Airstrikes targeted 11 Syrian hospitals in April, destroying infrastructure, killing patients and aid workers. In Syria, civilians are left with no choice but to adopt a risk mentality when rushing to hospital for treatment. Busy, noisy and overwhelmed hospitals now resemble silent library-like places, not attended in fear of being killed by targeted missiles. It’s clear that targeting hospitals and humanitarian workers has become a strategy of war in the Syrian conflict, but how has this impacted the civilian population and the humanitarians?
Bilal Abdul Kareem, an American journalist with On the Ground News (OGN), reported that 11 hospitals have been targeted with airstrikes rendering them out of service. In a video featuring an undisclosed hospital, Kareem explains how a hospital in northern Syria is empty as civilians are too scared to resort to a hospital for medical relief.
OGN tells MEMO: “Strikes took place in Arbin Hospital in Eastern Ghouta; Khan Sheikhoun which was targeted twice; Kafara Khareen in which airstrikes destabilised two hospitals for women and a special unit for children; Maaret Al-Numan hospital in Idlib; Abideen hospital in southern Idlib, Kafra Nubal hospital, Deir Al-Sharqi and three airstrikes in hospitals in Dara’a, all in April 2017, alone.”
What we do know is that it’s an aerial attack, and that the rebels do not have any planes nor any helicopters.
This only leaves the Syrian regime and Russian forces as possible perpetrators as, as yet, there have been no reports of coalition forces targeting hospitals. However, there is extensive historical data of the regime and its allies striking medical centres.
When I look at the [remains of] split shelling’s after bombing, they have Russian writing on it and it’s pretty clear.
Abdul Kareem explains.
Hospitals moved underground
With Syrian hospitals already overwhelmed with the war-wounded, civilians are desperately treated on the floor, corridors and frequently die due to inadequate medical equipment or treatment.
Dr Shajul Islam, a British-trained doctor working in Syria to assist injured civilians, says doctors are being forced to work in extreme circumstances in the knowledge that the next strike could end their lives. As a result, many hospitals have been moved underground, away from the sight of military aircrafts.
We [medical staff] take our precautions, and started moving out medical equipment underground. Medical facilities have been targeted since 2012, when I first came to Syria to help. Most of the hospitals are now underground or inside caves.
“After the Russians got involved in the war, they started executing stronger bombs on us, and recently we’ve seen an increase in the use of ‘bunker buster bombs’ on hospitals. It’s no longer safe for us to operate from basements as the whole building just collapses on you when hit and we’ve found that to be the case last week at Abideen Hospital, southern Idlib.”
Islam explains that the strategy which had previously been used to save patients and keep them away from the bombs became a hazard.
The hospital “it was targeted with two ‘bunker buster bombs’ and the hospital collapsed on the patients and closed off all the exits – the underground strategy became a disadvantage for us.”
Rescue workers spent a long time trying to dig people out. Emergency vehicles brought people to the hospital because they were hit by airstrikes elsewhere, but then the hospital was hit. One of our staff members was injured in the strike and four patients were killed.
The strategic attacks from unconfirmed entities have impacted the means and methods employed by doctors to treat the civilian population. Where “bunker buster bombs” failed to destroy temporary basements and make-shift hospitals in caves, the chemical chlorine attacks allow deeper penetration – causing fatal injuries to civilians.
“Another strategy the regime started using against hospitals is to use chemical attacks… a heavy substance that sinks down into the basements and caves,” Islam explains.
As we change our strategies, they [the regime] also change their strategies and adapt.
Patients are now too “terrified” to attend hospitals, and often end up arriving “unconscious or severely injured”, Islam explains. Then as soon as they are able they are “eager to get out of the hospital”.
I’ve seen myself, and had cases where, patients needed monitoring for a few hours, but they’ve self-discharged themselves and would say ‘we’re not staying! We’re not staying!’
Tauqir Tox Sharif, a British aid worker who works in Syria, says “a new wave of fear” has been circulating because of the number of hospitals which have already been targeted with people worried that more will be attacked.
Many of the hospitals are now empty, and we recently had a new wave of fear going around on Telegram and Whatsapp saying that the main hospital in Idlib is going to be targeted very soon.
“Women prefer to give birth in refugee camps with the poorest of facilities, as even maternity clinics have been bombed,” Sharif explains.
Islam says it’s increasingly clear that airstrikes on Syrian hospitals have become a customary stratagem of warfare. On 13 November 2016 he became one of the survivors of such an attack.
Five minutes after he finished operating on a patient, four airstrikes hit all four corners of the hospital destroying large areas, including the theatre room he had been working in.
“Five minutes before the attack, I left the operating room and this particular strike hit the side of the operation room and totally destroyed it. Other strikes hit the car park, destroying all the ambulances, warehouse and medical stores. This was a distressing time for the doctors and patients as it rendered the hospital out-of-service,” he explains.
It’s a policy that has spread fear into the hearts of not just the civilians but also hospital staff who have seen the destruction caused by airstrikes first hand.
I have witnessed it with my own eyes; I’ve seen damage that happened to hospital facilities… It’s one of the scariest things to comprehend, especially when you see injured civilians in the hospital trying to save their lives whilst thinking they could be killed at any moment – very scary.
.@jk_rowling @AlabedBana @Alhamdhulillaah @MuslimMatters @MoeenAli @SonnyBWilliams @YasirQadhi @omarsuleiman504 @SyriaCivilDef @TalkIslam1 I think about my patients; The child that just got bombed in her house. Long hours of operation to be bombed again IN the hospital. 💔 #Syria
— Dr Shajul Islam (@DrShajulIslam) April 30, 2017
Such attacks are in direct violation of international laws and amount to war crimes. Medical centres enjoy special protective status under international humanitarian law. When civilians are terrified of being treated in hospital it’s time to question why the international community is remaining silent.
The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Monitor.