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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.

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.

Recommendations

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.

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