As military confrontation between Syrian opposition groups and the Syrian government intensifies in the country’s northwest, all parties to the conflict must abide by international humanitarian law (IHL) and protect civilians and civilian infrastructure, including health care facilities, Physicians for Human Rights (PHR) said today.
Syrian opposition forces based in northwest Syria launched a military operation starting November 27, 2024, capturing major cities and towns in Idlib, Aleppo, and Hama governorates previously retaken by the Syrian government in 2019.
The escalation has resulted in the killing of at least 149 civilians, including 35 children and 16 women, in northwestern Syria between November 27 and December 3, 2024, according to the Syrian Network for Human Rights (SNHR). SNHR reports that 105 civilians, including 33 children and 13 women, were killed by the Syrian government; 27 civilians were killed by the Syrian Democratic Forces; eight were killed by Russian forces, including two children and two women; and five were killed by the opposition groups, including one woman. Four civilians were reportedly killed by unidentified perpetrators.
The renewed violence triggered mass displacement of civilians and caused widespread disruption of public services in affected communities.
The Syrian government and its allies, in particular Russian military units, have responded with attacks on civilian infrastructure, including at least two airstrikes on groups of hospitals and other critical health infrastructure. Reported attacks have struck Aleppo University Hospital, Idlib University Hospital, Ibn Sina Hospital, the National Hospital, the Maternity and Obstetrics Hospital, and the Health Directorate in Idlib. At least one health worker was reportedly killed during the recent fighting.
“Attacks on civilians and health infrastructure have been a consistent strategy of the Syrian government and its Russian ally throughout the conflict,” said Houssam al-Nahhas, MD, MPH, health and human rights researcher at PHR. “We are seeing Syrian doctors and patients in the crosshairs again. Such attacks violate international humanitarian law, which prohibits targeting health care facilities and medical personnel. Since the crisis in Syria began in 2011, the Syrian government and its allies have perpetrated at least 548 attacks on health care, aiming to undermine civilians’ resilience and force them to flee.”
“Violence against health care extends beyond physical damage to buildings or harm to patients and medical staff. These attacks disrupt access to life-saving medical services for affected communities and severely limit essential care. Vulnerable populations, especially women and girls, face disproportionate impacts, as their health needs are often neglected in crisis situations,” said Dr. Al-Nahhas.
PHR has also documented 24 attacks by opposition forces on health care facilities since the beginning of the conflict in 2011.
Humanitarian actors and Syrian non-governmental organizations are mobilizing resources to support the health system in newly captured areas, aiming to restore essential services. However, their capacity is limited due to the overwhelming needs in areas they already serve in Idlib and the Aleppo countryside. This challenge is compounded by the forced displacement of health care providers from the newly captured regions, driven by fear of retaliation from government forces or armed groups.
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.