The Syrian Conflict: Eight Years of Devastation and Destruction of the Health System

The Syrian Conflict: Eight Years of Devastation and Destruction of the Health System

As the eighth year of the crisis in Syria comes to a close, civilians continue to suffer through a conflict defined by human rights abuses and violations of international humanitarian law. PHR has researched, documented, and mapped widespread and systematic attacks on medical infrastructure in Syria since March 2011. While battlefield developments wound down and the conversation on Syria drifted toward refugee returns and reconstruction, 2018 was marked by phases of extreme violence as the Syrian government consolidated its hold over much of Syria’s territory. Within the shifting landscape of the Syrian conflict, it is more important than ever to maintain focus on past and ongoing crimes and to intensify calls for justice and accountability for the Syrian people.

PHR has corroborated 553 attacks on 348 separate Syrian medical facilities from March 2011 through December 2018.

The Systematic Targeting of Health Facilities

Attacks on health care, in gross violation of humanitarian norms and the Geneva Conventions, have been a distinctive feature of the conflict in Syria since its inception. PHR has documented and mapped 553 attacks on at least 348 separate facilities from March 2011 through December 2018. The reduction in the number of attacks over the past year is a clear reflection of the diminishing intensity of the conflict, which came as a direct result of the Syrian government’s takeover of most opposition-held areas. The systematic targeting of health facilities has been a crucial component of a wider strategy of war employed by the Syrian government and its allies – who are responsible for over 90 percent of attacks – to punish civilians residing in opposition-held territories, destroy their ability to survive, and draw them into government-held areas or drive them out of the country. This strategy of unbridled violence – which in addition to attacks on healthcare has included chemical strikes, sieges, and indiscriminate bombing of predominantly civilian areas – has devastated the civilian population, weakened opposition groups, and translated into direct military gains for the Syrian government.

Graph courtesy of the Lancet-AUB Commission on Syria based on Physicians for Human Rights data

Raining Terror from the Air

Of the total number of documented attacks on health facilities, nearly 73 percent were carried out from the air. Nearly 98 percent of attacks on health facilities perpetrated from the air are attributable to the Syrian government and its ally Russia, which entered the conflict in 2015.

The share of attacks on health facilities from the air has grew from 38 percent of the total in 2012 to 90 percent in 2018. The Syrian government became steadily more reliant on airpower as the conflict evolved. Through their air forces, the Syrian government and Russia extended their strategy of collective punishment deep into opposition-held territory and far beyond hardened front lines. The Syrian government and its allies disabled or destroyed hundreds of facilities through aerial bombardment, leaving countless civilians without access to vital medical services.

A Widespread Assault on Health Care

Attacks on health facilities have been verified in 12 out of Syria’s 14 governorates. Opposition strongholds and heavily contested areas – Aleppo (159), Idlib (123), Hama (40), and Rif Dimashq (84) – bore the brunt of the violence, incurring over 73 percent of all attacks on health facilities documented since 2011. These areas witnessed clear increases in attacks on health care during government military campaigns, and sharp falls in attacks once government control was re-asserted. Aleppo, for example, suffered 54 attacks in 2016, and only nine since its fall to the Syrian government in December of that same year. Idlib, the only remaining opposition stronghold, incurred a total of 123 attacks since 2011 and over a third of all attacks documented in 2018.

Map courtesy of the Lancet-AUB Commission on Syria based on Physicians for Human Rights data

Conclusion and Recommendations

The magnitude, frequency, and distribution of attacks on health care in Syria over the past eight years reveal a widespread and systematic pattern of violations. These attacks rise to the level of war crimes and, in PHR’s assessment, crimes against humanity. PHR calls on the international community to put a stop to these crimes and assure that any resolution to the conflict in Syria carries justice and accountability at its center. PHR calls on:

  • All parties to the conflict in Syria to immediately end attacks on unlawful targets, including civilians, health facilities, and medical personnel;
  • Russia, Türkiye, and the United Nations to maintain the de-militarized zone in northwest Syria and prevent military escalation in the area;
  • The United Nations and individual member states to maintain financial, political, and diplomatic support for efforts to document violations of international human rights and humanitarian law and principles, with insistence on justice and accountability for war crimes and crimes against humanity;
  • The United Nations and states supporting a political solution to the Syrian conflict to integrate accountability into efforts to bring the conflict to an end, knowing that sustainable peace can only be built on the foundations of justice.

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