According to Physicians for Human Rights (PHR), around 750 health workers have been killed in Syria in the past five years, 93 percent of whom were killed by government forces and their allies. Additionally, 148 health workers were tortured to death in government prisons. Between March 2011 and December 2016, there have been 411 attacks on medical facilities and personnel.

According to the Syrian American Medical Society (SAMS), the rate of attacks on health workers, services, and infrastructure in 2015 was one attack every four days. Following Russia’s intervention alongside the Syrian government in October 2015, the rate doubled to one attack every 48 hours.

Armed groups have also carried out indiscriminate attacks that have struck hospitals. In May 2016, Islamist rebels attacked Assad Hospital in Deir ez-Zor. Furthermore, Islamic State militants have reportedly restricted the work of doctors in the Syrian city of Raqqa. Militants force female doctors to wear a black cloak covering their face and prevents them from treating male patients. In 2015, Islamist militants have ordered the closure of all women’s clinics supervised by male gynecologists.

People living in besieged and hard-to-reach areas have extremely limited access to health care. According to the United Nations Office for the Coordination of Humanitarian Affairs, roughly 4.5 million people are living in hard-to-reach areas, including 600,000 people living in besieged areas where both bombing and inadequate access to aid, food, water and medical care are very common. The Government of Syria denied more than 70% of entry requests to besieged areas, hindering the delivery of food and medical aid. Even in areas where aid was allowed in, the Syrian government has removed life-saving items from convoys. In February 2016 alone, the United Nations said some 80,000 medical treatments were excluded or removed from aid convoys to besieged areas.

Evacuation of wounded civilians from besieged and hard-to-reach areas remains a serious problem in Syria. According to a report by PHR and the Syrian American Medical Society, 86 people died in the besieged town of Madaya between July 2015 and May 2016 from siege-related causes, including 65 from malnutrition and starvation.