The Syrian regime is increasingly attacking hospitals and health care workers in rebel-held areas, experts say, as it cedes ground to the opposition. Médecins Sans Frontières last week reported attacks on or near nine hospitals in Idlib province in a period of four days. Saying that the attacks represented an "increasing pattern of health care structures and civilians being affected as a result of the ongoing war," MSF reported that three staff members were killed as well as one patient and seven civilians. A further 31 were wounded. This year, the months of April, May and June witnessed the highest number of attacks on hospitals and clinics in a single quarter since the war began in early 2011, according to Widney Brown, program director at Physicians for Human Rights. The NGO has been documenting attacks on health care facilities and workers throughout the war, and updates an interactive map of incidents online. MSF's head of mission for Syria Sylvain Groulx described last week's Idlib attacks as part of a wider, worrying trend of targeted attacks on health care services. "These recent attacks are a clear violation of International Humanitarian Law, which prohibits military attacks on hospitals," he said in a statement. Brown says that over 95 percent of all attacks have been committed by the regime. Early on in the uprising, violations mostly consisted of doctors being detained by security authorities for aiding injured protesters. Increasingly, however, attacks focused on hospitals in opposition-held areas. Since the war began, 654 medical personnel have been killed, with the regime responsible for 624 of those, according to PHR's research, which is a collaborative project with other groups. Of the 295 attacks on facilities, 265 were carried out by the government, it also reported. Speaking to The Daily Star, Brown says she believes the regime has upped its attacks on hospitals due to two main factors. Firstly, "with the U.S. and coalition forces taking on ISIS, the Assad government can ignore ISIS and concentrate on the opposition." The government has lost territory over the last couple of months, primarily in Idlib province, and rebels are launching new assaults in Deraa and near Damascus. Assad now only controls one quarter of the country, by land mass, Reuters has reported. Brown says this is a second key factor behind the uptick in regime attacks against medical facilities. "As the government continues to lose territorial control, it turns around and bombs clinics. It tries to destroy infrastructure," she says. The attacks, Brown says, are not random – they are deliberate, targeted attacks on places where people are receiving medical care – which constitutes a war crime. "When you have this level of systematic attack, it's a strategy." Appalling enough as targeted attacks on hospitals already are, Brown is doubly horrified that Assad trained as a doctor – he trained in ophthalmology in Damascus and then London before occupying the presidential seat. "It's collective punishment," she says, "based on a presumption that [the victims] support the opposition. Bomb the schools, and hospitals." The destruction caused even now, before the war shows any signs of ending, mean the infrastructure will take years to rebuild, Brown says. There are now worrying signs that the regime is deliberately targeting medical personnel when they leave hospitals – a car carrying a urologist and a nurse in opposition-held Aleppo was recently struck from the air. Even when hospitals and medics themselves are not being targeted, there are severe shortages of medicines and equipment in many opposition-held areas. In opposition-held eastern Aleppo, Brown says, clinics have anesthetics and antibiotics, but nothing sophisticated. Traumatic injuries, if they are to be survived, require the patient getting to Turkey for treatment, and chronic illnesses, such as cancer, are largely untreatable. The rudimentary clinics do not even have MRI machines, Brown says, for "they cost a lot and they know they'll be destroyed in the next bomb attack." The situation in besieged areas is even more dire. Brown recently spoke with a doctor from Eastern Ghouta, who had treated a boy with a traumatic chest injury. Without anesthetic, the doctor had to perform a central line on the boy – inserting a catheter into his chest, to administer fluids: "The boy was begging the doctor just to let him die." The situation is not helped by security forces regularly holding back humanitarian aid destined for besieged areas. In July 2014, the U.N. Security Council, in a rare display of unanimity on Syria, passed Resolution 2165, which allowed for U.N. agencies and others to send aid directly across border crossings not held by the government, rather than funneling it through Damascus. It was a "mystery" therefore, that OCHA – the U.N.'s humanitarian office – continues to do just that, Brown says. The first real challenge to alleviating the medical situation will be getting OCHA to bypass the capital, she says. In response to a question on the issue, OCHA spokesperson Jens Laerke said that, "The U.N. and our humanitarian partners provide aid to people in Syria through all means and routes available. This includes deliveries between government controlled areas inside Syria and across conflict lines in-country to areas controlled by non-state armed groups. "It also includes deliveries across borders from neighboring countries as authorized by the U.N. Security Council. These cross-border operations have increased the provision of aid in particular in non-government controlled parts of northern and southern Syria. Meanwhile, millions of people in need can only be reached from inside Syria." Fundamentally though, Brown says, there is no way for attacks on medical facilities – amongst other places – to cease until the resolution, which specifically mentions barrel bomb attacks and the seizure of humanitarian aid, is enforced. Resolution 2165 stipulated that if the government was noncompliant, additional steps would be taken. "No additional measures have been taken," Brown says. "What more evidence do you need? There's a real frustration there."
