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Read our latest issue on the systematic bombing of hospitals in Syria.

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Targeting of hospitals resumes in Idlib




Ikhlas Hospital after an airstrike on 6 November 2019. Image from a video report by Macro Media Centre.


7 NOVEMBER 2019

Yesterday, Wednesday 6 November 2019, two hospitals were hit by airstrikes in northwest Syria.

The Syrian Network for Human Rights reported that fixed-wing warplanes believed to be Russian carried out two strikes on al Ikhlas Hospital located southeast of Shnan village in the Jabal al Zaweya area in southern Idlib province, injuring two medical personnel, partially destroying the hospital’s building and severely damaging its equipment. As a result, the hospital went out of service.

The UK-registered charity Hand in Hand for Aid and Development reported that their hospital in the town of Kafranbel, Idlib province, was hit three times at 16:51 local time. The initial attack with air to ground missiles was followed by ground to ground bombardment. According to Hand in Hand, all staff and patients were trapped inside for several hours before contact was restored, and they were freed and brought to safety.

Both hospitals had been attacked previously. Ikhlas Hospital was one of at least a dozen medical facilities bombed by Russian or Syrian regime forces in a wave of attacks in April 2017. Kafranbel Surgical Hospital has been attacked several times over the years. This was the fourth air attack against the hospital this year, according to Hand in Hand, after two separate attacks on 4 July, the first by military helicopters and the second just short of an hour later by air to surface missiles, and one attack on 5 May 2019, where a series of four munitions struck the hospital, three of which were caught on video.

The 5 May attack on Kafranbel surgical hospital was investigated first by Syrian Archive, and then by a team at The New York Times. That New York Times investigation had access to intercepts of radio communications between Russian military pilots and ground controllers, and found evidence that a Russian pilot was responsible for the sequence of four airstrikes against the hospital on 5 May.

The hospital in Kafranbel is on a UN ‘deconfliction’ list of civilian locations, meaning its location is shared with international powers intervening in Syria, including Russia, as a location that should be protected.

On 30 July, after the UN Security Council heard 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, ten members of the Security Council called for a UN investigation. This internal United Nations Headquarters Board of Inquiry is now investigating ‘a series of incidents’ of destruction or damage to facilities on the UN’s deconfliction list and UN-supported facilities in the area.

The three-member board of inquiry is led by Lieutenant General Chikadibia Obiakor of Nigeria and also includes Ms Janet Lim of Singapore and Ms Marta Santos Pais of Portugal. Briefing journalists in September, the UN Secretary-General’s spokesperson Stephane Dujarric said:

‘Board of Inquiries—and they routinely happen—are internal documents and not for public release. That’s what I can tell you at this point. It’s also important to know that Board of Inquiries are not judicial bodies. They’re not criminal investigations. They make no legal findings and do not consider questions of legal liability or legal responsibility.’

While the Board of Inquiry is not a criminal investigation, and its report not intended for public release, this kind of investigation can lead to public identification of a party responsible for an attack, if the inquiry has access to the necessary evidence.

One precedent to the current inquiry is the 2016 UNHQ Board of Inquiry into the 19 September 2016 attack on a UN-coordinated inter-agency aid convoy in Aleppo province, Syria. While that inquiry remained secret, a summary was published identifying likely perpetrators, but not confirming responsibility:

‘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.’

As detailed in our Autumn 2019 issue, United States officials briefed journalists and the US Senate Committee on Armed Services that they had evidence implicating the Russian Air Force, but the summary published by the UN indicates that the US government didn’t share that information with the UN inquiry.

Even if the current UN inquiry were to definitively identify perpetrators, however, given that the International Criminal Court does not have jurisdiction in Syria, and that the Russian and Syrian governments are protected at the Security Council by Russia’s veto power, it will for now be up to individual governments and national justice systems if any consequences are to follow from the identification of perpetrators.





Above: From a Halab Today video showing three of the munitions that struck Kafranbel Surgical Hospital on 5 May 2019. Via Syrian Archive.


From our Case files selection in the Autumn 2019 issue of Syria Notes:

At approximately 17.30 on 5 May 2019, the surgical hospital in Kafranbel, Idlib was bombed. Local sources reported that Russian aircraft carried out the attack. According to Hala Systems, observers in the area reported both Russian fixed-wing aircraft and Syrian regime Su-24 aircraft in the vicinity. One person was reported killed, later rising to two.

This attack took place on the same day as the earlier airstrikes on Kaferzita Cave Hospital, Hama, and on Nabad Al-Hayat Hospital, near Hass, Idlib. According to UOSSM, Kafranbel Hospital also had its location coordinates shared with military actors through the UN deconfliction mechanism to prevent accidental targeting.

The Syrian Archive produced an extensive report analysing videos and photographs of this attack, showing that the hospital was hit four times during the attack. Amnesty International included this attack in their 17 May 2019 report covering several airstrikes on hospitals in Syria. Physicians for Human Rights have also published a case study on Kafranbel Hospital.

According to Physicians for Human Rights, the history of Kafranbel Hospital goes back to July 2012, when a group of local activists established a medical point and pharmacy. In June 2013, it was turned into a hospital under the name of Orient Hospital. In November 2016, the British NGO Hand in Hand for Aid and Development took control of the hospital.

Physicians for Human Rights has verified several attacks on the facility from June 2014 on. The earliest was a Syrian regime airstrike on 29 June 2014, which killed a newborn baby, a doctor, and an anesthesia technician, and caused major damage to the hospital. The hospital was attacked twice more that year, with the last 2014 attack killing fifteen people. The hospital was attacked four times in 2015, twice in 2017.

Funds raised by Hand in Hand allowed an underground facility to be built, after which the hospital was bombed again in February 2018.

After the 5 May attack, the hospital was attacked again on 4 July 2019.

Hand in Hand for Aid and Development, the UK NGO that supports Kafranbel Surgical Hospital, provided Syria Notes with more background.

The building is an underground facility that HIHFAD funded through UK public donations, with the aim of allowing safe and uninterruped service even under heavy airstrikes. That was put to the test in February 2018 when the hospital was hit by four targeted airstrikes. The airstrikes destroyed the hospital above ground, but the underground hospital survived intact and ensured no staff member or patient was injured in the attack.

In the 5 May 2019 attack, the hospital suffered at least six direct hits from 17.25 local time, according to the NGO, killing two patients and inflicting significant damage on the hospital.

On 4 July 2019, the hospital was again targeted; the second major attack in eight weeks, despite the hospital being registered through the UN deconfliction mechanism. The hospital sustained not one but two offensives on 4 July: the first by military helicopters at 14:52, and the second just short of an hour later at 15:40 by air to surface missiles. The attacks were directed at the entrance to the hospital, and all services had to be suspended.