaring that the Syrian health care system had collapsed as a result. MSF has stopped formally informing Syria’s government or its Russian allies about the GPS coordinates of medical facilities, because of concerns that doing so could make them targets. While the majority of attacks on health care have taken place in rebel-held areas, there have been violations in government-held areas as well.
It has been well documented that the Syrian government and its allies, including Russia, conducted aerial attacks on medical facilities in rebel-held areas. These attacks have been roundly and rightly denounced as they violate international humanitarian law (IHL) and the principle of medical impartiality. However, violations of medical impartiality don’t just occur when a medical facility is attacked in an aerial bombardment. The principle of non-interference prohibits any obstruction to medical services, including temporarily stopping medical personnel or supplies reaching sick or injured people. In many government-held areas, parties to the conflict prevent civilians’ access to medical care. Civilians deemed as sympathetic to a certain party to the conflict have been denied access to medical care by other forces as a result of their political or religious affiliation.
Deir ez-Zur, a government-held town in east Syria, is besieged by the Islamic State (ISIS). In August 2014, it was estimated that 63,000 individuals were living in the town. Many of them had fled from surrounding areas. A report stated that the lack of health services had consistently been categorized as “catastrophic”, in Deir ez-Zur since November 2013. The UN Office for the Coordination of Humanitarian Affairs (OCHA) reported in January 2016 that residents were in need of immediate and urgent humanitarian assistance; particularly food, nutrition and health supplies. In 2015, health personnel inside the town documented 15-20 deaths as a result of starvation. Only one hospital in the city remained active, but it suffered from a severe lack of medication, supplies and health personnel. Further, there were documented cases of the skin disease Leishmaniosis and Typhoid as a result of poor sanitation compounded by the lack of medical care. Jalal, a member of Justice for Life, an NGO based in Deir Ez-zur, described the situation in the town in February 2016: “We don’t know if aid will ever reach us… and it is always too little.” A shopkeeper named Abdul Qasim, reported that the local hospital was full of malnourished children suffering from diarrhea, malabsorption and other diseases due to hunger. In June 2016, the Under-Secretary-General for Humanitarian Affairs said, “While we continued to reach those in Deir ez-Zur through high-altitude airdrops, the one-off and inconsistent land access throughout May was simply not enough.”
Al-Hasakah, a town in north-east Syria, is partly government-controlled. The government-held areas of the town are surrounded by Kurdish forces including the Kurdish People’s Protection Unit (YPG). In August 2015, the International Committee of the Red Cross (ICRC) stated that heavy fighting had taken place over several weeks. Subsequently, many civilians were injured and required urgent medical care. The organization said that multiple frontlines made road access to al-Hasakah difficult, meaning that regular delivery of supplies was not possible. In March 2016, it was reported that an exodus of medical staff and lack of medicine had led to a deterioration in the town’s health sector. Medical staff highlighted the potential for outbreaks of disease given a lack of vaccinations and poor sanitation. Civilians in the town report being unable to afford urgent medical procedures. Patients from Al-Hasakah have been forced to travel to Damascus to receive medical treatment. A man from al-Hasakah said, “there is no land route between Damascus and al-Hasakah. We are forced to come here by plane, which means additional costs.” MSF reports that an acute shortage of drugs, medical supplies and skilled personnel are having a devastating impact on health care in the area.
In May 2016, Jableh National Hospital in the government stronghold of Latakia was attacked. A suicide bombing at the entrance of the hospital killed over 40 patients and visiting family members. The attack also injured 35 people. An emergency doctor and two nurses were killed. The World Health Organization (WHO) reported that the hospital had to close directly after the attack and that patients had to be transferred to other hospitals. ISIS later claimed responsibility for the attack.
The villages of Kafriya and Al-Fu’ah, north of Idlib, are government-controlled and surrounded by opposition forces. The two towns form a Shiite enclave, which opposition forces see as unsympathetic. Whilst there have been reports of the Syrian army’s helicopters dropping aid, it is difficult for the villagers to reach areas outside of the villages’ borders where the aid is dropped. As such, there are little food and medical supplies. In March 2016, the Syrian Observatory for Human Rights (SOHR) reported that 12 people from the towns of Al-Fu’ah and Kafriya had reached the town of Al-Suqaylabiyah in the western countryside of Hama. Some of those who arrived were wounded and required medical attention.
In May 2016, al-Dabbit government maternity hospital in Aleppo was damaged when opposition forces fired rockets. The attack killed at least 19 people, including three children. The attack was seen as a retaliation for the earlier bombing of al-Quds hospital by the Syrian government.
In each of these cases the principles of medical impartiality are violated. By besieging areas and restricting the flow of medical aid, the principle of non-interference is breached. Direct attacks on medical facilities also violate this principle. Non-interference is a legal obligation for governments and parties to a conflict. It is also violated when parties refuse to allow medical care to reach citizens in areas who are seen as loyal to other forces. Whilst these violations continue to take place, the UN Security Council should give the International Criminal Court a mandate in Syria to hold perpetrators accountable.
Photo Credit: BBC