Syria Report

Syrian air force
fires missiles at Aleppo hospital


Syrian government fighter planes fired rockets that struck the main emergency hospital in an opposition-controlled area of Aleppo on 14 August 2012, wounding two civilians and causing significant damage, Human Rights Watch said in a statement after visiting the damaged hospital. The organisation says the attack is a violation of international law.

The hospital is an established medical facility and clearly marked with a red crescent emblem on the front.

A rocket attack by government aircraft on the hospital two days earlier, on August 12, killed four civilians and wounded three, according to a physician at the hospital.

“Fighter jet attacks on a hospital twice in three days indicate that this was no accident,” said Ole Solvang, emergencies researcher at Human Rights Watch. “By firing rockets at a clearly marked hospital, the government shows blatant disregard for civilian lives.”

All hospitals, whether civilian or military, are specially protected under international humanitarian law, known as the laws of war. They may not be targeted, even if being used to treat enemy fighters. Under the Geneva Conventions, hospitals remain protected unless they are “used to commit hostile acts” that are outside their humanitarian function. Even then, they are only subject to attack after a warning has been given setting a reasonable time limit, and after such warning has gone unheeded.

Under the laws of war, parties to a conflict must take all feasible precautions to ensure that a target of attack is a military objective and not a civilian object. Attacks that do not discriminate between military targets and civilian objects are prohibited. Individuals who order or carry out unlawful attacks wilfully – that is, deliberately or recklessly – are responsible for war crimes. States are obligated under the laws of war to investigate alleged war crimes and prosecute those responsible.

Human Rights Watch visited the Dar al Shifaa Hospital, in the Sha’ar neighbourhood of Aleppo, about one hour after the August 14 attack, and examined the physical damage and rocket remnants. Hospital staff told Human Rights Watch that no opposition fighters were deployed at the hospital at the time of the two attacks, and only several armed hospital guards were providing security. Human Rights Watch saw no signs of opposition military activity in or around the hospital building.

On the fourth floor of the hospital, Human Rights Watch saw the tail remnants from about a dozen S-5 rockets. These rockets are fired from aircraft with a range of three to four kilometres.

The attacks on August 12 and 14 caused major damage to the four upper floors of the hospital, destroying walls, floors, windows, and equipment in operating rooms and other wards. According to the chief physician, Dr Mohammed Asi, the attack on August 12 killed four civilians outside the hospital and wounded three nurses. The August 14 attack wounded at least two civilians who were on the street outside the hospital, he said.

One of the wounded in the August 14 attack was a doctor from a makeshift field hospital in western Aleppo, who said he had stopped by Al Shifaa Hospital to get medical supplies for his clinic. The doctor sustained shrapnel wounds on his upper legs, left foot, and both arms. He told Human Rights Watch that another person was wounded when one of the rockets hit the street near the hospital.

Doctors at Al Shifaa Hospital told Human Rights Watch that because the area had been subjected to earlier attacks, they had limited the use of the upper floors to emergency surgery. As a result of the two rocket attacks, hospital staff are now only using the bottom two floors.

“We had just finished surgery and moved to the second floor when the rockets hit,” one doctor told Human Rights Watch. “If they had hit just minutes before we would have all been dead.”

The doctors said that Dar al Shifaa Hospital is the main emergency hospital in the eastern part of the city of Aleppo, an area currently controlled by the opposition Free Syrian Army (FSA). According to hospital records, on August 14, when Human Rights Watch visited the hospital, the hospital had that day received 24 civilian casualties, including four children and four dead bodies from other attacks around the city, mainly from shelling in the Tariq al-Bab area. The hospital keeps separate records for wounded and killed FSA soldiers.

The doctors said that government forces had used Al Shifaa Hospital until opposition forces took control of the area in late July.

In addition to the two recent attacks on Al Shifaa hospital, government forces have allegedly targeted an ambulance in Aleppo. The head of Dar al Shifaa Hospital, Dr Asi, told Human Rights Watch that a helicopter attacked an ambulance with rockets about 2 weeks prior to the attack on the hospital, killing the driver, a nurse, and a wounded man in the ambulance. Human Rights Watch was unable to verify his account.

“Hospitals, doctors, and ambulances should never be attacked,” Solvang said. “In Aleppo, the Syrian government has flouted this principle of international law.”


WHO calls on
international community
to assist Syria’s neighbours
in health care

With more than 120,000 registered displaced Syrians currently temporarily located outside the country, and thousands more still pending registration, the World Health Organisation (WHO) issued a statement from Cairo calling on the international community to extend its support to the neighbouring countries of Jordan, Lebanon and Iraq to ensure the availability of essential healthcare services and maintenance of the high cost of medical care for hospital-based health conditions such as palliative care for cancer and other complicated trauma cases.

The WHO also reported severe shortages in medicines and pharmaceutical products in the Syrian Arab Republic as a result of the current crisis.

More than 90% of medicines in Syria were locally produced before the unrest began in February 2011. Since then, economic sanctions, currency fluctuations, difficulty in the availability of hard currency and an increase in operational costs have negatively affected the production of medicines and pharmaceutical products. The recent escalation of clashes has impacted the pharmaceutical plants located in rural Aleppo, Homs and rural Damascus, where 90% of the country’s plants are located. Many of these plants have now closed as a result of the on-going clashes and increased cost of fuel, resulting in a critical shortage of medicines and other life-saving pharmaceutical products.

Syrian Ministry of Health statistics show that prior to the unrest, 52.7% of the population was receiving treatment for gastrointestinal diseases, respiratory diseases, cardiovascular diseases, renal diseases and cancer. Many of these patients are still dependent on locally produced medicines that are now no longer obtainable, and the reported shortages could have catastrophic results.

Urgently needed medicines identified by the WHO and the Syrian Ministry of Health include those for tuberculosis, hepatitis, and other chronic health conditions such as hypertension, diabetes, thalassemia and cancer, as well as medicines for kidney disease. There is also an urgent need for chemical reagents for blood screening tests to ensure the safety and quality of blood used in surgical and trauma care in hospitals.

 Date of upload: 26th Sep 2012


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