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Investigating hospital attacks

Can a new UN inquiry achieve results?

This article is from the Autumn 2019 issue of Syria Notes.


1. Demarche

For several years, human rights organisations have been documenting attacks on hospitals in Syria, mainly by the Assad regime and by Russian forces. On 30 July 2019, following a briefing by UN aid chief Mark Lowcock, the UN Security Council heard Susannah Sirkin of Physicians for Human Rights explain the scale of these attacks.

Up to July 2019, Physicians for Human Rights corroborated 578 attacks on 350 separate medical facilities, and documented the killing of 890 medical personnel. Of those 578 attacks, 521 were by the Assad regime and its allies: 297 by by the Assad regime and 224 by either Russian or Assad regime forces.

‘Since the beginning of the conflict in Syria, the ongoing assault on health care facilities and personnel has been a defining factor,’ Susannah Sirkin told the Security Council, ‘a deliberate, inhumane, illegal strategy of war.’

After the Physicians for Human Rights presentation, ten of the Security Council’s fifteen members delivered a demarche, a diplomatic petition in person, to UN Secretary-General Antonio Guterres, calling on him to launch an inquiry into attacks on medical facilities in Syria. The ten petitioners were the United Kingdom, France, the United States, Germany, Belgium, Peru, Poland, Kuwait, Dominican Republic, and Indonesia.

According to Reuters news agency, the petitioners highlighted that ‘at least fourteen UN-supported facilities on the list of deconflicted facilities have been damaged or destroyed in northwest Syria since the end of April.’



Mark Lowcock listens to Susannah Sirkin at the Security Council, 30 July 2019.
Image via UN video library.


This UN deconfliction list is a list of civilian facilities such as hospitals and schools which have chosen to share their locations via the UN to make clear that they are civilian objects and therefore protected under international humanitarian law.

Medical units are particularly protected. They can only lose protection if they are used to commit acts harmful to the enemy, outside their humanitarian duties, and protection may cease only after due warning has been given, with a reasonable time limit, and after such a warning has remained unheeded.

The ten petitioners pointed to the precedent of the previous Secretary-General Ban Ki-moon using his discretionary power to open an inquiry into an attack on a UN-coordinated humanitarian convoy in Aleppo in 2016. Following the demarche, the Secretary-General decided to establish an internal United Nations Headquarters Board of Inquiry to investigate ‘a series of incidents’ in the Idlib area of northwest Syria since the September 2018 de-escalation agreement between the presidents of Russia and Turkey.

The investigation is to cover destruction of, or damage to facilities on the UN’s deconfliction list and UN-supported facilities in the area. The Board is to report to the Secretary-General upon completion. The Secretary-General urged all parties to cooperate with the Board once it had been established.


2. Deconfliction

The UN’s deconfliction approach has been controversial, and often misunderstood. In his 30 July 2019 briefing to the Security Council, Mark Lowcock, the UN’s aid chief, explained the basics of how deconfliction is supposed to protect civilian locations such as hospitals, and told of how it is failing:

‘Through that system, humanitarian agencies, mainly NGOs, provide information to OCHA to identify static civilian locations or humanitarian movements. The United Nations then shares the coordinates with the International Coalition Forces, the Republic of Turkey and the Russian Federation.

‘When there is an incident on a deconflicted site, we notify the parties and request an investigation be undertaken.

‘As I said to you last week, whether the information provided through the deconfliction system is is being used by the parties to protect civilian facilities from attack or to target them for attack is an extremely important question.

‘As you know, I have asked the Russian Federation for clarification of what it does with the information we give them. I continue to hope to receive further clarification.

‘We have also sent Notes Verbale to parties to the conflict in respect of six different attacks in northwest Syria in 2019 in relation to deconflicted locations or movements. While we have received a formal response from Turkey, we have not yet received one from the Russian Federation.

‘In spite of our efforts to work with parties to the conflict to prevent attacks on civilian objects and humanitarian workers, I have come to the conclusion that in the current environment deconfliction is not proving effective in helping to protect those who utilise the system. I have asked my team to meet again with the humanitarian organisations who would like their activities to be deconflicted to update them on the current situation and determine again whether we should continue to provide information to the parties on new sites or humanitarian movements.’

There is a clear reason to share coordinates of hospitals and schools in conflicts where military forces are making some effort to observe international humanitarian law: the set of rules in the Geneva Conventions and other agreements which seeks to limit the humanitarian impacts of war.

The war in Syria, however, began with the Assad regime using military force against peaceful demonstators, and it has continued as a war waged primarily against civilians. From the start, medics were targeted, beginning with anyone giving first aid to injured demonstrators, and continuing with blocking medical supplies to besieged areas, and then with bombing hospitals.

Despite the Assad regime’s manifest strategy of targeting civilians, UN agencies and some NGOs followed the same practice in Syria as in other conflicts, sharing coordinates for hospitals and other civilian locations with OCHA, the UN Office for the Coordination of Humanitarian Affairs.

Syrian humanitarians greeted this practice with astonishment. In early February 2016, Marcell Shehwaro of Kesh Malek told a meeting in the House of Commons about her experience of receiving a request from OCHA for locations of schools run by her NGO:

‘Four months ago, the UN sent us an email saying, please can you locate your schools so we can send their location to the Russian air force, for protection? And I was shocked by the email. Seriously? That’s why we need the UN? To send the location to the Russian air force, and pray to God that the Russian air force won’t use the locations that we send them to bomb us?

‘And in the email there is this explanation of, “We can’t promise anything, but we can hope that they are not going to bomb them.” To me, I think that as long as we are doing this at that level of managing the conflicts around the conflict itself, the Russians are not going to stop.

‘What we should do is a no-fly zone for sure, and that’s been done somewhere else, and we should do it for civilians that have been asking it for years now. And who can do it? I think those who are claiming to be the Syrian people’s friends. And in the London Conference I said that I wish we had his [Assad’s] friends. His friends are much better.

Yes, we need a no-fly zone. I used to say we don’t need it, but yes, we need it. We need it to survive. We need it to be able to work. We need it to open the battle of personal freedom together with each other. Right now, the only thing we talk about is death.’

On 18 February 2016, Médecins Sans Frontières announced that they were stopping sharing the location of hospitals. In a statement, MSF’s Dr Joanne Liu said, ‘Healthcare in Syria is in the crosshair of bombs and missiles.’

Dr Liu described an air attack days earlier, on 15 February 2016, in Ma’arat al-Numan, Idlib Province. At nine in the morning, aircraft fired four missiles, destroying a hospital supported by MSF. At least twenty-five people were killed, among them nine medics and sixteen patients.

‘Forty minutes later, after rescuers arrived, the site was bombed again. These secondary strikes—in military jargon known as “double taps” —that target rescue and medical personnel trying to save the injured are outrageous.

‘But it didn’t stop there. A nearby hospital that received many of the wounded from the first strike was itself hit an hour later.

‘This attack can only be considered deliberate.’

In the following months, attacks on hospitals and humanitarian workers escalated as Assad regime and Russian forces lay siege to east Aleppo city.

In March 2016, speaking at a meeting in the House of Commons, Hamish de Bretton-Gordon, a chemical weapons specialist who had trained Syrian medics, argued that as Russian and Assad regime forces already knew where hospitals were, it was better to share locations via the UN in order to establish the fact that these were known to be hospitals. (Syria Notes no. 8.)

‘… I think first of all the Russians and Assad know exactly where these hospitals are, that’s my point, they know where they are anyway. At the moment, the Russians are saying, “well we are not targeting, we didn’t mean to target”—we all know that they are. If we reinforce publicly, in the UN Security Council and elsewhere, these are the hospitals Putin and Assad, they are designated safe areas, you are not to attack them, and they are attacked, then that’s irrefutable.’

On 27 April 2016, the MSF-supported Basel Aslan (Al Quds) hospital was hit. The attack began with an airstrike on a building across the road. Then the nearby staff residence was hit. Minutes after, a third strike hit the entrance to the emergency room, killing and injuring medical staff who were bringing in patients wounded from the first strike. Five minutes later a fourth strike hit the hospital, destroying the top two floors.

Dr Hamza al-Kateab told Syria Notes that this attack was clearly carried out by Russian forces as it took place in the evening darkness, and in that period the Assad regime air force wasn’t capable of night attacks.

The Atlantic Council report, Breaking Aleppo, said that by the time the 2016 siege began, east Aleppo city was served by only ten hospitals and seventeen clinics, staffed by just over thirty doctors. These were repeatedly bombed. Aleppo residents said that Russian forces were using more powerful weapons than had been seen in earlier regime attacks, including bunker-buster bombs able to destroy basement shelters. The Syrian American Medical Society (SAMS) reported that bunker buster bombs were used to destroy the underground M10 Hospital in Aleppo, and in other hospital attacks.

According to SAMS, there were seventy-three attacks on medical facilities and personnel in Aleppo city between June and December 2016. During the final offensive from September 2016 on, ‘the limited hospital facilities were overloaded, trauma patients littered the floors and hallways, and the few remaining doctors worked around the clock with dwindling supplies,’ according to the Atlantic Council’s report.

And air attacks on hospitals continued after the fall of east Aleppo city. By the end of 2017, SAMS was reexamining the question of sharing hospital locations, and on 12 March 2018, they, along with eleven other humanitarian organisations working inside Syria, shared coordinates of sixty health facilities in Syria with UN OCHA, for OCHA to then share with the parties involved in the war. In a statement on 4 April 2018, they wrote:

‘After more than seven years of relentless and systematic attacks on healthcare across Syria resulted in no meaningful accountability, this measure represents a last-resort decision on the part of our combined organisations, as we seek to protect our staff and their patients and deter future attacks, and to potentially implement a process for investigating every alleged attack on healthcare throughout Syria in the future.

‘Although health care facilities throughout Syria have been targeted consistently and deliberately, particularly those in non-government areas, this decision was a result of lengthy consultations with, and full endorsement by, our teams inside Syria and doctors working in these hospitals. Coordinates were only shared after the staff in each facility agreed to the process.

‘Since the beginning of the conflict in Syria, medical personnel have braved continuous bombardment to care for the sick and injured in a blatant violation of international humanitarian law. Hospitals are considered among the most dangerous places, often discouraging patients from seeking treatment. In February 2018 alone, twenty-six medical facilities in East Ghouta, and at least ten in Idlib were targeted, forcing twelve to interrupt their services. Doctors and nurses have repeatedly come under attack while trying to save lives with the limited resources they have. Between February 18-20, thirteen medical facilities in East Ghouta were attacked in 48 hours, resulting in the death of three SAMS medical staff.’

Dr Munther al-Khalil, head of the Idlib Health Directorate, told Syria Notes that there was no unanimous decision on deconfliction. Most medical staff weren’t confident that this move would provide protection, but some agreed. Believing they would be subjected to attacks anyway, they hoped that sharing locations might at least reduce the frequency of the bombing. There was also pressure from UN institutions, Dr al-Khalil said, with constant encouragement to provide hospital coordinates.

It was soon clear that a theoretical threat of future war crimes trials wasn’t going to deter Assad regime or Russian forces. Within the first month, two hospitals on the new deconfliction list were attacked: Arbin Surgical Hospital on 20 March 2018, and Hamdan Hospital on 7 April 2018.

According to Mohamad Katoub of SAMS, there were six attacks in all on medical facilities on the UN deconfliction list in 2018. And 2019 has been worse. Out of a total count of thirty-eight attacks on medical facilities between 26 April and 22 July 2019, fourteen were on sites on the UN list.

Dr Katoub told Syria Notes that, while of course local staff give the approval to share their own coordinates, they are desperate for this to bring some result. By only doing the sharing coordinates part, this mechanism will not work, he wrote, not without ‘a very serious investigation on every single incident report and every single attack.’


3. Aircraft tracking

Amongst those states that petitioned the UN Secretary-General for the new investigation are members of the anti-ISIS Coalition and of NATO. These states seem to be in a position to provide valuable evidence to the UN Board of Inquiry. They have military technology able to show whose aircraft were present when hospitals and other civilian locations were attacked.

According to Justin Bronk, Research Fellow, Airpower and Technology at the Royal United Services Institute, NATO AWACS aircraft and other Coalition aircraft ‘will track and share the locations of Russian and Syrian aircraft from the time that they take off to the time they land.’



RAF Boeing E-3D Sentry. Photo: Adrian Pingstone via Wikipedia.


NATO’s AWACS inventory includes Royal Air Force E-3Ds, US Air Force E-3Gs, French Air Force E-3Fs and the NATO pooled E-3A fleet. These are the cornerstone of the Coalition’s airspace surveillance and management over Syria, including deconfliction with Russian and Syrian aircraft, Justin Bronk explained to Syria Notes.

Coalition aircraft typically broad­cast a radio transponder signal which can be picked up by any radar controller, including by those in Damascus, and by the E-3 AWACS. Also, Coalition aircraft will be on Link 16, an airborne datalink network which allows all aircraft on the link—from fighters, tankers, surveillance aircraft to AWACS themselves—to share sensor data to build collective situational awareness. This means that all Coalition aircraft are typically well aware of allied aircraft and what those can see, with the AWACS fleets providing overall coordination as well as contributing a lot of situational awareness from their on-board wide-area surveillance radar.

For deconfliction and tracking of Russian and Syrian aircraft, which typically do not broadcast a transponder signal, more traditional tracking and radio communications are used. AWACS and fighter assets where available will track and share the locations of Russian and Syrian aircraft from the time they take off to the time they land. If there is a need to deconflict for flight safety, the AWACS crew will typically contact these aircraft via the internationally recognised ‘guard’ frequency—243.0 MHz for military operations—to advise or warn them.

To positively identify these non-transponder broadcasting aircraft, many Coalition assets such as AWACS aircraft and the US Air Force’s F-15 and F-22 fighters can use techniques such as Non-Cooperative Threat Recognition (NTCR) which involves using onboard radar to focus on and classify unknown aircraft by identifying distinctive features like engine fan blade size and engine spacing.

In the UK, MPs of different parties have in recent years called on the Government to consider using this kind of tracking data to identify which parties are responsible for attacks. Up to now, these calls have been rejected.


4. The inquiry

While the UK, the US, and their allies might be able to provide valuable evidence to the UN Headquarters Board of Inquiry from military tracking data, past form suggests they may withhold this information.

In the case of the earlier UN Headquarters Board of Inquiry into the 19 September 2016 attack in Urum al-Kubra, or Big Orem, in western Aleppo province, where a UN-coordinated aid convoy was bombed, it seems that the US military withheld radar tracking data from the UN inquiry.

Twenty people were killed in that attack, which lasted from 8pm until near midnight. One of those killed was Omar Barakat, director of the town’s local branch of the Syrian Arab Red Crescent. US officials briefed journalists that two Russian fighter jets were in the air at the location of the attack.

Louisa Loveluck and Thomas Gibbons-Neff of The Washington Post gave a particularly detailed account in their story dated 24 September 2016:

‘US radar and satellites equipped with thermal sensors detected two distinct heat signatures leaving Russia’s Khmeimim air base that evening, a senior defense official said, speaking on the condition of anonymity to discuss intelligence matters. The two Su-24 swing-wing bombers took off and banked northeast, heading for Aleppo. They were the only jets in the area of the convoy, the official said.

‘He said the US military is confident Syrian helicopters also participated.’

At a hearing of the US Senate Committee on Armed Services on 22 September 2019, in reply to a question from Senator Richard Blumenthal asking whether there was any any doubt that Russian planes were responsible for attacking the convoy, the chairman of the US Joint Chiefs of Staff, General Joseph Dunford, said:

‘What we know are, two Russian aircraft were in that area at that time. My judgment would be that they did. There were also some other aircraft in the area, that belonged to the regime, at or about the same time; so, I can’t conclusively say that it was the Russians, but it was either the Russians or the regime.’



Aftermath of the 19 September 2016 aid convoy attack. Photo: Ammar Abdullah, AMC.


It appears that the UN Headquarters Board of Inquiry on the convoy attack was not given access to any US radar or satellite data that might have confirmed the presence of Russian jets.

Only a summary of the report was publicly released. Then-Secretary-General Ban Ki-moon wrote to the UN Security Council that, ‘as with all United Nations boards of inquiry, the Board’s report is an internal document and is not for public release.’ On attributing responsibility, the published summary said the following:

‘The Board indicated that it had received reports that information existed to the effect that the Syrian Arab Air Force was highly likely to have perpetrated the attack and, furthermore, that the attack had been carried out by three Syrian Mi-17 model helicopters, followed by three unnamed fixed-wing aircraft, with a single Russian aircraft also suspected of being involved. However, the Board did not have access to raw data to support those assertions and, in the absence of such data, it was unable to draw a definitive conclusion. Moreover, the Governments of both the Russian Federation and the Syrian Arab Republic denied all allegations of their involvement in the incident.

‘The Board noted in this connection that there were technical issues pertaining to a hypothesis of the incident having been a result of a joint Syrian Arab Air Force Russian Federation strike. The Board was informed that that the Russian Federation did not conduct joint strikes. A high degree of interoperability and coordination would be required for two air forces to operate in the same airspace, targeting the same location.’

So from the precedent of the 2016 Board of Inquiry, we can see that Coalition and NATO forces may decide to withhold evidence from this new Board of Inquiry on attacks in northwest Syria, despite having called for its establishment; that as a consequence its report may well be inconclusive; and that in any case the UN will most likely not publish the report in full.


5. Other investigations

The potential for the UN’s new Board of Inquiry to have an impact may seem limited, but there are other avenues to investigate hospital attacks, inside and outside the UN.

First among these is the UN Commission of Inquiry on Syria, established in August 2011 by a Human Rights Council resolution, with a mandate to investigate all alleged violations of international human rights law since March 2011. This Commission of Inquiry is already investigating hospital attacks. For example, its June 2018 report, The siege and recapture of Eastern Ghouta, reported multiple attacks by Assad regime forces on medical facilities in the last months of the siege of eastern Ghouta. It found ‘a pattern of attacks against hospitals and medical facilities’ by pro-Assad forces, ‘repeatedly committing the war crime of deliberately attacking protected objects, and intentionally attacking medical personnel.’

Then there is the IIIM: the International, Impartial and Independent Mechanism to assist in the investigation and prosecution of persons responsible for the most serious crimes under International Law committed in the Syrian Arab Republic since March 2011. This was established by a UN General Assembly resolution in December 2016, with a mission to ‘collect, consolidate, preserve and analyse evidence,’ and to ‘prepare files in order to facilitate and expedite fair and independent criminal proceedings.’ The IIIM can’t prosecute cases itself, but prepares cases to be tried in any suitable courts or tribunals that have jurisdiction, or that may have jurisdiction in the future. There is little immediate prospect of international tribunals taking on Syria cases, so national courts may be more likely venues.

Mohamad Katoub of SAMS told Syria Notes that humanitarian NGOs have been asking for timely investigation, not for another investigation body.The new Board of Inquiry has no further mandate or authority beyond what the Commission of Inquiry or IIIM already have, he points out:

‘We just need their reports to be issued in a timely manner, not months or years after a hospital is hit, or a school is targeted, or a humanitarian worker is killed, and this is because we lost hope that the international community will do a concrete action, so our hope is just to point fingers to perpetrators while they are still doing their crime. Our hope is just to make some pressure on the perpetrators by those reports, so they think twice before the next attack.

‘States members to the UN Security Council should make all the efforts to make those three investigation bodies work in a timely manner.

‘They should point fingers to perpetrators, and use the Commission of Inquiry reports which lay the responsibility of the majority of those attacks on the Syrian regime and its allies, to make the needed pressure to stop those attacks.’

Dr Munther al-Khalil of the Idlib Health Directorate told Syria Notes:

‘The most important thing in these investigations is that they are continuous and that they clearly and directly specify the party which committed these crimes even if there are currently no mechanisms to try the criminals. But at least the perpetrators should be identified as criminals for future reference, and this may be the best available at this time to reduce the frequency of these crimes.’

Outside of the UN, states can in some circumstances mount their own investigations of crimes in Syria, as is happening in Germany and France where international arrest warrants have been issued for senior Assad regime figures accused of mass torture and murder. While prospects of arrest are remote, such warrants can be a strong counter to any moves to normalise relations with the Assad regime.

In some countries, private citizens may be able to take legal action, as happened in the US when the family of journalist Marie Colvin, killed by Syrian regime forces in 2012, successfully brought a civil case against the Syrian government.

Finally, governments can impose sanctions against individuals and organisations they accuse of crimes. This doesn’t require bringing a legal case, but may demand presenting a case strong enough to withstand parliamentary scrutiny, and for joint sanctions with international allies, a case strong enough to convince other governments.

Dr Munther al-Khalil of the Idlib Health Directorate suggested to Syria Notes that given the failure of UN institutions, because of the Russian veto, the US and the UK should carry out investigations outside the UN, and publish their results directly or through organisations specialising in documenting war crimes and crimes against humanity. ‘In this way we can have evidence that can be used in the future,’ he said.

Fearing that a number of countries might reestablish relations with the Assad regime and restore legitimacy to it, Dr al-Khalil argued that for this reason it was important to highlight the criminality of the regime, and to bring to trial those involved in war crimes and crimes against humanity.


6. Early warning

As well as providing evidence in connection with attacks on civilian targets, the Coalition’s ability to track Russian and Assad regime aircraft could also provide more accurate early warning to civilians. In early 2015, The Syria Campaign publicly called on the US to share radar information with Syria Civil Defence—the White Helmets—but to no avail. The Syria Campaign quoted Khaled Khatib of Syria Civil Defence as saying, ‘if we could only get warning that the planes were coming, we could warn families, tell people to run from the markets, get the children out of the schools, let the medical centres know so that they can take cover.’

At that time Syrians were already using some technology for early warning of air attacks. Radios were used to listen in to Assad’s pilots, and aircraft observers would watch Assad’s bases to call in warnings of helicopters and jets taking off. In the town of Kafranbel in Idlib province, activists launched Radio Fresh in mid 2013 in part to broadcast air raid warnings.(Syria Notes Spring 2019.)

These efforts to warn civilians had limited accuracy and cover. In the absence of any sharing of radar data, more was needed to give timely effective warning. In 2016, Hala Systems launched Sentry Syria, a digital network that takes input from human aircraft spotters and from remote acoustic sensors, calculates where and when an airstrike is likely, and then sends out warnings via Syria Civil Defence networks.

On early warning systems, Dr Munther al-Khalil told Syria Notes that they help to a degree, so in some cases it’s possible to evacuate hospitals, or bring patients and medical staff down to the shelters. Mohamed Katoub of SAMS told Syria Notes that early warning can reduce risk, along with building hospitals underground, but that as long as attacking hospitals is a tactic in this war, ‘with no reaction from the international community,’ the attacks will not stop.

‘It is like a pain relief medicine to a patient who suffers from cancer. But do we have other options? Those tools saved lives, and protected humanitarian workers, but this should not be our call—our call should be to stop those attacks.

‘I would like people of the UK to send letters to their parliament, and government, and ask each of them to do what they would do if the attacked hospital is the place where their children are being delivered to life, receiving vaccinations, and treated. What will they do then? Just imagine that the hospital in your town, where you take your kid to get treatment is attacked, what will you do then?’


7. Evidence

The years of war in Syria have seen the pioneering of new open source investigation techniques. The potential of collective online investigations was first demonstrated when Eliot Higgins and fellow enthusiasts identified Croatian weapons being supplied to Syrian opposition forces in early 2013. Later that year, the same methods helped unravel details of the Assad regime’s Sarin nerve agent attack on two suburbs of Damascus on 21 August 2013.

These methods continue to be applied and developed to examine events in Syria and in other conflicts, and to be linked to other disciplines. The Global Legal Action Network cooperates with Bellingcat on investigating airstrikes in Yemen, where they combine GLAN’s legal expertise with Bellingcat’s open source techniques. Airwars have worked with Amnesty to bring their database of open source casualty reports together with Amnesty’s on the ground investigations, and their joint Strike Tracker project has added to the picture through crowdsourcing analysis of satellite imagery.

Early warning data has added a useful extra layer to investigations into hospital attacks by the Syrian Archive, Bellingcat and the Syrian Network for Human Rights. Data gathered by Hala Systems for early warning can’t fully replicate the detail gathered by NATO and Coalition aircraft tracking systems, but it does provide an alternative source of evidence for identifying parties responsible for particular attacks.

In a very recent attack, when a market in Ma’arat al-Nu’man was bombed on 22 July 2019, killing 39 civilians according to the Syrian Network of Human Rights, witnesses on the ground said that Russian aircraft were responsible for four initial strikes, with Assad regime aircraft conducting follow up attacks in the hours afterwards.

Russia’s Ministry of Defence immediately denied that its planes had carried out the airstrikes, saying they had not flown any missions in Idlib that day. Allegations of Russian involvement were ‘a fake’ by the White Helmets, the Ministry said in statement reported by Reuters.

Syria Civil Defence—the White Helmets—responded to the Russian accusation with their own statement, saying that the Sentry Syria system had reported a Russian aircraft taking off from Hmeimim airbase at exactly 08.03 that morning, and that further observations were made of the Russian warplane circling Ma’arat al-Nu’man at the time of the first attack at 08.36, and that it remained in the area until 09.03. Later a Russian surveillance plane played a support role to Assad regime warplanes that arrived from the T4 and Hama airbases to conduct five further airstrikes, intended to target rescue teams and roads leading to the site.

According to a report by the Syrian Network for Human Rights, the first two Russian strikes hit the vegetable market, each time firing a missile:

‘The same warplane then headed to the east of the city and carried out a third air raid, again using a missile, this time in the vicinity of Ma’arat al-Numan Prison near the Uwais al Qarni Mosque in al Sharqi neighborhood. The air raid caused moderate material damage to both the mosque and to al Salam Hospital, which is supported by the Syrian American Medical Society (SAMS), located 100 meters from the raid site. It was followed by a fourth air raid on the building that formerly housed the Cultural Centre.’

This attack illustrates that the bombing by Russian and Assad forces is a joint campaign not just against hospitals, but against all key elements of civilian life, including markets, mosques, and rescue workers.

Given the Russian Ministry of Defence’s denial, this attack is also a good example of where NATO or Coalition tracking data could play a useful part in verifying Sentry Syria evidence, and verifying reports from witnesses on the ground, in order to build a case for legal action or sanctions.


Next: The men who give the orders — Officers responsible for Russia’s airstrikes



Case files
Hospital attacks, 28 April–10 July 2019.