Dozens of strikes on medical facilities in Syria, mostly carried out by regime forces and its allies, placed the war-torn country at the top of a global ranking of attacks on hospitals and doctors.
The ranking was released in a report documenting more than 700 attacks on hospitals, health workers, patients and ambulances, in 23 countries in 2017 alone. The report said more than 101 health workers and 293 patients had died as a result.
The comprehensive report released by the Safeguarding Health in Conflict Coalition this week warned that assaults on health care in conflict areas are going unpunished and may also be rising.
Of the hundreds of cases of attacks on medical professionals, more than 250 took place in Syria. Of these, 34 were found to be perpetrated by Syrian President Bashar Al Assad’s regime and Russian allies, one by rebel group Jaish Al Islam and three by unidentified groups. Other attacks on medical staff across the country were on transport and personnel.
Runners-up on the list were the Palestinian Territories with 93 documented cases and Afghanistan in third with 66 cases.
"These attacks terrorise communities. They deprive already-suffering civilians of the life-saving treatment that they deserve," said Susannah Sirkin, of Physicians for Human Rights (PHR), which is part of the coalition behind the report.
In Syria, the retaking of Eastern Ghouta by government forces in April was a reminder that the eight-year war continues to be characterised by a disregard for civilian life. PHR verified 38 individual attacks on medical facilities during the offensive alone.
"In early 2014, Syrian forces bombed or shelled hospitals more than 100 times, more than had been documented in any other conflict," the coalition's chair, Len Rubenstein, said in the report.
"By the end of 2017, the number of hospitals shelled or bombed in the country approached 500, and then that grisly milestone was surpassed in early 2018."
In the occupied Palestinian territory, Israel’s occupation and blockade are increasingly exacerbated by its security forces’ interference with the delivery of health care, obstruction of medical transport and “denial of impartial care to wounded civilians”.
The report cites incidents of violence within hospitals, including against medical staff - pushing, kicking and beating, as well as the disruption of medical treatment, resulting in the death of patients. The report cited a case documented by Amnesty International in which Israeli forces were pursuing Mohammad Abu Ghannam, a young man with a major chest wound in a critical condition.
They reportedly entered the operating theatre and “shoved and hit” the doctor who was trying to provide urgent care. Mohammed died of his wounds during the incident. A nurse working during the raid said, “I have never been so scared in my life. All I remember were loud sounds and pushing and screaming. It was total chaos ... There was blood all over the place, on the floor, on the walls.”
In Afghanistan, where international and national armed forces have embroiled the country in a decades-old bloody conflict, there were at least 66 attacks on medical facilities and personnel in 2017. The Taliban carried out at least 27.
The report also listed 52 attacks in the Central African Republic, 37 in South Sudan, 35 in Iraq, 24 in Yemen, 23 in Nigeria and 20 in Congo.
Separately this week, the Committee of the Red Cross said that more than 1,200 violent incidents against hospitals and medical personnel have taken place in 16 countries in the two years since the UN adopted a resolution demanding that combatants protect staff and facilities treating the wounded and sick.
The ICRC Director-General Yves Daccord told the UN Security Council that "the gap between words and action is rather dramatic".
Another report on health care in Libya, published on Tuesday by the UN Mission in Libya and the UN human rights office, said 36 attacks on medical facilities, personnel or patients were reported from May 1, 2017, to May 1, 2018.
But, the report said, "the actual number of attacks is believed to be significantly higher".
"Hospitals and other health care facilities in Libya have been bombed, shelled and hit by violence during armed violence," it said.
The report also noted that foreign doctors and nurses have fled the country, "further affecting the quality of available health care in Libya".