Syrian hospitals face a “uniquely horrific” situation and were attacked more than hospitals in any other conflict zone last year, the author of a new report told Syria Deeply.
Attacks on healthcare facilities in Syria last year were “by far the worst case, in terms of the intensity and impact,” compared to 23 other countries in conflict, including Yemen, South Sudan and Afghanistan, said the “Impunity Must End” report by the Safeguarding Health in Conflict Coalition, coauthored by Leonard Rubenstein of the Center for Public Health and Human Rights at Johns Hopkins University. Compiling data from a comprehensive range of sources such as Medecins Sans Frontieres (MSF), the Syrian American Medical Society (SAMS) and Physicians for Human Rights (PHR), the report compared the different countries based on reports of bombing, shelling and looting of health facilities; the abduction, intimidation, arrest or killing of health workers; obstruction or attacks on ambulances and humanitarian assistance; and the occupation of health facilities.
The findings, released last week, reveal a striking failure of the international community to prosecute or prevent these violations of humanitarian law.
Incidents in each of those categories were reported in Syria in 2016, meaning that what “was already the biggest humanitarian crisis of our time has only grown worse,” according to the report, which was coauthored by Carol Bales of IntraHealth International.
Syria Deeply spoke with Rubenstein about the report’s most striking findings, the dire healthcare situation in Syria and the steps the international community should take to put an end to attacks on healthcare facilities without consequences.
Syria Deeply: What insights did you glean by comparing health situations in 23 conflict countries as opposed to the findings from other reports on the weaponization of healthcare in Syria? What was most surprising or new to you?
Leonard Rubenstein: Our report reveals how severe violence inflicted on healthcare has major global dimensions. We found, for example, that hospitals were bombed or shelled in 10 countries. Aside from Syria, hospitals in Yemen were most frequently attacked. Almost everywhere we found multiple instances of intimidation of, threats to, arrests of and assaults on health workers – and in 10 countries health workers were killed. Obstruction of access to care was also severe, often in places which were not much in the news in 2016 for interference with healthcare, such as Turkey, Ukraine and the Occupied Palestinian Territories.
Syria Deeply: You write in the report that health facilities are “too often among the most dangerous places in communities” and health workers are at risk of being killed. Did your research reveal the motives behind attacks on health facilities, workers and patients?
Rubenstein: We couldn’t determine motives in particular cases, but patterns do emerge. Often, combatants either don’t grasp or don’t accept that their conduct needs to be constrained by international law when there is a perceived military advantage in conducting an attack on healthcare facilities or personnel or obstructing access to care. And they have little incentive to follow the law as they suffer no consequences for their actions. Those military advantages can extend beyond control of a strategic location; often, combatants seek to control, move or terrorize populations by assaulting facilities and personnel that fill a critical need for a population. In other cases, combatants don’t want people they deem enemies to have access to healthcare.
Syria Deeply: You also point out that Syria is “by far the worst case, in terms of the intensity and impact of attacks” on healthcare. How does Syria differ from other countries, both in terms of the type of attacks and identity of the perpetrators?
Rubenstein: What makes Syria uniquely horrific is the sustained targeting of hospitals and health workers over a period of years. As soon as the conflict began, doctors who treated demonstrators or members of the opposition were targeted for arrest. Since war broke out, there have been more than 450 documented attacks on hospitals – more than 100 in 2016 – almost all of them by the Syrian government and its Russian ally. We have not seen the scale and relentlessness of such attacks, nor the continued targeting of hospitals over years, anywhere else.
Syria Deeply: How does the blocking of humanitarian access and sieges affect the healthcare situation in Syria?
Rubenstein: Sieges in Syria deny food, health supplies and equipment, and other forms of critically needed aid to about 1 million people in Syria. They have led to malnutrition, the spread of preventable disease. And, of course, enormous suffering and death.
Syria Deeply: Protecting the wounded, sick and those who treat them is a pillar of international humanitarian law. Moreover, the U.N. Security Council adopted a resolution in May 2016 condemning attacks against medical facilities and personnel in conflict situations. Yet your report concludes with a chapter on the lack of accountability. What else could the international community do to prevent more of these attacks from happening?
Rubenstein: The U.N. secretary general laid out a series of actions to carry out the Security Council’s resolution, recommending, for example, that governments reform their laws to end the imposition of criminal penalties for treating a person deemed an enemy; establish rules of engagement consistent with international law and training their militaries in the rules; conduct thorough, timely and impartial investigations of violations of law; prosecute violators; stop arms sales to entities that attack healthcare facilities and personnel; and track incidents in a systematic way. He also asked that governments report on what they have done. Further, he urged that where states fail to conduct appropriate investigations and hold people to account, the Security Council should authorize investigations and accountability procedures. That is a good list of required actions, but the recommendations to date have been largely ignored. It is past time to follow through on them.
This interview was conducted by email and has been edited for length and clarity.
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