After midnight on October 16, Russian forces carried out airstrikes on two hospitals in Syria. Al-Hader Hospital and al-‘Ais Hospital were both put out of service, leaving the southern Aleppo countryside without a functioning medical facility. With terror in their voices, staff from these hospitals gave impassioned testimonies: “There are zero hospitals [left], everyone, zero.” And, “Now there isn’t [a hospital] for civilians. There are mothers and small children here.” Zaidoun al-Zoabi of the Union of Syrian Medical Relief Organizations echoed these sentiments in his recent interview on CNN saying, “[They’re] so scared, so scared. I have never seen this in Syria before,” referring to the estimated 35,000 Syrian civilians fleeing the southern Aleppo countryside following Russian and Syrian airstrikes.

Russia’s entrance into the Syrian conflict has made an already grim situation far worse. Initially, the concern among policymakers was that Russia’s engagement would stall peace efforts; and indeed, opposition groups have publicly stated that they will not engage in peace talks as long as Russia continues its attacks. However, the nature of Russia’s military attacks, in step with Bashar al-Assad’s strategies, signals a new level of deterioration in the conflict. Russia’s intervention extends and intensifies Assad’s strategy of systematically targeting civilian infrastructure, providing de facto legitimization of the Syrian regime’s blatant indifference to civilian life and the laws of war.

Physicians for Human Rights (PHR) has documented seven Russian attacks on medical facilities, with three occurring in the first four days of Russia’s intervention alone. On October 20, we at PHR received reports that Russian fighter jets carried out a double-tap strike in Sarmin, Idilb – a tactic utilized repeatedly by the Assad regime wherein warplanes launch an attack, wait a few minutes until first responders arrive on the scene, and then strike again. The second strike landed 20 meters away from Sarmin Hospital, damaging the hospital and killing two of its staff members.

In what seems to be an attempt at maintaining a façade of adherence to international law, the Russian Defense Ministry continues to boast about the precise nature of their airstrikes: each statement posted on their website goes into detail about the intelligence they gathered and uses phrases including “pinpoint attack,” “precision strike,” and “high accuracy.” Almost every time we receive reports of a new hospital attack, the defense ministry issues a statement claiming that Russian aviation performed a precision airstrike in the exact same area as the hospital. The reasonable way to interpret this is that either Russian forces are actively targeting these hospitals or claims of precision are merely propaganda and the Russians are launching indiscriminate attacks on civilian areas. Either way, these attacks constitute egregious violations of the laws of war.

These attacks also confirm a trend that we have noticed over the past six months: at least in the context of attacks on medical facilities, barrel bombs are being traded in for more sophisticated weaponry. During the first half of 2015, roughly half of the attacks carried out by Syrian forces on hospitals were with barrel bombs. Since July of this year, PHR’s data reveals that Syrian government forces have begun favoring missiles and rockets over barrel bombs. In September, only one of the six attacks on medical facilities that PHR documented was carried out with barrel bombs – the other five were with missiles and rockets – and we have not received a single report of an attack on a hospital with barrel bombs in October.

At first glance, a shift away from indiscriminate weaponry seems positive, especially considering the horrific role that barrel bombs have played in the Syrian conflict. Indeed, stopping the barrel bombs has been central to international efforts to combat the killings of civilians in Syria. However, it is clear that with or without barrel bombs, President Bashar al-Assad is intent on systematically dismantling the opposition’s health care system. Furthermore, as Russia joins in this criminal campaign, it is evident that President Vladimir Putin views the laws of war as little more than vapid suggestions. These atrocious attacks must stop, period. And the discussion has to move beyond barrel bombs.

So far, the message the international community is sending to Syrians is that their humanity is irrelevant and secondary to politics. And I fear that the latest failure by the international community to take any tangible action to protect civilians in this nightmarish war has drowned any lingering hope among Syrians that anybody is listening. This is shameful. We cannot continue to simply bear witness to these heinous crimes. We need to do more. We, as human rights activists, global citizens of conscience, and members of the international community, need to hold Assad and Putin accountable.

This post originally appeared on Women Under Siege.

Following the elections in late 2007, Kenya endured significant atrocities, including murder, ethnic cleansing, and rape. The media reported on hundreds of cases of sexualized violence during that time, and the Commission of Inquiry on Post-Election Violence confirmed the allegations. Today, years after that violent crisis, women are still seeking justice.

This is one of their stories.

In January 2008, during the violence that followed Kenya’s disputed 2007 elections, someone banged on my door.

The man was a friend of my neighbor and, since my neighbor wasn’t home, I thought I might be able to help. But when I opened the door, he forced his way into my house and raped me.

After the rape, I didn’t go to the hospital right away. Because of the pain, it was quite difficult to move. Instead, I went two days later, only to find the hospital closed. I decided to try the police station, but the officer in charge of taking statements wasn’t there. So, despite my efforts, I never attained justice for the criminal act I had painfully endured.

A hearing is scheduled for October 27 as part of a case against the Kenyan government for its failure in protecting people and properly investigating cases of sexualized violence that took place during the country’s post-election violence. My story is just one example of the countless cases of rape that occurred during such clashes in my country. It is also an example of the many hurdles a survivor must overcome in order to pursue justice. While I knew it was important to see a doctor, and I tried to get to the hospital and police station, neither institution had the proper infrastructure to ensure that I received justice…

Read the full article on Women Under Siege.

A few months ago, I had the opportunity to see Dr. Khaled Kandil receive an award from the Syrian American Medical Society at their annual conference in Gaziantep, Türkiye. He was being honored for establishing the dialysis center at Bab al-Hawa Hospital – one of the few remaining treatment centers in the opposition-held territories in Syria. When he came to the stage to accept the award, I thought perhaps this was not the same gregarious physician I had the pleasure of meeting 18 months earlier at a Physicians for Human Rights (PHR) gathering in Jordan. He was thin and frail – a changed man. He had been battling cancer for some time and it had taken its toll. Dr. Khaled passed away this week and his loss is felt keenly by his family, colleagues, patients, and all of us at PHR who knew him.

Amid the carnage in Syria for almost five years, quietly heroic physicians like Dr. Khaled have continued their lifesaving work in the face of grave risks. Every month PHR adds to the grim tally of medical workers who have been killed in the conflict. As of August 2015, that number stands at 670. While Dr. Khaled will not be added to that list, his death is also tied to this war. We will always wonder if, in peacetime, he could have received a more timely diagnosis and treatment that could have saved his life.

He is a member of a remarkable group of physicians, nurses, medical students, dentists, EMTs, and so many others who have chosen to stay in Syria and be of service to their people. For every one of them we lose, thousands of patients go untreated. As his sister, also a physician, once said to me, “If we leave, who will replace us?”

No one can replace Dr. Khaled, but we will remember him and honor him by continuing to call for an end to the atrocities he spent the end of his life addressing.

This post originally appeared in The Huffington Post.

What would you be willing to do for $1 million? Most of us would probably do something foolish or embarrassing. In Afghanistan, in the aftermath of the attacks of September 11, 2001, many Afghans sold out their neighbors for bounties offered by the United States for “terrorists.” Psychologists James Mitchell and Bruce Jessen designed and implemented a torture program for the CIA for more than $1 million each, $5 million in indemnity against legal liability, and $81 million for the firm they established – Mitchell, Jessen, & Associates. That $5 million indemnity payment was a tacit recognition that in designing and implementing a torture program, Mitchell and Jessen were breaking the law and that should this come to light, they might need some money to defend themselves. The ethically challenged psychologists, wanting to prove the effectiveness of their methods of torture, tested the theory of “learned helplessness” on human beings.

Thanks to the ACLU, Mitchell and Jessen are now facing the possibility of some form of accountability for their crimes. It is a scandal that the U.S. government engaged in the torture of people it detained – in some cases on the flimsiest of evidence. But it is equally appalling that health professionals, who took an oath to “do no harm,” used their training to both help build the program of torture as well as justify its use.

Mitchell and Jessen conducted unethical research and experimentation in an attempt to test the purported safety and effectiveness of their theories and tactics. Engaging in torture-related experiments on human beings violates the absolute prohibition against torture and ill-treatment in both domestic and international law. Their abhorrent actions violate the Nuremberg Code, which prohibits any health professionals from engaging in human experimentation without the full and informed consent of the subjects. Their actions also rank among the worst medical crimes in U.S. history.

As the name indicates, this code was drafted in the aftermath of the revelations of horrific forms of experiments conducted on people held in Nazi concentration camps. The name of Josef Mengele is reviled for his association with these experiments that turned human beings into objects to be used and forced to suffer for his edification.

The United States does not have clean hands on this issue. The infamous Tuskegee study, in which medical professionals studied the impact of syphilis on African-American men while withholding treatment, is a shameful chapter in the history of the U.S. medical profession. Similar to the men held in U.S. detention facilities, black men in the United States have been so vilified that trained health professionals came to see them as objects to be harmed with impunity.

Such actions are a betrayal of the fundamental trust that is required between health professionals and those whom they treat – a trust based on informed consent.

Mitchell and Jessen’s recommended torture system was designed to destroy the victims’ sense of autonomy and control – the theory being that it would make them more compliant to their interrogators’ demands. The methods they employed included waterboarding, being forced into stress positions and denied sleep for days, being stripped naked and plunged into ice water repeatedly, being slammed into walls while at the end of a choke collar, mock burials, rectal feeding, and sensory deprivation – to name a few.

The U.S. government, trying to claim legitimacy even as it undermined well-established international human rights and humanitarian law, renamed these forms of torture “enhanced interrogation techniques.” The U.S. Department of Justice argued that because psychologists attested to the effectiveness and safety of these methods, the program was legal. For an $81 million contract with the CIA, Mitchell and Jessen provided a veil of legitimacy for torture.

Torture is defined as the deliberate infliction of severe pain or suffering. Safety and effectiveness of acts of torture are not a defense.

Mitchell and Jessen have added their names to the hall of shame of health professionals who don’t just harm people, but turn them into objects. The names of other health professionals who colluded in torture or failed to report it remain hidden behind the U.S. government’s shroud of secrecy around its counter-terrorism policies. However, national security laws were never intended to cover up unlawful actions by the government. A comprehensive investigation is needed regarding the complicity of Mitchell and Jessen and all other health professionals in U.S. torture. The public’s trust in the healing professions can only be restored through accountability.

Hopefully, the ACLU’s case against Mitchell and Jessen will be a critical step toward greater transparency and, ultimately, accountability for those who have done so much to undermine ethical standards within the health profession and broken both U.S. and international laws against torture and human experimentation.

Even in a world inured to violence, the U.S. airstrike on a Doctors without Borders (MSF) hospital in Kunduz, which killed both staff and patients, was shocking. While the U.S. government acknowledged that it was responsible for the attack, General John Campbell, the top U.S. commander in Afghanistan, has referred to the attack as an accident in which a few civilians were killed.

To be clear, 22 people were killed, including three children and 12 volunteer health professionals. The hospital had repeatedly sent the U.S. military and other groups fighting in the region the exact coordinates of the hospital so that it would not be bombed – accidentally or otherwise.

The U.S. military cannot just dismiss this attack as “collateral damage,” which would imply that the military knew what it was doing, but thought the harm to the hospital was proportionate to the military advantage of the attack. Nor is an “accident” an acceptable explanation as it indicates that the military acted without undertaking the due diligence required to ensure the legitimacy of the target. General Campbell has admitted that the U.S. military did not follow its own protocols in carrying out this attack.

The U.S. military brings sophisticated and deadly weapons to the conflict in Afghanistan; it has a responsibility to deploy these weapons in a manner consistent with international humanitarian law. When it fails to do so and the consequences of that failure result in the deaths of civilians, it constitutes a war crime.

The claim that Taliban fighters were being treated at the hospital is a red herring, as wounded combatants are protected under the Geneva Conventions. The doctors working for the MSF hospital were risking their lives to fulfil their ethical obligation as health professionals to treat those in need regardless of political affiliations.

Over the last 14 years, the U.S. government has undermined international law by claiming that in its fight against terrorists, the rules do not apply. This argument is fundamentally flawed and deeply dangerous. In Syria, Bashar al-Assad has also shredded the laws of war claiming that all is fair in a fight against terrorists. Four years and 250,000 deaths later – the international community remains paralyzed on Syria and attacks on hospitals and the killing of doctors has become the new normal in the country.

The U.S. must own its responsibility in undermining the very laws that were carefully drafted and adopted over decades in an attempt to shield civilians from the hell that is war. But in Afghanistan, Gaza, Iraq, Syria, Yemen, and too many other conflict zones, it is civilians who are suffering as governments claim exceptions to the rule.

The international community must act to stop this deadly slide into lawlessness that will undo decades of hard-won gains in the protection of civilians. It can start by calling for an independent international investigation into the attack on the MSF hospital in Kunduz. And it must take forceful actions to stop violations in Syria and in other conflicts. No state is above the law, and no state should be allowed to rewrite the laws. The only way to begin restoring these weakened standards is by holding those who violate them to account.

In this report, Physicians for Human Rights (PHR) builds on its previous research on land confiscations in Myanmar by using an epidemiological survey tool to assess the human rights, livelihood, and health impacts on communities displaced by the reservoir created by Paunglaung dam in southern Shan state.

The purpose of this research was to determine if human rights were violated during the displacement process, and – if so – to measure the impacts of these violations on the displaced population. PHR developed an epidemiological survey tool consisting of several modules that can be used to assess if the eviction process followed the two major international legal frameworks relating to evictions and displacements – the Guiding Principles on Internally Displaced Persons (Guiding Principles) and the Basic Principles and Guidelines on Development-based Evictions and Displacement (Basic Principles and Guidelines) – and to measure the impacts of the displacement on livelihoods, food security, and access to health care and water.

PHR’s research found that the Guiding Principles and the Basic Principles and Guidelines were not followed in the planning and construction of the Paunglaung dam, and that the flawed displacement process led to the loss of jobs and income, as well as increased food insecurity, poverty, and limits on access to water. PHR also found high rates of depression and suicide among the displaced population.

These findings contribute to the growing body of evidence that land confiscations for economic development projects are having devastating impacts on the livelihoods and health of the people of Myanmar, including violations of the right to work, water, food, and life. Economic development projects are destroying the economies of people who live near them.

Earlier this month, Abdullah Kurdi lost his entire family in an attempt to escape the Syrian war; his two sons Aylan and Galip and his wife Rehan drowned in the Mediterranean Sea after their raft overturned. The image of three-year-old Aylan’s body on the shore of Türkiye galvanized people across the world, bringing heightened attention to the refugee crisis unfolding from Syria to North Africa and Europe and leading to increased pressure on countries to accept Syrian refugees. However, in the three weeks since Aylan’s photo circulated around the world, little has changed for refugees seeking safe passage from conflict. The boats of smugglers continue to be steered into the Mediterranean, and refugees continue to lose their lives trying to seek safety.

Despite the increased attention being paid to the current refugee crisis, these deaths will continue as long as states continue to violate the right of refugees to seek asylum. While the current crisis in Europe is being driven by extreme violence in Afghanistan, Eritrea, Libya, Somalia, and Syria (among other countries), the drownings – some 2,800 already – are not simply a result of war but also of closed borders and failed immigration policies. And the responsibility for these and similar deaths lies with the nations, including the United States, who attempt to shirk their responsibilities under international law by barring, deporting, or harassing asylum-seekers. Young Aylan survived the Syrian war only to die for lack of safe passage.

Under international law, all refugees have the right to seek asylum – a right that has been repeatedly affirmed and supplemented since the 1951 United Nations Convention Relating to the Status of Refugees went into effect. All of the legal protections granted to asylees and refugees are founded on the existence of this right: without the ability to seek protection from their persecutors, the promise of asylum is a fiction. Despite the clarity of this right, and its fundamental importance to refugees and displaced people, governments regularly interfere with it by closing their borders to refugees entirely, pushing them into the most dangerous types of border crossings, and/or detaining and mistreating them with the hope that the danger and poor treatment will dissuade others from making a similar trip. These deliberate choices have cost countless lives across hundreds of borders.

Since the photograph of Aylan crystalized the current crisis in Europe, some countries – most notably Germany, and to a much lesser extent other EU countries and the United States – have offered to accept greater numbers of refugees. But the committed numbers account for an incredibly small percentage of the 1 million people expected to arrive in Europe just this year. Furthermore, increased quotas in response to this particular crisis will leave in place the shameful policies that have led to so many deaths in transit. For example, refugees have been trapped between the borders of Croatia, Hungary, Macedonia, Serbia, and Türkiye, as one country after another has closed its borders – and many have actively worked to dissuade refugees from entering or staying through the construction of walls, setting up of extra-legal “transit zones,” and detention and prosecution of refugees. Each such action affects the route that refugees take, as they are forced to try more remote and potentially dangerous paths, including routes strewn with landmines.

The United States is also guilty of these behaviors, but its inhospitable southern border hides the effects that were so clearly displayed on the beach in Türkiye. In the United States as well as Europe, aggressive enforcement and closed borders push people into the most dangerous crossings. Refugees, including children, are detained with the express purpose of dissuading others from attempting the journey. For refugees like Aylan trying to reach Europe, policies like these lead them to try their luck in the Mediterranean. For those trying to cross the United States’ southern border, it’s the Sonoran Desert, where people, including women and children, die of dehydration and exposure to the elements trying to reach safety. Usually, only their bones are found and the remains are rarely identified. The photo of Aylan this month simply made public the effect that government policies on asylum have had for decades.

The right to seek asylum is one of the most fundamental rights in international law. Honoring and respecting this right means not just permitting refugees to apply for asylum, but also permitting safe passage across state borders. It means not punishing refugees with detention and poor treatment in the hopes that they will abandon their claims or, despairing of receiving protection, travel further and across more dangerous terrain to reach safety somewhere else. Refugees do not want to abandon their homes and communities, but under the threat of persecution and death, they often have no choice. As long as conflicts exist and refugees flee, the international community must provide safe passage for those who need it.