Under-Secretary-General Mark Lowcock and Attacks on Health in Syria

In his latest briefing to the United Nations Security Council on the situation in northwest Syria, the UN’s humanitarian chief, Under-Secretary-General Mark Lowcock, demonstrated his exasperation over the continued targeting of health facilities in Hama and Idlib and the lack of political will to put a stop to this gruesome practice. Mr. Lowcock relayed some questions his office had received from states, NGOs and doctors operating in Syria’s northwest, and families affected by violence, and his answers sent a strong message to a gridlocked Security Council. Considering the confines of his position and mandate, we thought the USG for Humanitarian Affairs came very close to breaking traditional UN diplomatic ambiguity and actually naming names. Given Physicians for Human Rights’ (PHR) extensive documentation of these violations since 2011, we thought we would take the opportunity to try to fill in the blanks in Mr. Lowcock’s careful statement and clarify what we take to be his underlying but unspoken messages. Mr. Lowcock’s questions and answers appear below in gray and red; PHR’s answers follow.

Question: “Who is bombing all these hospitals?”

I can’t say. But at least some of these attacks are clearly organized by people with access to sophisticated weapons, including a modern air force and so-called smart or precision weapons.

PHR’s extensive research on attacks on health care facilities in Syria leaves next-to-zero ambiguity regarding the identity of the perpetrators: the Syrian government and its allies, including Russia. From the rudimentary (barrel bombs) to the sophisticated (high-explosive guided munitions), the Syrian government and its allies have used every means at their disposal to obliterate health systems in areas they are targeting. In PHR’s assessment, the Syrian government and its allies – including Russia – have carried out 90 percent of the 566 documented attacks on health facilities since the conflict began.

Question: “Are hospitals being deliberately targeted?”

I don’t know. The people who do are the ones dropping the bombs. What I can tell you is that there are a lot of attacks on these health facilities.

In many instances of attacks on health facilities, the people who are dropping the bombs certainly do know what they are targeting. There are many indicators that some of the attacks that PHR has documented were intentional. Conducting multiple attacks on the same facilities is one such indicator. The Kafr Nabl Surgical Hospital in Idlib has been targeted a total of 11 times since June 2014, most recently on May 5, 2019.

Not only are these attacks carried out in a cold and calculated manner, they are a fundamental part of a ruthless military strategy that the Syrian government has applied across Syria to terrorize the population, force people into flight, and gain control of territory.

Question: “Is it true that you provide details of where hospitals are, in order to protect them?”

Yes. The obligation to protect civilian objects – including hospitals – comes from international humanitarian law. We give details of some hospital locations to the parties to the conflict so that they can comply with those obligations.

This is another clear indicator of the deliberate nature of attacks on health facilities. The facilities the USG is referring to here are ones whose civilian character is verified by the UN and whose coordinates are shared with belligerents. In other words, these are sites the parties to the conflict were explicitly told are medical facilities. Yet the warring parties continue to launch attacks on the medical facilities with utter disregard for their protected status under international law.

Question: “Is the information being provided about the locations of hospitals in fact being used not to protect hospitals but to target them?”

I don’t know. Again, the people who can answer that question are the ones dropping the bombs. Many deconflicted sites which are not hospitals have not been attacked.

Attacks on deconflicted sites could be pinned on a failure of this specific protection mechanism, but it’s more likely, given the systematic pattern of these violations, that the Syrian government or its allies are unwilling to comply with the process when it pertains to health facilities and personnel. What the deconfliction mechanism essentially does is remove any margin of deniability. Based on all available evidence, PHR is convinced that these sites were targeted because they are medical facilities. Has this kind of thing happened before during the Syria conflict?

Question: “Has this kind of thing happened before during the Syria conflict?”

Yes. The then Special Envoy, Staffan de Mistura, and I last year raised concerns about similar attacks in eastern Ghouta with Council Members who we thought might have relevant information and who we thought could prevent a recurrence.

“This kind of thing” has been a recurring nightmare in the context of the Syrian conflict. The case of Eastern Ghouta, which PHR recently highlighted, is a harrowing example of the systematic wiping out of an entire health network as part of a specific military operation. Between February 18 and April 7, 2018, Eastern Ghouta was subjected to 29 attacks by Syrian government forces and their allies, including the Russians, on health facilities that PHR was able to verify. To varying degrees, Aleppo, Daraa, and Madaya all witnessed similar patterns of abuse.

Question: “Did you get satisfactory answers at that time?”

We have yet to receive full answers to the questions we raised last year.

Mr. Lowcock’s answer really says it all. No answers.

Question: “If I were an NGO running a hospital, why would I want to give you details of my location if that information is simply being used to target the hospital?”

That is a good question. We are thinking about what conclusions to draw from recent events in respect of the deconfliction system in so far as it covers health facilities.

This is a question that our partners on the ground have actually answered. To some of the hospital administrators under threat of targeting, the decision to include their facilities in the deconfliction mechanism had nothing to do with protection. For example, the administrators of the Hassan al-Araj Hospital in northern Hama (targeted a total of seven times since its establishment) deconflicted their site to eliminate any room for deniability should their facility be attacked again. They specifically sought to build evidence that their site was being targeted. And it was attacked again, twice, after the coordinates were shared in the “deconfliction” process.

Question: “What is your advice to parents of children who live in the de-escalation zone – should they take their children to the hospital in the case of an illness or injury?”

That is a very difficult question. I am deeply concerned about the impact on the health of children, and their safety, when so many medical facilities are being attacked.

Having to weigh the risks and benefits of taking your child to a hospital for treatment shouldn’t fall to any parent. But it’s a calculus that most civilians who live in areas under Syrian government attack have to make all the time. Russia, Iran, and Türkiye have made an agreement to protect the civilians living in the area. Syria and Russia should immediately cease all attacks on medical facilities. All states have an obligation to ensure respect for international humanitarian law. The responsibility lies with the international community to address the horrors in Idlib, not on Syrian parents who are just trying to keep their children alive.

Question: “Hasn’t the Security Council passed a resolution reinforcing that countries shouldn’t bomb hospitals?”

Yes. Security Council Resolution 2286, passed in 2016, specifically covered that.

Security Council Resolution 2286 was a landmark step, but sadly, it is not being implemented in any real way. Through the resolution, the Security Council condemned attacks on health facilities, demanded compliance with international humanitarian law and, most importantly, urged member states and the UN Secretary-General to take concrete steps to prevent attacks on health and hold perpetrators accountable. Three years later, attacks continue with utter impunity because the Security Council has failed to exercise the requisite pressure on perpetrators and has not referred the situation in Syria to the International Criminal Court, which can investigate, prosecute and try those responsible. Since resolution 2286 was passed on May 3, 2016, PHR has documented 199 individual attacks on medical facilities in Syria.

Question: “What is the point of the Security Council passing resolutions like that if States are not going to comply with them?”

That, Mr President, is also a very good question. It is, of course, not really addressed to me.

The Security Council’s job is to maintain international peace and security and protect civilians. That means the Security Council needs to move beyond internal divisions and push the parties to the conflict in Syria, in particular, the Syrian government and its allies, to stop attacking civilians and civilian structures and abide by longstanding international rules of conflict.

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