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As Putin bombs hospitals in Ukraine, I hear echoes from Syria

‘Whether a hospital is bombed in Mariupol or Aleppo, in Sana’a or in Kunduz, those responsible must be held to account.’

A damaged building hospital sign is seen in Irpin, northern Ukraine, on 1 April 2022, more than a month into Russia’s invasion of the country.

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Many Syrians are experiencing heart-wrenching flashbacks as we watch the mounting devastation in Ukraine and the millions of refugees fleeing. As a Syrian physician who provided medical care amid the war in my country, it’s especially painful when clinics or hospitals are bombed.

I’m haunted by the escalating attacks on healthcare facilities in Ukraine, which leave me feeling that I have been here before.

Since the Syrian conflict began in March 2011, my colleagues at Physicians for Human Rights have documented 601 attacks on 400 healthcare facilities there. In Ukraine, it’s happening again: At least 119 attacks on health facilities, workers, and transports like ambulances have reportedly been perpetrated since Russia’s invasion began in late February, according to the World Health Organization.

Even after 11 years of such attacks on healthcare targets in Syria, no perpetrator has been held accountable for these crimes.

Things can be different for Ukraine. While Russia has blocked multiple attempts by the UN Security Council to refer the Syria conflict to the International Criminal Court, with Ukraine the ICC does not need the Security Council’s go ahead. Last month’s unprecedented referral by 41 ICC member states, combined with Ukraine’s declarations that it accepts the ICC’s jurisdiction (despite not being a state party), means that the court can proceed.

If just one positive development emerges from the ongoing horrors there, let it be a wake-up call: Global leaders must no longer stand by passively as war crimes such as attacks on civilians and “civilian objects” (like hospitals, schools, theatres) continue unabated.

This begins by actively supporting efforts to hold perpetrators of war crimes and crimes against humanity accountable for the bloodshed. It means ensuring that the ICC has the political and financial support it needs to do its work, while also supporting accountability efforts in other jurisdictions. Such investigations have already been launched by domestic prosecutors in countries like Germany, France, and Sweden.

What I witnessed

Last month, as I watched the videos and saw the photos of a maternity hospital in Mariupol, Ukraine that had been bombed by Russian forces, I was thrust back to a painful memory from a hospital in the al-Sakhour neighbourhood of Aleppo, Syria where I was working in 2014.

I had noticed a young woman enter the health clinic, looking excited for her final pre-natal check-up. While waiting for the doctor to call out her name, an aerial bombardment suddenly blasted the hospital, injuring three staff members and killing two patients. Shrapnel penetrated the pregnant woman’s stomach. With smoke still thick in the air, we rushed her into emergency surgery. She survived. Her baby did not.

“When you kill a doctor, you harm her patients. When you bomb an ambulance, you terrorise a community and intimidate residents from seeking the medical care they need.”

As a Syrian doctor, I can imagine Ukrainian medics scanning the sky for fighter jets while moving a patient out of an ambulance. I know the feeling of trying to focus on hearing your patient’s concerns, when your ears are instead listening for the distant roar of aircraft.

I can envision Ukrainian doctors pausing mid-surgery to ask their colleagues about new threats of shelling, even amid the overwhelming flood of war injuries that many have never seen before.

A war strategy

Attacks on healthcare are not only catastrophic, but they are also illegal under international humanitarian law. The Geneva Conventions and its Additional Protocol I, to which both Russia and Ukraine are parties, prohibit the targeting of those providing or receiving healthcare in armed conflicts.

These horrific attacks don’t just happen in Syria or Ukraine: Violence against healthcare workers and facilities is a particularly abhorrent feature of some armed conflicts around the world. They are also a signature of Russia’s brutal war strategy.

Read more → Inside Idlib’s bombed out hospitals and clinics

In Chechnya, the Russian military levelled healthcare facilities as part of its scorched-earth tactics and crackdown on civilians. Many parties to the conflict violated medical impartiality and attacked healthcare targets, but witnesses reported that the greater volume of abuses was perpetrated by Russia’s federal forces, including the bombing of medical facilities. Russia’s federal forces destroyed or damaged at least 24 different medical facilities.

According to data collected by Physicians for Human Rights, some 244 of the 601 total attacks on healthcare targets in Syria occurred after the Russian military entered the conflict on the side of the Syrian government in 2015, and can be attributed to either Syrian or their allied Russian forces.

April 27 marks the six-year anniversary of two bombs hitting the front of al-Quds Hospital in Aleppo, where several of my friends – including Dr Hamza Al-Khataeb, depicted in the Oscar-nominated documentary For Sama – toiled in what became known as “the last hospital standing in Aleppo”.

In total, Syria and Russia have carried out around 90 percent of all attacks on healthcare targets in Syria, including the killing of 942 health workers.

In one illustrative case, the Russian military bombed four hospitals in one town in just over 12 hours in May 2019, as The New York Times meticulously documented.

These attacks are not only profound tragedies for health workers who are killed, and their families. They also cripple entire health systems. When you kill a doctor, you harm her patients. When you bomb an ambulance, you terrorise a community and intimidate residents from seeking the medical care they need.

Civilians pay the price. When being in a hospital becomes more dangerous than staying home, people will naturally avoid medical care for fear of becoming targets. The long-term impacts are also devastating, and communities subjected to violence against healthcare targets don’t just see conflict-related injuries. War can also exacerbate chronic and noncommunicable diseases; women are less likely to see reproductive and neonatal doctors; and indicators of maternal and newborn health decline.

In Syria’s case, a decade-plus of destruction, obstruction of aid, and neglect has caused a near-collapse of health systems in parts of the north not controlled by President Bashar al-Assad’s government.

Sowing fear

While we will never know exactly what Vladimir Putin or al-Assad – or other leaders whose armed forces attack healthcare targets, like Min Aung Hlaing of Myanmar or Mohammed bin Salman of Saudi Arabia – are thinking, to me it’s clear that sowing fear is the point. Attacking healthcare is a way of shattering the resilience of the community. It is a devastating but grimly effective strategy.

With the ICC unavailable in Syria, a few universal jurisdiction trials in Europe are helping to provide a small measure of justice for some victims and survivors of the Syrian government’s atrocities. But to date, no one has ever faced accountability for bombing a hospital or torturing a medic.

Ukraine now offers an opportunity for the ICC to investigate the same types of brutal tactics that Russia honed in Syria.

I hope my Ukrainian medical colleagues never have to experience what is the most disturbing part of my experience in Syria: Despite volumes of comprehensively documented evidence and years of courageous activism by Syrians, impunity pervades.

So let the international community hear this loud and clear: We cannot fail the besieged health workers and patients in Ukraine the way that Syrians were failed by the global community.

Standing up for justice means robustly supporting the ICC’s work and pushing for accountability in domestic jurisdictions as well. It means working more vigorously to implement UN Security Council Resolution 2286, which was meant to ensure better protection for medical and humanitarian personnel in armed conflict. It means continuing to isolate Russia politically and financially. And it means upholding the legal right to seek asylum and welcoming those fleeing the ravages of war, no matter the colour of their skin.

Whether a hospital is bombed in Mariupol or Aleppo, in Sana’a or in Kunduz, those responsible must be held to account.

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