Date Uploaded: November 19, 2019
Throughout the Syrian conflict, Syrian government forces and their allies have perpetrated the vast majority of the 583 verified attacks on medical facilities in Syria. These attacks have effectively transformed medical facilities into deadly spaces, both for medical professionals and their patients, and left the Syrian medical sector in shambles. Physicians for Human Rights has painstakingly documented attacks on medical care in Syria throughout the eight-year conflict. This is the fourth in a series of brief case studies that underscore the intentional nature of many of these attacks and highlight the glaring violations of international humanitarian law and international human right law these cases represent.
Name of facility: Al-Quds Hospital
Location and background:
Al-Quds hospital was located in the Sukary neighborhood in Aleppo. It was a private hospital before the conflict but was abandoned and was later re-equipped in November 2012 by a group of health workers who found the hospital empty of almost all medical equipment and supplies except for a few small devices and some medication. The small group, including Dr. Hamza al-Kateab and a number of nurses, started by setting up a small pharmacy inside the hospital. Next, they equipped the emergency room, the obstetrics and gynecology room, and two surgery rooms. In response to the increasing demand for medical care due to the escalation of the conflict and subsequent rise in civilian injuries, Dr. Hamza began recruiting other medical professionals and working to expand the hospital’s services. By 2013, the hospital was providing services to 1,000 cases per month and grew to accommodate up to 4,000 cases per month, or 100–150 people a day, by mid-2014. By mid-2015, al-Quds Hospital was a full-service facility, with a staff of 110 medical professionals. It offered services in internal medicine, neurology, pediatrics, cardiology, oncology, surgery, and dental care.
In August 2015, after the original facility had survived three attacks but fearing it might not structurally withstand another, the staff decided to move the hospital to a new location. They began to fortify an empty building in the Salah al-Dine district that would soon become the new location for al-Quds Hospital. The building had six floors above ground and two below and was fortified with sand bags. It took the staff an entire year to prepare the new location. The hospital staff moved to the new location on August 15, 2016 and started receiving patients.
Date of Attack(s):
PHR has verified three attacks on al-Quds Hospital that caused significant damage and repeatedly disrupted medical activities. The facility was hit twice in two weeks on June 11 and June 26, 2015. Both attacks severely damaged the hospital, including the top floor, which housed the nursery. The June 26 attack injured two staff members. The third attack was the most violent and took place on April 27, 2016, when two bombs hit the front of the hospital.
Circumstances of the Attacks:
The attacks on al-Quds Hospital were part of an escalating series of targeted assaults on Aleppo’s health facilities. Throughout 2016, Syrian government forces unleashed a string of military offensives to recapture Syria’s largest city and the area surrounding it. In the course of the military campaign, Syrian government forces and their allies systematically targeted the city’s health facilities, eventually destroying the eastern half of Aleppo’s medical grid almost in its entirety. During the period of October 1, 2016 through November 18, 2016 – the lead-up to the Syrian and Russian forces’ final offensive on Aleppo – PHR documented 10 Syrian government or Russian attacks on five hospitals, including al-Sakhour Hospital, al-Bayan Hospital, al-Hakim Hospital, Omar Bin Abdelaziz Hospital, and al-Zarzour Hospital. These hospitals were repeatedly targeted until they were put out of service.
Al-Bayan Hospital was targeted three times in six days. The attacks, on October 14, 16, and 18, destroyed the facility and its ambulances. On October 16, al-Hakim Hospital (also known as the Children’s Specialized Hospital) was also attacked, trapping staff and patients in the basement of the hospital for hours. The hospital resumed its operations the next day but was attacked once again on October 18, rendering it inoperable. In addition, Omar Bin Abdelaziz Hospital was attacked on November 18, putting it out of service. Al-Sakhour Hospital was attacked on October 1, 3, and 14. The bombing destroyed the hospital, killing at least five people and injuring more than 15. These three attacks on al-Sakhour Hospital represent just a fraction of the 11 attacks on the hospital documented by PHR, pointing to the systematic nature of the assaults on the facility.
On November 19, 2016, officials from Aleppo‘s Health Directorate and the World Health Organization declared that all medical facilities in opposition-held Aleppo were out of service. However, al-Quds Hospital was still operating. Dr. Hamza explained that the announcement was intended to confuse Syrian and Russian forces in the hope of averting a renewed attack on the facility. Dr. Hamza stated, “we did not leave Al Quds Hospital until the end of the evacuation period on the 23rd of December.”
By the end of the Syrian government and Russian military campaign to recapture Aleppo, al-Quds was the only hospital left standing, despite having reportedly suffered numerous indiscriminate attacks.
Impact of the Attacks on Facility’s Operations:
The first two attacks on al-Quds Hospital, in June 2015, caused minor damage to the higher floors of the facility and minimal disruption of services, as the majority of care provision happened on the lower floors. Following each of the first two attacks, the hospital was closed for a few days for repairs. The third attack, in April 2016, caused the largest amount of damage, destroying the emergency wing as well as causing significant damage to the front of the hospital. The hospital entrance collapsed, trapping patients and medical staff inside. Another missile hit the rear of the hospital and the building behind it. A total of 55 people were killed in the attack, including six medical staff members: one of the last pediatricians in the city, a dentist, two nurses, a technician, and a guard. The hospital was out of service for one month following this attack.
After the hospital moved to its new location in August 2016, Dr. Hamza reported several attacks on the facility, saying “during the siege between November and December 2016, there were daily attacks on the hospital. Luckily, the hospital was well fortified and was able to withstand the attacks with very little damage.”
Eyewitness Account:
Dr. Hamza al-Khataeb, one of the founders of al-Quds, lived in the hospital with his wife, Waad, and his daughter, Sama. He explains: “I felt guilty. I was making my family live in the most dangerous area in Aleppo – the hospital was the biggest target.”
Dr. Hamza also described problems between hospital administrators and the locals in the area, who blamed the hospital for the constant aerial bombardment of the neighborhood. He said the dynamic between the medical facility and the civilians in the area was “a strange relationship, where they knew they needed our services but were also angry about the proximity of the facility to their homes, since it was obvious that the hospital itself was a target.”
Analysis of Attacks and Responsibility:
During its military efforts to recapture opposition-held Aleppo, the Syrian government and its allies repeatedly attacked health facilities and put them out of service. In the aerial campaign leading up to their final push to re-take eastern Aleppo, the Syrian government and Russia systematically took out functioning medical facilities one after the other, until al-Quds was the only remaining hospital in opposition-held districts.
PHR corroborated only two attacks in Aleppo City in the aftermath of the aerial campaigns. The last attack recorded was on December 5, 2016 by opposition forces on a Russian military hospital. Attacks on medical facilities ended with the ceasefire reached on December 13. PHR has documented similar patterns of escalating attacks on health facilities by Syrian government forces during military operations and subsequent de-escalations once the government recaptures an area. For example, attacks on health facilities increased dramatically during the various operations in Eastern Ghouta and stopped once the government had recaptured the area in April 2018. The case of Aleppo once again highlights the Syrian government’s systematic targeting of medical facilities as part of its strategy of war.