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Medical Workers Seek Accountability for Syrian Healthcare Attacks

Medical workers are monitoring attacks on healthcare facilities in Syria. Their aim is to provide data that can be used by international agencies to enforce legal protections and hold the perpetrators accountable for breaches of international law.

Written by Hashem Osseiran Published on Read time Approx. 6 minutes
A map of verified attacks on healthcare facilities in Syria, by governorate.Reprinted from The Lancet,, Elamein et al., Attacks against health care in Syria, 2015–16: results from a real-time reporting tool, Copyright (2017), with permission from Elsevier

BEIRUT, Lebanon – A new, real-time reporting tool for attacks against health facilities and staff in Syria promises to make it easier to track perpetrators of war crimes and eventually hold them accountable.

At least half of the hospitals in rebel-held areas in Syria were attacked between November 2015 and the end of 2016, leaving more than 261 people dead and 677 others wounded, according to a new study published in the Lancet last week as part of its series on assessing the evidence base for health interventions in humanitarian crises.

Aerial bombardment was reported to be responsible for roughly 70 percent of the attacks, which mostly took place in the rebel-held Idlib and Aleppo provinces, making it unlikely that Syrian opposition groups – who do not have air force capabilities – are culpable.

President Bashar al-Assad and his Russian allies, however, have repeatedly denied responsibility, claiming there is no credible evidence linking them to attacks against healthcare facilities.

A newly implemented reporting tool, described in the Lancet report, promises to change that. It aims to provide robust and credible data that could be used by international agencies to enforce legal protections and achieve accountability for breaches of international law.

The Monitoring Violence against Health Care (MVH) system, the first systematic method for collecting robust data about attacks, is a real-time reporting tool that monitors and verifies attacks on medical facilities in Syria using a network of ground sources present in several governorates.

These organizations and health professionals report on attacks against healthcare services and staff using a 293-member WhatsApp group that allows alerts and requests for information to be shared rapidly.

The MVH system operates a vigorous and unparalleled verification process that requires confirmation for each incident from an internal partner who has either visited the targeted facility or was present during the attacks, as well as verification from external reports.

Syria Deeply spoke to Dr. Alaa Abou Zeid, WHO’s health cluster coordinator in Yemen and the lead author of the paper, to learn more about how the data produced by this reporting tool could be used to achieve accountability for war crimes.

Syria Deeply: Why is this reporting tool important?

Alaa Abou Zeid: Till we started this process, all the data that health specialists were communicating before was disregarded as being inaccurate and as following no particular method. Right now we have done our job as health specialists, we have provided robust data, and we have reported correctly, using a well-known method for identifying attacks. We are calling on other parties to take responsibility and use this data to hold perpetrators accountable.

Syria Deeply: What impact would the adoption of a standardized method of reporting attacks against healthcare facilities have on a larger scale? Does it have the potential to reduce attacks?

Abou Zeid: Documentation of attacks allows us to better understand the extent and nature of the problem. With this data, we can inform our advocacy and actions to eventually prevent further attacks. So accurate information on attacks is crucial. In the short term, it’s very important to have accurate and defendable data that nobody could question. Would it contribute to reducing attacks? I hope so, but as you know the act of reducing attacks or working with parties to the conflict to uphold health as a human right and the international humanitarian law often takes significant effort at the political level. It is not just a health issue but also a political issue at an international level.

Syria Deeply: Considering that aerial bombardment was reported for 69.5 percent of incidents, does this point the finger of blame in the direction of the Syrian government and its allies?

Abou Zeid: The Syrian airspace is used by many other air forces, not just the Syrian government. What we can confirm is that opposition groups do not have a military air force. As health professionals, doctors, nurses, staff in health facilities, it is impossible for us to identify the type of warplane or who it belongs to. The maximum we can say is that it is an aerial bombardment.

Syria Deeply: The reporting tool provides critical information about the attacks but it doesn’t tell us who was responsible for them. Do you think it is also important to mention who is behind most of the attacks?

Abou Zeid: Our role as health specialists, especially for the WHO mandate, is to identify and document attacks against healthcare. Our role is to document robust data on these attacks. We depend on other organizations, who work on international law and the Geneva conventions, to use this data to do further investigations to identify their perpetrators within their mandate. As a health organization, we have done our part and we are asking the other agencies to do their part and use our data to identify the perpetrators, which is within their mandate, not our mandate.

Syria Deeply: Analysis of time trends in incidents suggests that increased attacks on health services are associated with land operations to take over a specific location, such as the escalation in and around Aleppo city in November–December, 2016. Is it possible to assess the level of intentional targeting?

Abou Zeid: We report and document and verify attacks, we confirm attacks on heathcare, including physical damage to facilities and injuries or death of staff or patients. We do that. However, health specialists cannot investigate whether these attacks are intentional or not. Other agencies and organizations can use our data to reach these conclusions. For example, they can use information on the frequency of attacks, or how many attacks took place on the same health facility within a certain time frame. All these indications can help agencies reach conclusions as to whether these attacks are intentional or not. Most of the time, the impression of the health workers in the field as I talk to them, was that it was intentional, it was direct targeting.

Syria Deeply: What made them think that it was intentional?

Abou Zeid: The frequency of the attacks. Some health facilities were targeted several times in a certain time frame. For example, during the ground operation in Aleppo, we have seen eight hospitals targeted many times, not just once or twice, but more than 40 times. Probably this is why the healthcare staff felt that it was intentional.

Syria Deeply: In the 14-month period covered by this study, alerts were received that described 402 individual incidents of which only 158 were verified. Does the rigorous verification process run the risk of generating a large discrepancy between the number of attacks that were verified and the number of attacks that actually took place?

Abou Zeid: Usually we have to strive for both accuracy and inclusivity. Previous inclusive data sets that include all reports of attacks were rejected by many parties as being inaccurate. So between accuracy and inclusivity, our system is somewhere in the middle. Although it seems that the number of verified attacks compared to the larger number of incidents generally reported is low, still each one of these 158 incidents can bring the perpetrators to justice if it is correctly used. These 158 attacks are verified and we can defend this data, we can stand strongly behind it and say that it actually happened and no one can question the information. WHO is now finalizing its global data collection tool that has three levels of certainty (possible, probable and confirmed) that will allow WHO to speak out quickly and with confidence in the prescribed levels of certainty while further information is being gathered.

Syria Deeply: International organizations that document and record human rights violations in Syria are currently struggling with convincing their partners inside Syria to keep reporting on violations. Does the reporting tool for attacks against healthcare face the same problem?

Abou Zeid: We have faced the same issue and it was a serious problem. The issue was raised many times during general meetings in Gaziantep, Turkey. Some partners asked why we were still reporting when we were not seeing any effect. By effect, they mean decrease in the number of attacks. Many said that we were wasting time and resources and that we should focus on a practical thing because this won’t stop the attacks. We believe that it is very important to report what is going on, so the world understands the extent and nature of the problem both in specific countries and globally – and to inform our action to stop attacks.

This interview has been edited for length and clarity.

The views expressed in this article belong to the authors and do not necessarily reflect the editorial policy of Syria Deeply.

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