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An Unprecedented Chance to Confront Russian Attacks on Hospitals in Syria

Rubble outside of a destroyed building
A photo taken on May 5, 2019 shows destruction at the entrance of a hospital in the village of Kafr Nabl, south of the jihadist-held Syrian province of Idlib. Two hospitals in the Syrian province of Idlib were put out of service by Russian air strikes according to the Syrian Observatory for Human Rights. © Omar Haj Kadour/AFP/Getty

In the afternoon of May 5, 2019, a missile slammed into Kafr Nabl Surgical Hospital in northwest Syria. Over the next 18 minutes, 3 more airstrikes would rain down on the facility, while doctors, patients and visitors cowered in fear inside. Due to previous repeated attacks, the hospital had moved underground to continue serving the community and to protect patients and staff, but Russian aircraft repeatedly targeted its entrance. One man was killed immediately, and his brother died from his injuries a few months later. Their deaths might otherwise have been just another statistic to add to the death toll of more than half a million in Syria’s grueling 13-year long conflict. But this time, some accountability may be at hand. 

Thanks to a rare multitude of evidence including recordings of radio communications between a Russian pilot and ground control, flight observations by civilian plane spotters, open-source material, footage, photos, and testimony from eyewitnesses, as well as expert evidence, the attack has been conclusively traced back to the Russian Air Force. Since 2015, Russian President Vladimir Putin has sent fighter jets to bombard opposition-held areas to prop up the regime of Syrian leader Bashar al-Assad. Moscow has been accused of committing countless atrocities in the country but on May 1st, the Open Society Justice Initiative filed a complaint at the UN Human Rights Committee in Geneva which could result in the first instance of accountability for Russian violations committed in Syria.


Kafr Nabl hospital was one of at least three other hospitals in the area that were also attacked that day, despite being nowhere near active fighting, and it was also on a deconfliction, or a “do not strike,” list that Russia received from the UN. Since the New York Times reported on the May 5 attack, it has been bombed again. The protection of hospitals during armed conflicts is a core tenet of international humanitarian law but their targeting is increasingly employed as a deliberate strategy of war from Gaza to Sudan to Ukraine. Physicians for Human Rights has documented more than 600 attacks on Syrian health facilities since 2011.

The case presented to the committee relies on evidence painstakingly compiled by a coalition of groups, including; Syrian Archive, Physicians for Human Rights, the White Helmets, and Hand in Hand For Aid and Development, the humanitarian organization which was supporting Kafr Nabl Hospital at the time, as well as leading international legal experts. Increasingly, open-source information, from satellite imagery to social media posts, together with metadata from digital files, can evidence violations committed in armed conflict. So far, this type of information has not been extensively relied on in courts and tribunals to prove violations: this case could pave the way for their increasing use in future cases.

The impunity that Russia enjoys for its violations in Syria has encouraged it to continue its deliberate strategy of attacking health care in Ukraine, with the World Health Organization (WHO) documenting over 1,500 attacks on medical facilities since the full-scale invasion in February 2022. It is a troubling trend observed in other conflicts around the world. A year of fighting between government and paramilitary forces in Sudan has killed dozens of medical professionals and seen the destruction of healthcare infrastructure across the country. Meanwhile hospitals across Gaza have been besieged and subject to relentless assaults.

There is a clear and present risk that without accountability, intentional and indiscriminate attacks on health care are becoming normalized. That’s why this submission to the committee could be momentous. If it finds that Russia has violated its human rights obligations, the committee could order Russia to conduct an investigation and compensate the victims. Of wider importance would be the acknowledgement of the violations committed and the identification of the culprit as a matter of historical record. A decision finding that Russia attacked Kafr Nabl hospital that day can uphold fundamental principles of international humanitarian law so that future belligerents may think twice before attacking health care.

Russia may still deny culpability or fail to comply with a ruling against it. But this submission is vital not only for the relative of the victims, whom’ we represent, but for the staff and patients whose lives Russia endangered at Kafr Nabl hospital that day, and for all civilians and health care workers who have died or been injured in Russia’s unrelenting attacks on hospitals in Syria. A positive judgment by one of the world’s preeminent human rights bodies can set an important precedent. The world cannot allow such a brutal breach of international standards to be normalized, and perpetrators of atrocities will be held to account. 

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