Physicians for Doctors in the Crosshairs: Human Rights Four Years of Attacks on March 2015 Health Care in Syria A Syrian man carries a wounded child at a makeshift clinic following reported air strikes by forces loyal to President Bashar al-Assad in the rebel-held area of Douma, north east of the capital of Damascus. Photo: Abd Doumany / AFP / Getty Images About Physicians for Human Rights For more than 25 years, Physicians for Human Rights (PHR) has used medicine and science to document and call attention to mass atrocities and severe human rights violations. PHR is a global organization that was founded on the idea that health professionals, with their specialized skills, ethical duties, and credible voices, are uniquely positioned to stop human rights violations. PHR’s investigations and expertise are used to advocate for persecuted health workers, prevent torture, document mass atrocities, and hold those who violate human rights accountable. Acknowledgments This report was written by The findings and analysis contained Elise Baker, investigations in this report are drawn from program assistant, and Widney research by Physicians for Human Brown, director of programs. Rights, originally produced in Erin Gallagher, director of “Anatomy of a Crisis: A Map of investigations, Adrienne L. Fricke, Attacks on Health Care in Syria.” Syria advisor, DeDe Dunevant, For additional information, director of communications, and please visit www.phr.org/syria-map. Donna McKay, executive director, reviewed this report. Eliza B. Young, publications coordinator, edited and prepared this report for publication. 2 Doctors in the Crosshairs: Four Years of Attacks on Health Care in Syria Introduction here was a sense of hope Since 2011, the Syrian government has These numbers are conservative given when Syrians took to systematically violated this principle and difficulties in reporting during a war. the streets in 2011 amid is using attacks on medical workers But one thing is certain, these attacks the waves of protests and facilities as a weapon of war. It are deliberate and have a cascading that swept across the began when the government interfered effect on the health of Syrians. Four Middle East and North with and compromised health care years and hundreds of attacks later, a TAfrica following the self-immolation services by arresting injured protesters single bombing on a hospital today can of Mohamed Bouazizi, a Tunisian in emergency rooms, but quickly have catastrophic consequences. With man who was protesting a repressive escalated into bombing hospitals in dwindling numbers of medical facilities government, corruption, and lack opposition-held areas and detaining, and providers, an attack could demolish of economic opportunity. No one torturing, and executing doctors who the only hospital and kill the only doctor imagined that four years later the were adhering to medical ethics by serving an entire neighborhood. For world would be standing by as Syrians treating the wounded regardless of every additional doctor killed or hospital endure a protracted civil war that has their political beliefs. The doctors who destroyed, there are hundreds – even spilled across its borders and led to the have risked their lives to remain in thousands – of Syrians who have largest displacement of people since Syria and treat the injured have been nowhere to turn for health care. World War II. The consequences of decimated by Bashar al-Assad’s forces, the international community’s failure which consider it a crime punishable by Syrian doctors have shown bravery and to protect Syrians from systematic and death to provide medical treatment to resilience in the face of this generation’s repeated violations of both human “the other side.” worst humanitarian disaster. Over the rights and humanitarian law have been past four years, they have not only devastating. Yet, one in particular As we approach the fifth year of provided medical care in desperate stands out: the erosion of the long- the conflict, at least 610 medical conditions, but have also witnessed established principle that neither personnel have been killed, and colleagues, friends, family members, militaries nor armed groups can target there have been 233 deliberate or and thousands of civilians die from medical workers and the health care indiscriminate attacks on 183 medical unlawful attacks and lack of care due system for attacks. facilities. Physicians for Human Rights to the country’s decimated health has documented these killings and care system. Attacks on health in Syria attacks through its interactive online have intensified with each year of the map, which is updated monthly. The conflict, yet doctors have continued Syrian government is responsible for 88 risking everything to save lives. percent of the recorded hospital attacks and 97 percent of medical personnel killings, with 139 deaths directly attributed to torture or execution. Remains of an opposition field hospital in al-Qusayr in Syria’s central Homs province. Photo: AFP / Getty Images phr.org 3 Year One Doctors Deliberately Targeted and Killed n March 22, 2011, During the first year of conflict, A Broken System: The Struggle government forces government forces launched eight to Provide Care in Syria entered Daraa attacks on medical facilities and killed National Hospital, 75 medical personnel. The majority Given extreme levels of violence and cleared it of non- of the attacks and deaths took place the government’s direct targeting of essential staff, and in central and southern Syria – Daraa, their profession, thousands of medical Opositioned snipers on the roof. The Hama, and Homs governorates – and personnel have fled the country in snipers remained for two years, firing were carried out with hand-held fear for their lives, leaving entire at the sick and wounded to ensure weapons and mortar fire. The majority cities without emergency medicine that only government supporters could of medical personnel died as a result of physicians, cardiologists, and other enter the hospital. On April 8, a nurse shooting, while others were executed, specialists. The personnel who trying to rescue an injured person was killed by shelling and bombings, or remain use pseudonyms to protect shot and killed by government forces in tortured to death. their identities and have built field Daraa city. This was just the beginning hospitals run by local councils and aid of the government’s deliberate attacks organizations. Doctors, nurses, medical on medical personnel and facilities as a students, veterinarians, and volunteers weapon of war. without formal training operate these makeshift facilities. Dozens of hospitals have closed due to lack of staff, funding, and supplies, leaving civilians wounded by their government’s aerial bombardments with no options for treatment. Hospitals consistently deal with shortages of gauze, blood bags, syringes, anesthetics, and body bags, as the government systematically obstructs the delivery of medical aid to opposition-controlled areas. Government forces have also consistently harassed and detained those traveling with medicine and materials as modest as gauze, in order to deprive pro-opposition populations of medical supplies. In one case in 2012, a nurse from Rif Dimashq was arrested for providing medicine to the opposition. He was tortured in detention, and his family was notified of his death in August 2014. Syrians watch as bulldozers clean the debris outside Dar al-Shifa Hospital in Aleppo, northern Syria, after government forces bombed the facility. Photo: Francisco Leong / AFP / Getty Images 4 Doctors in the Crosshairs: Four Years of Attacks on Health Care in Syria Year Two Attacks on Health Care Triple etween August and only leaving when their hospital was Attacks on health care more than November 2012, decimated. Even then, they did not stop tripled in the second year, with government forces treating patients. Instead, they moved government forces responsible for repeatedly attacked Dar down the street to establish Dar al-Shifa 97 percent of the 90 facility attacks and al-Shifa Hospital, located field hospital, which treated anyone 99 percent of the 199 personnel deaths. in the densely populated in need and was eventually attacked Aleppo, Damascus, Deir ez-Zor, and Rif Bal-Shaar neighborhood in Aleppo. again. This campaign illustrates a trend Dimashq governorates were hit hardest. After at least three earlier attacks, seen throughout the war: repeated While the weapons used in hospital the hospital finally suspended service airstrikes on the same facility, designed attacks were similar to the previous year, following a missile strike on November to intimidate medical workers and deaths as a result of shooting decreased 21. A 23-year-old medical student patients and cripple health care in and deaths by execution, bombing, and working as a paramedic in the hospital opposition-controlled areas. shelling increased. died. Despite repeated targeting, Dar al-Shifa’s staff remained stalwart, The summer of 2012 was particularly devastating. PHR documented 28 attacks on medical facilities between July and August – the record high for the conflict. With 26 killings, July also represented the second deadliest month for medical personnel, after May 2014. Year Two: Weapon Use in Attacks on Medical Facilities by Percentage Mortar Fire Aerial Bombardment 4 Hand-Held Weapons 6 Bombardment with Unknown Weapons Missiles and Rockets 8 Unknown Weapons 40 11 21 phr.org 5 Year Three The Rise of Heavy Weaponry and Non-State Armed Groups A doctor looks at the register of dead people, stained with blood, in a hospital in the eastern sector of the city of Aleppo. Photo: Miguel Medina / AFP / Getty Images n June 20, 2013, In the third year of the conflict, During this time, non-state armed government forces attacks by government forces groups emerged as perpetrators, bombed Raqqa increased in brutality. More than half responsible for nine attacks on medical National Hospital, of the 53 medical facility attacks PHR facilities. The self-declared Islamic State located on a large, documented were caused by rockets, (IS) and various other opposition groups easily distinguishable missiles, and aerial bombardment.