Syria: targeting health centers as a way to instill terror

On Monday 15th February, two hospitals, among which an MSF-supported one, have been destroyed by an airstrike in Northern Syria, leading to the reported deaths of dozens of staff and patients, including children. This new strike is the latest one in a series of attacks specifically aiming at health centers and the civil society, many of which were supported by various international and national NGOs.  This recurring and escalating violence against health centers is proving to be very strategic and highlights three main factors and impacts: the strong and violent resurgence of the Bachar al-Assad’s regime, the powerlessness of the Western countries’ mediation, and the growing endangerment of international humanitarian law.


Recurrent bombing raids on health centers and the civil society

The use of violence against civil society and in particular health centers and hospitals has been a systematic and recurrent occurrence since the beginning of the Syrian crisis. Between August 2012 and December 2015, nearly 330 health centers have been reported as having been specifically targeted at and destroyed by aerial raids, nearly all of them situated in the Northern part of the country which is mainly under rebellion and opposition’s control. 
The cost for the civil society is abysmal: from 2011 to 2015, 700 medical staff have been killed, according to a report by the NGO Physicians for Human Rights.  This death toll easily amounts to thousands if patients and civilians are to be taken into account, non-including the wounded and missing persons.
The impact goes unfortunately deeper than the direct life cost: the destruction of health centers and hospitals leaves thousands of people without access to medical attention in high-risks and active conflict zones, as Massimiliano Rebaudengo, MSF’s head of mission in Syria, remarks following this month’s attack on the MSF-supported hospital. According to a 2014 report conducted by the NGO Save the Children, more than 200,000 Syrians civils died of chronic diseases –such as asthma or diabetes- which could have been avoided or cured, with accessible medical services. Adding this figure to the existing statistics would contribute to double the casualties’ number caused by direct violence since the beginning of the conflict. However, accurate data on casualties’ number is extremely difficult to obtain in Syria, since NGOs have restricted possibilities and means at their disposal and the official figures given by the government are often carefully selected at best and manipulated at worst.
As a result, the Syrian healthcare system is deeply affected and in a poor state, particularly in non-governmentally controlled zones:  the life expectancy, which was around 75 years, had dramatically dropped to 55. The increasing lack of doctors represents also an alarming problem: 90% of them are reported as having fled the country since the beginning of the war, leaving behind them non-professional voluntaries.

An intensifying violence in the past few weeks

Even though aiming at health centers and hospitals is hardly a novelty in the Syrian conflict, a clear increase in violence and occurrence of airstrikes specifically targeting them has been noticed. There have been fourteen attacks so far this year, and seventeen in the past six weeks: among them, four medical facilities, including two UNICEF-supported ones and a child and maternal hospital, have been bombarded, as reported by the UN organization. Since last October, the NGO Physicians for Human Rights have reported that Russia was responsible for seven attacks on health centers.

The sign of a strong comeback of the Assad regime and its allies?

This intensifying violence is directly linked to the stronger position that the Assad regime seems to hold these past few months: strengthened by the help of its Russian and Iranian allies, the Syrian government is steadily gaining ground. Since the end of January, it now encircles the rebel-held city of Aleppo, prompting the peace talks in Switzerland -that had only begun- to a quick and premature end.
In this context, aiming at the civil society, and in particular at health centers, in rebel-held zones is completely strategic: it enables Bachar al-Assad to terrorize the population, leading them to flee these locations. Indeed, all populations remaining in the rebel-held zones are perceived as being accomplices to the opposition and therefore treated as terrorists, as Mego Terzian, the President of MSF, indicates: “Today, to work or to lead first-aid operations, in particular medical ones, is, in the Syrian’s government coalition point of view, a criminal act. They consider that all medical staff working in a rebel-held zone is a terrorist, even MSF. They consider us terrorists. Therefore, bombarding health centers becomes a legitimate act. Targeting five MSF-supported hospitals in a six weeks time-lapse and in total seventeen ones is very significate. There have always been bombarded hospitals, but it doubled or even tripled in a few months.” 

The humanitarian international law jeopardized and the failure of mediation

As targeting the civil society and in particular health structures is a serious violation of international humanitarian law, the international community was on the whole prompt to condemn these acts. The United States has denounced the brutality of the Bachar al-Assad government and the responsibility of Russia in the attacks. This resurgence of violence highlighted the lack of influence and powerlessness of the Western countries, which participated in the elaboration of the agreement of a “cessation of hostilities” that was reached in Munich at the beginning of the week. Barack Obama supported the idea by urging Russia to stop bombarding Syrian rebel-led zones. However, as Bachar al-Assad himself claimed on Monday 15 February at Damascus, a cessation of hostilities doesn’t necessarily implicate that both parties stop using weapons, but this decision is used to prevent terrorist groups from gaining ground and strengthening their positions. Meanwhile, Turkey, which is currently harboring 2,2 million Syrian refugees, condemns the Russian strikes, referring to them as “obvious war crimes”. 
In such a noxious context, it appears that airstrikes targeting health centers and the civil society in Syria are not likely to stop anytime soon. As part of the strategic plan of Bachar al-Assad and its allies to terrorize the population still remaining in the rebel-led zones and to gain ground in those territories, it seems highly dubious that the unanimous international condemnations will be enough to prevent future potential attacks. 


Léa Guinet, Research assistant at CIPADH


Helene Sallon, « Hôpital de MSF bombardé en Syrie: c’est une guerre à huis clos ou l’on massacre les gens », Le Monde, 15 février 2016. Available online :

Beirut and Kilis, “Syria’s war: Assad on the offensive”, The Economist, February 13th 2016. Available online:
Reuters, «La reconstruction du système de santé syrien estimée à 8 milliards de dollars», L’Orient Lejour, 16 février 2016. Available online :

MSF website, «Syrie : l’escalade de la violence n’épargne pas les structures de santé», Médecins sans Frontières, 29 octobre 2015. Available online :

Kareem Shaheen, “Airstrikes hit two Syrian hospitals, with Turkez condemning obvious war crime”, The Guardian, 16 February 2016. Available online:

Al Jazeera staff, “Syria peace talks plunged into new crisis”, Al Jazeera, 3 February 2016. Available online: