A Decade of Death, Destruction, and Denial

Ten Years into Syria’s Conflict, Impunity for Atrocities Prevails

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“We didn’t know which hospitals were still standing and which ones were in ruins. We didn’t know who was dead and who was alive. We were completely disoriented. Completely overwhelmed. Patients were streaming into the hospital non-stop… A single medical worker taking a break could have meant the death of a patient. That pressure only rose as more hospitals and clinics were destroyed.”

Rami, a health care professional working at a prominent hospital during the last offensive on Eastern Ghouta (PHR case study)

After 10 years of war and untold suffering in Syria, the landscape for human rights, justice, and accountability looks bleak. In the spring of 2011, peaceful protesters took to the streets across Syria, demanding basic human rights and dignity. They were met with a fierce crackdown by the Syrian government. That violence has since spiraled into a brutal and protracted conflict that has devastated the country.

Hundreds of thousands of Syrians have been killed in the fighting, and millions have been displaced. Health professionals and other civilians have been relentlessly and unlawfully targeted, and international laws and treaties blatantly disregarded. Despite multiple peace talks and United Nations (UN) Security Council resolutions – a number of which were vetoed by Russia and China – the fighting and suffering have continued. The pandemic has made a dire situation so severe that it is hard to imagine a path forward that can end the suffering for Syrians.

Illegal Attacks on Health Care

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    Attacks on health facilities documented by PHR since the beginning of the Syrian conflict

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    Of medical personnel were killed in aerial attacks or shelling

During the past decade, Physicians for Human Rights (PHR) has used research, investigative, and training methodologies – combined with advocacy based on its unique medical voice – to advance efforts to secure justice and accountability for human rights abuses committed in the Syrian conflict. Our online, interactive map documents attacks on health care facilities and the killing of medical personnel, and provides location information and details on attacks which PHR was able to independently corroborate – 90 percent of which have been committed by the Syrian government and/or its Russian allies.

March 15, 2021 will mark 10 years since the uprising in Syria. To mark this somber milestone, PHR created an interactive retrospective of some of the key moments that defined this conflict. Alongside these events, we trace efforts for documentation and accountability, and PHR’s growing tally of hospitals bombed and health care workers killed.

Explore the timeline below, or jump to PHR’s recommendations.

Tracing a Decade of Deadly Conflict

March 2011

Protests erupt in Syria, sparking a nation-wide revolution

Demonstrators in Daraa protest the detention and torture of students for anti-government graffiti. Protests erupt across the country calling for freedom, democracy, and social justice and are met by the Syrian government with force; within a few weeks, more than 200 people are killed. The government begins a sustained campaign of extreme violence and intimidation, including an all-out assault on the country’s medical system.

PHR begins to investigate attacks on health workers

Government forces enter Daraa National Hospital, clear it of non-essential staff, and position snipers on the roof to ensure that only government soldiers or civilians from government-controlled neighborhoods can receive care.

Establishment of the Independent International Commission of Inquiry on the Syrian Arab Republic

In August, the UN Human Rights Council establishes the Independent International Commission of Inquiry on the Syrian Arab Republic (COI) to investigate all alleged violations of international human rights law in Syria since March 2011.

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Government begins widespread detention of medical personnel

The Syrian government pursues a strategy of targeting and detaining medical personnel as punishment for providing medical treatment to injured protestors or to civilians denied medical treatment in government hospitals.

PHR verifies 89 attacks on health care facilities in Syria throughout the year

In an August attack, government forces repeatedly shell a field hospital in Homs for two days, hitting it with 20 shells.

President Obama issues “red line” statement

In August, U.S. President Obama states that the movement or use of chemical weapons by the Syrian government would be a “red line” that would change his administration’s calculus of the conflict. Meanwhile, the UN General Assembly condemns the violence in Syria and backs the Arab League’s proposal for a political transition.

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First large-scale chemical weapons attack on civilians

On August 21, the first large-scale use of chemical weapons in Syria occurs in Eastern Ghouta, killing more than 1,400 civilians and sparking international outrage. PHR calls for an independent investigation.

PHR verifies 48 attacks on health care facilities in Syria throughout the year

In June, a bomb is dropped on al-Raqqa National Hospital, destroying its intensive care unit. In July, government forces destroy Jaban Hospital in Aleppo after sustained shelling and aerial bombardments. More.

UN Security Council adopts resolution on the use of chemical weapons

On September 27, the United Nations Security Council (UNSC) unanimously adopts Resolution 2118 on the use of chemical weapons in Syria. This resolution requires the verification and destruction of Syria’s chemical weapons stockpiles, calls for the convening of the Geneva II peace talks, and endorses the establishment of a transitional governing body in Syria.

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Health workers, their patients, and civilians are targeted with deadly force while massive displacement continues

Despite chemical weapons agreement, a crisis continues for Syrian refugees and IDPs: more than two million people have fled Syria and 4.25 million are internally displaced. More.

PHR verifies 86 attacks on health care facilities throughout the year

In April, government forces drop a barrel bomb filled with chlorine gas near Wisam Hospital in Kafr Zita. Patients and medical staff are forced to evacuate in order to escape toxic fumes, and medical service is interrupted.

In June, government forces aerially bombard the Orient Hospital, in Kafr Nabl, Idlib with a guided vacuum missile, damaging the dialysis center, pharmacy, and equipment. A newborn baby is killed, along with a doctor and an anesthesia technician.

UNSC Res 2165 authorizes cross-border humanitarian aid in Syria

After the Syrian government fails to fulfil its obligations under UN Security Council Resolution 2139, the UNSC adopts Resolution 2165, which authorizes cross-border and cross-line access for the UN and its partners to deliver humanitarian aid in Syria.

Russia, China block Security Council referral of Syria to International Criminal Court

In May, Russia and China block the adoption of a UN Security Council resolution giving the International Criminal Court a mandate to investigate human rights violations in Syria.

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Release of the “Caesar Photos,” documenting torture and deaths of detainees held by the Syrian government

An official forensic photographer for the Syrian military police, using the alias “Caesar,” defects and smuggles out of the country more than 50,000 photos of the bodies of detainees who have died in Syria’s detention centers. PHR’s team of forensic pathologists review the images for evidence of torture and cause of death to verify their authenticity.

PHR verifies 123 attacks on health care facilities throughout the year

On September 30, Russia begins its first aerial bombing campaign in support of the Syrian government, and repeatedly targets hospitals.

In the early morning of October 16, a series of airstrikes hit al-Hader Hospital in southern Aleppo, damaging the facility, equipment, and supplies. The hospital’s electricity is also cut, putting it out of service, and patients are evacuated. Sources believe the attack was carried out by Russian warplanes.

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Syrian Government retakes eastern Aleppo

By the end of the government’s campaign to capture the city from the opposition, 95 percent of Aleppo’s doctors have fled, been detained, or been killed.

PHR verifies 109 attacks on health care facilities throughout the year

Attacks against health care remain high, including many from the Syrian government’s siege and assault on opposition-controlled eastern Aleppo. In one of many such attacks in July, Syrian government and/or Russian warplanes bombard Atarib Hospital in a series of strikes. The facility suffers significant damage and the hospital is put out of service.

In Idlib province, at least seven are killed in another attack against an MSF-supported hospital.

Establishment of the IIIM for Syria and the adoption of UNSC Res 2286, condemning attacks against medical facilities and personnel in conflict settings

The UN Security Council unanimously adopts Resolution 2286 condemning attacks against medical facilities and personnel in conflict situations. Meanwhile, the UN General Assembly adopts a resolution establishing the International, Impartial and Independent Mechanism (IIIM) to assist in the investigation and prosecution of those responsible for the most serious crimes under international law committed in Syria since March 2011.

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Syrian Government launches military offensive to retake control of eastern Ghouta

After four years of besieging eastern Ghouta, the Syrian government launches a military offensive between February and April to retake control of the region. Within the first day of the offensive, five health facilities are reportedly attacked and either heavily damaged or destroyed. By the end of the offensive, humanitarian and civil society organizations on the ground report 31 attacks on 26 separate medical facilities. More.

PHR documents 39 attacks on health care facilities in Syria throughout the year

The Syrian government or its Russian allies launch five aerial attacks on three of the main hospitals in Syria’s Idlib governorate, which is part of the so-called de-escalation zones. Three of these attacks take place on the same day.

Chemical weapon attack on Khan Shaykhun


On April 4, just before daybreak, Syrian government aircraft launched an assault on the town of Khan Shaykhun in an opposition-held area of Idlib province. The payload includes a chemical agent, reportedly sarin – among the deadliest toxins in existence. This chemical attack kills more than 80 people. A few hours later, number of airstrikes targeted al-Rahma hospital while medical staff were treating chemical attack victims. The hospital suffered material and structural damage and was forced to suspend operations.

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Government wages an offensive on Daraa

The Syrian government wages a campaign to retake control of Daraa province, targeting and destroying much of the region’s health infrastructure and facilities as a deliberate strategy of war.

PHR verifies 58 attacks on health care facilities throughout the year

PHR verifies 58 attacks on health care facilities in Syria during 2018. Impunity continues for attacks on health, and attacks continue to occur, often against repeat targets. Kafr Zita Specialty Hospital in Hama is attacked for the thirteenth time.

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Impunity continues for the use of arbitrary detention, forced disappearance, and torture

The Syrian government continues to target health care workers and other civilians for arbitrary detention, forced disappearance, and torture, with complete impunity.

A major PHR investigation into the targeting of health professionals exposes how the Syrian government has criminalized the provision of nondiscriminatory care to all, regardless of political affiliation.

UN Board of Inquiry is established

The UN Secretary-General establishes a UN Board of Inquiry to investigate the destruction of UN-supported facilities and facilities on the UN deconfliction list, including health facilities, targeted during the Syrian and Russian governments’ offensive in northwest Syria.

PHR briefs the UN Security Council on attacks on health and the humanitarian crisis in Syria.

Russia, backed by China, casts 14th UN Security Council veto on Syria to block cross-border aid

Russia and China veto a UN Security Council resolution that would have allowed cross-border humanitarian deliveries for an additional 12 months from two crossings in Turkey and one in Iraq.

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COVID-19 hits Syria, further weakening a crippled health system

The Syrian government’s targeting of health care workers and other civilians for arbitrary detention, forced disappearance, and torture continues with complete impunity. A major PHR investigation into the targeting of health professionals exposes how the Syrian government has criminalized the provision of nondiscriminatory care to all, regardless of political affiliation


PHR’s investigation records the decline of the health system in Daraa province since its return to government control in 2018, leaving a once functioning health sector unprepared for the COVID-19 pandemic and other public health threats.

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Children are seen on the rubble of a building in the Jarabulus district of Aleppo, Syria on October 1, 2016. Photo: Halil Fidan/Anadolu Agency/Getty Images


As the Syrian conflict enters its eleventh year, it is critically important to redouble efforts to uphold, promote, and respect the human rights of the Syrian people, and all who have been and still are impacted by this immense humanitarian and human rights crisis.

Below we outline key actions that governments and international institutions must take now within three issue areas that PHR has focused on over the last decade: justice and accountability, detainees and missing persons, humanitarian access, and – in the last year – the right to information during the COVID-19 pandemic.

Justice and Accountability

The Syrian conflict is marked by widespread human rights violations, war crimes, and the greatest refugee and displacement crisis since World War II. Physicians for Human Rights has held that these violations could constitute crimes against humanity. As part of its mission to document human rights abuses, as of March 2021 PHR has documented 599 attacks on hospitals and other health care facilities since the start of the conflict. These illegal attacks leave communities without the critical health care infrastructure they rely on. Our interactive map showcases the years, locations, and alleged perpetrators of these attacks. In a push for accountability for attacks on hospitals, PHR’s director of policy, Susannah Sirkin, briefed the UN Security Council in 2019 and urged an “investigation into attacks on health facilities and personnel in Idlib, northern Hama, and western Aleppo, and on the failure of the [UN] deconfliction mechanism.”

PHR has demanded accountability not only for attacks on health care, but also for the use of chemical weapons during the conflict. As part of this work, PHR has shared data with the Organisation for the Prohibition of Chemical Weapons and international justice mechanisms. As Syria marks a decade of conflict, pursuing accountability for crimes committed in Syria must be at the forefront of the international community’s efforts.

PHR’s recommendations:

To the Syrian Arab Republic:

  • Cooperate with international justice mechanisms working to investigate crimes and violations committed during the Syrian conflict; and
  • Stop intimidating, threatening, arresting, disappearing, torturing, and killing health care workers.

To Officials in Charge of International, Regional, and National Justice and Accountability Mechanisms:

  • Because China and Russia – allies of the Syrian government on the United Nations Security Council – have blocked referral of the situation in Syria to the International Criminal Court (ICC), it is critical that officials in charge of other international, regional, and national justice and accountability mechanisms move forward to address the human rights abuses and war crimes committed in Syria. There are many international, regional, national, and hybrid justice and accountability models that are flexible enough to meet the unique requirements of these cases. In addition, courts and prosecutors in countries that may be willing to investigate and prosecute war crimes and grave human rights abuses nationally under universal jurisdiction can and should pursue accountability, justice, and remedies for these crimes. A recent successful prosecution of a former member of Syria’s security services for torture in a German court provides a roadmap for how such cases can be advanced in national courts in other countries.

To the United Nations:

  • The Independent Senior Advisory Panel on Humanitarian Deconfliction in the Syrian Arab Republic should provide recommendations not only on how to strengthen the requirements of the UN deconfliction mechanism and future compliance, but also on how best to enforce the requirements and hold accountable actors who violate them;
  • Demand accountability for previous and ongoing violations of civilians’ right to health across Syria, committed by both the Syrian government and its allies in areas retaken by the government; and
  • Ensure that refugee host states are cooperating with the principle of non-refoulement, or the right of a person not to be returned to a place where persecution is likely.

To the United States Government:

  • Investigate and prosecute possible perpetrators of crimes in Syria who are present in the United States;
  • Provide any additional resources and support that made be needed to advance the work of the UN Independent, Impartial, and Investigative Mechanism, the Commission of Inquiry, and the Humanitarian Deconfliction Mechanism for Humanitarian Organizations Operating in Syria; and
  • Immediately revoke sanctions against officials of the ICC, and rescind the executive order that provides authority for such sanctions.

Detainees and Missing Persons

The Syrian government has detained thousands of people since the start of the conflict in 2011. Many remain missing as families desperately seek information about them and their fate. In the report “’My Only Crime Was That I Was a Doctor’: How the Syrian Government Targets Health Workers for Arrest, Detention, and Torture,” PHR documents the systematic arrest of health care workers and the physical and psychological torture many were subjected to. PHR calls on all parties to the conflict, particularly the Syrian government and affiliated forces, to immediately and unconditionally release all arbitrarily or unlawfully detained individuals, allow unconditional access to detention sites in the country, and allow for unconditional access to health care to those who remain in detention.

PHR’s recommendations:

To the Syrian Arab Republic

  • Immediately and unconditionally release all arbitrarily or unlawfully detained individuals from official and unofficial detention sites, starting with health care workers and the most vulnerable, including children, women, the elderly, and the disabled;
  • Disclose the locations of all official and unofficial detention sites and provide comprehensive lists of all those held in those sites;
  • Allow humanitarian service providers, medical personnel, and human rights observers immediate access to enter facilities and speak with and provide services to any detainees held in custody, including administering vaccines and treatment for COVID-19;
  • Improve detention conditions in compliance with international standards, including through ensuring detainee contact with families, access to medical care, and sufficient water and food, as well as preventing torture, ill-treatment, and sexual violence; and
  • Make public all information regarding the whereabouts of missing persons, and provide the remains of the deceased to their loved ones.

To the Syrian Constitutional Committee:

  • Elevate release, care, and remedies for people who have been arbitrarily detained as a central outcome of ongoing negotiations.

To the United Nations Security Council:

  • Address non-implementation of prior UN Security Council resolutions – such as Security Council resolution 2474 (2019) – by adopting a stand-alone resolution on the situation of detainees and missing persons, setting out in detail the steps that all parties to the conflict are required to take under international law; and
  • Establish an independent commission to collect and analyze information on the whereabouts of missing persons.

To the United States Government:

  • Facilitate consensus within the international community on compliance with international human rights and humanitarian law in the conflict in Syria, including pathways to release of detainees and ensure adequate justice, accountability, rehabilitation, and remedies for individuals arbitrarily detained or subjected to torture or cruel, inhuman, or degrading treatment; and
  • Call for the release of arbitrarily arrested detainees as part of ongoing and future peace negotiations.

Humanitarian Access

In the 10 years since the start of the Syrian conflict, many Syrians have relied on UN-facilitated aid deliveries to support them. The UN estimates that more than 13 million Syrian civilians are in need of aid, including the six million who are internally displaced. Since 2014, the UN has authorized humanitarian aid deliveries to reach Syrians, initially through four border crossings. As of July 2020, the UNSC resolution 2533 renewed cross-border aid delivery through only one border crossing: Bab al-Hawa from Turkey. After this decision, PHR’s director of policy, Susannah Sirkin, briefed the UN Security Council on the humanitarian situation in Syria amidst the COVID-19 pandemic. She highlighted that facilities in the northeast – which used to receive aid through the Al Yarubiyah border crossing from Iraq – are facing difficulties, with limited equipment and aid. The UN, member states, and donors must work to provide more aid to all parts of Syria, rather than limit aid delivery to one border crossing in the northwest.

PHR’s recommendations:

To the Syrian Arab Republic:

  • Expand access for desperately needed humanitarian aid to areas retaken by the government.

To the United Nations:

  • Pressure the Syrian government to permit the delivery of aid and allocation of health services so that organizations such as the WHO and other UN agencies, international NGOs, and local actors can reach populations in a neutral, effective, and equitable manner;
  • Reopen all four border crossings to distribute humanitarian aid; and
  • Allow humanitarian aid to reach internally displaced persons, those residing in Al-Hol, and those in the Rukban camp.

To the United States Government:

  • Pressure the governments of Syria and Jordan to allow access for aid to the Rukban camp, which is currently not receiving aid from the UN.

COVID-19 Pandemic

Due to systematic attacks by the Syrian government and its allies throughout the 10 years of conflict, the health care infrastructure in Syria has been significantly weakened. Syria is now having to face the COVID-19 pandemic. In PHR’s December 2020 report “Obstruction and Denial: Health System Disparities and COVID-19 in Daraa, Syria,” PHR found that, as the virus spreads in the country, the Syrian government has failed to implement adequate preventative measures, protect its health care workers with medical supplies and personal protective equipment (PPE), and test large numbers of people for COVID-19. 

PHR’s recommendations:

To the Syrian Arab Republic:

  • Release transparent data on COVID-19 cases in the country;
  • Adopt transparent measures to prevent diversion of assistance and provide donors with accounts of aid distribution in reconciled areas, including COVID-19 testing and PPE distribution;
  • Expand access for desperately needed humanitarian aid to areas retaken by the government; and
  • Cooperate with the World Health Organization (WHO) to distribute PPE and necessary medical aid to reconciled areas in the country and work with the WHO to develop an effective vaccine dissemination plan.

To the United Nations and the World Health Organization:

  • Demand the distribution of timely, detailed epidemiological information about the extent of the COVID-19 pandemic in Syria consistent with the right to information; and
  • Prioritize the vaccination of Syrian health care workers and the elderly in a timely manner, in all areas of the country.

Supported with German Federal Foreign Office’s funds by ifa (Institut für Auslandsbeziehungen), Funding programme zivik.

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