On February 15, a UN spokesperson reported that at least 50 people were killed in missile attacks that struck four hospitals in the provinces of Aleppo and Idlib and a school used to shelter internally displaced people in northern Syria. According to many activists and observers, Russian warplanes were responsible for the attacks. The medical organization Medecins Sans Frointeres (MSF) ran one of the hospitals that was targeted. MSF’s Head of Mission said that the incident appeared to be “a deliberate attack on a health structure” and “leaves the local population of around 40,000 people without access to medical services in an active zone of conflict.”

Attacks on medical facilities in Syria have been ongoing since 2012. According to the UN High Commissioner for Human Rights, such attacks (the majority of which are committed by Syrian government forces) intentionally deny medical assistance to those who have been wounded as a result of the war. According to the UN, these continued attacks against Syrian civilians constitute a violation of international humanitarian law that could amount to war crimes. The UN statements are significant because they highlight that the attacks on medical facilities and the denial of basic health care to Syrian civilians constitutes a troubling and consistent trend which breaches international law.

Article 18 of the Fourth Geneva Convention bans deliberate attacks on civilian hospitals. As the International Committee of the Red Cross (ICRC) explains, Article 18 requires military forces “to take special precautions to spare hospitals as far as is humanly possible” when conducting operations. The Rome Statute, which grants the International Criminal Court jurisdiction over serious violations of the Geneva Conventions, explicitly describes intentional attacks against civilian populations and hospitals as types of war crimes.

High quality documentation is crucial to holding perpetrators of attacks on medical facilities accountable. The ICRC provides several considerations that can help human rights defenders refine their strategies when documenting attacks on hospitals. For example, the ICRC states that structures with exterior medical symbols  and markings (such as the red cross or red crescent symbols) should not be attacked. Thus, documenters can collect information, pictures, and interviews that help establish that the structure was clearly marked and that the perpetrator knew or should have known of the structure’s medical functions. Another consideration is whether the civilian hospital was far from military objectives and was not being used for military purposes. Documenters can collect interviews and facts to establish the distance between legitimate military targets and the hospital as well as the civilian rather than military use of the facility for treating the sick and wounded.

However, the urban nature of modern warfare, particularly in the Syrian context, presents serious challenges  to documenting these types of attacks. Fighting is primarily taking place in populated cities and towns where the line between civilian and military is largely blurred. Moreover, the Syrian government has not been adhering to the principles of the Geneva Conventions or the  ICRC guidelines while it wages war. Rather, the government and its allies appear to deliberately target hospitals as a policy to incite fear and intimidate civilians and humanitarian aid workers. Thus, many hospitals intentionally avoid using medical symbols and operate “underground” in order to avoid such attacks. As a result, human rights defenders may not be able to easily demonstrate that the perpetrators knew or should have known that the structure was a medical facility at the time of the attack.

Future transitional justice mechanisms should dedicate special attention to addressing the complex issue of hospital destruction and damage since 2011. In addition to allowing for criminal prosecutions, the post-conflict government or transitional body should rebuild medical infrastructure and prioritize the provision of health care to victims that need treatment for their long-term physical and psychological injuries. Additionally, steps can be taken to memorialize the efforts of Syrian and international health care workers who risked their lives to treat and aid the sick and wounded in their time of need. Without a concerted effort to holistically address the issue, the widespread destruction of hospitals will have devastating impacts for Syrians and their ability to access adequate healthcare for many years after the end of the conflict.

For more information and to provide feedback, please email SJAC at info@syriaaccountability.org.