February 25 was a "horrific day of indiscriminate attacks in Idlib,” according to international NGO Médecins Sans Frontières (MSF). At least five schools were hit by airstrikes on the same day, flooding MSF-supported hospitals with hundreds of injured civilians. Many of those schools were being used as temporary shelters for civilians displaced by the ongoing “scorched earth” campaign by Bashar al-Assad’s forces, backed with Russian airpower, to regain control over the rebel-held northwest.

But targeting hospitals has become routine in the northwest. On February 17, Russian jets bombarded the Al-Fardous Maternity and Child Care Hospital in Daret Ezzeh, west of Aleppo, damaging its maternity ward. There were no casualties. The hospital had decided the day before the attack to minimise operations due to the imminent threat of airstrikes and shelling around them.

Some 50 metres down the road, Al-Kinanah Emergency Hospital was then hit, resulting in damages to its operations room. The earlier strike on the Al-Fardous ward had given staff at Al-Kinanah Hospital some advance warning, so everyone ran quickly downstairs to hide in the basement. Again, there were no casualties.

Obaida Dandoush, response officer with the Syria Response and Development (SRD) NGO that supports the hospital, told SyriaUntold: “Heaven forbid, had the first strike been aimed at Al-Kinanah, it could’ve caused a massacre inside the hospital.”

The two hospitals served a population of about 300,000 local residents and displaced civilians with maternity, paediatrics, dialysis services and surgeries—all free of charge.

Now that the two hospitals are out of service, even a simple injury can prove fatal. For many of the former patients at the two clinics, the nearest hospital is now a three-hour drive away—at the Bab al-Hawa crossing along the Syrian-Turkish border. That journey used to take about half an hour, but now takes at least four times that because of the extreme road congestion caused by the largest displacements yet seen in the Syrian conflict. The movement of Turkish troops and tanks southwards, and Syrian civilian population northwards, leaves very little room for ambulances.

According to SRD’s Dandoush, both hospitals had chosen not to share their location coordinates with the UN—part of a deconfliction mechanism, meant to avoid attacks on hospitals, that has failed to protect even those hospitals that signed up to the initiative.

On January 29, Russian and regime bombardments targeted the Al-Shami Hospital in the Idlib town of Ariha. By then, the Al-Shami facility was the only medical centre with surgical facilities left in the town. And yet the hospital had shared its location coordinates. The bombing put the facility out of service and 12 people died—including its manager, Zakwan Tamma'.

The recent waves of displacement, with up to 950,000 people displaced since December, is the worst yet in the nine-year war that Assad has waged against a population demanding his ouster. The targeting of hospitals—described as a deliberate part of the “war strategy” of pro-Assad forces, by UN investigators—continues to deprive the desperate population of much-needed medical services.

And isn’t that the intention? Last month, a TV journalist with state-run channel Al-Ikhbariyeh entering the newly seized area of Hreitan in the Aleppo countryside, told viewers: "As always, we uncover entire medical facilities, for the ‘terrorists,’ full of medicine."

The official regime narrative has not only denied that pro-government forces target medical facilities, but also criminalised the medical facilities themselves for providing medical aid to those it regards as terrorists as well as the "terrorists' social incubator,” meaning the entire civilian population living in areas under opposition control.

'It makes very little difference'

Fully aware of these constant violations of international law by the Syrian regime and its Russian backers, in 2014 the UN Office for the Coordination of Humanitarian Affairs (UNOCHA) launched what it called its “Humanitarian Deconfliction Mechanism” with the aim of protecting medical facilities and aid missions. It defined deconfliction as: “The exchange of information and planning advisories by humanitarian actors with military actors in order to prevent or resolve conflicts,” with the aim of removing “obstacles to humanitarian action” and avoiding " potential hazards for humanitarian personnel.”

The idea was that by sharing their locations with all warring forces currently fighting on Syrian territory, or backing those that are—including the Russians, Turks and US-led coalition forces—the evidence of prior knowledge of a facility’s location could legally prove the premeditated nature of any attack against it, and possibly deter similar attacks in the future.

It did not.

By 2016, MSF issued a decision to stop sharing the locations of medical facilities that the NGO supported with the Syrian regime and its Russian allies, following repetitive, systematic attacks against those facilities. Nothing was mentioned about sharing those locations with the UN, which in its turn shares information with the Russians.

In an extensive investigation carried out by the New York Times last year, yet more evidence proved that the targeting of hospitals was a deliberate strategy by both Syrian and Russian forces. That investigation also highlighted how the UN had been dragging its feet about whether to investigate the matter further. A deeper look at the organisation of the mechanism uncovered the lack of sufficient UN scrutiny into the information provided, thereby helping the Russians excuse themselves by undermining the reliability of the data.

Dr. Hassan Rabea is the manager of the Surgical Specialist Hospital in Idlib city, one of the two largest health facilities in what is now the most populous city left in the rebel-held northwest.

In January, the hospital was forced to halt all non-emergency operations in an attempt to minimise casualties caused by deliberate targeting by airstrikes.

Dr. Rabea told SyriaUntold that hospital management had made the decision to share their location with the UN, after some internal and external consultations with other hospitals and the opposition-affiliated Idlib Health Directorate, which attempts to coordinate medical services across the northwest.

Without pointing any fingers, Dr. Rabea said, some other hospitals were reluctant to share information at first, but then gave in after coming under "pressure” to do so.

According to a lower-ranking employee in another hospital in the city, speaking to SyriaUntold before that conversation with Dr. Rabea, that pressure had come from donor organisations.

Even after the hospital was targeted by aerial bombardment in 2016, management did not change their decision, Dr. Rabea added.

“Hospitals are large public buildings, their location is no secret. We had a meeting with other facilities—some said they [Russians] have satellite imaging anyway; others pointed to the constant surveillance aircraft hovering above.”

“It makes very little difference to give [information] to them,” Dr. Rabea said.

According to the doctor, not only is it almost certain the Russians would know the location of a hospital anyway, but there are also doubts about whether the UN could prove liability for an attack or not.

Early warnings

As a permanent member of the UN Security Council, Russia continues to block all effective decisions with the ability to halt its attacks in Syria or even just properly investigate them. Confident of having successfully crippled international peacekeeping mechanisms and gotten away with ignoring international laws for almost a decade now, a UN mechanism to prove liability changes nothing in their military strategies.

Al-Fardous Hospital's Dandoush informed us that they had chosen not to share their locations.

“We were asked if we wanted to share, and we said no because there were no results. If there were, we would,” he told SyriaUntold. "Whether or not you share, the targeting [of hospitals] is taking place."

Locating a hospital is very easy—the same goes for any building for that matter. Google Earth, or even a conventional map, can determine a hospital's location precisely. Additionally, hospitals are buildings that see lots of movements visible from the skies. Surveillance aircraft, broadcasting images live back to the Russians, are always hovering around.

The actual hospital protection systems are those put in place by the hospitals themselves. As head of the security assessment office at SRD, Dandoush's job is to operate and improve their early warning systems.

According to Dandoush, an early warning system based on constant monitoring of the latest developments on the ground on an hourly basis, to be able to foresee and assess any potential attack that may target them. That includes following warning messages from opposition groups and the Syria Civil Defence—transmitted via walky-talky—WhatsApp and Facebook groups as well as a range of other sources.

Dandoush’s hospital have also introduced roster systems for staff as well as levels of operations—ranging from full to partial emergency, and partial to full evacuation of staff and equipment if the threat is deemed so serious that the whole facility may be destroyed.

The UN’s assumption that proof of liability represents a sufficient deterrent has been proven wrong by a permanent Security Council member so fond of using its veto powers in the council. The obvious ease of accessibility to information about hospital locations to individuals using modern-day technology, let alone armies and governments with very advanced military technologies, means the UN initiative only humours blatant deceptions following any denial by the Russian military. The fact that the Russians still manage to find some weaknesses in the details of the application process of the mechanism, to use them as an excuse for undermining the credibility of the entire mechanism, only goes to show how little that act of humouring achieves.

There have been attempts to at least name and shame the culprits in the past.

Last July, the Syrian Network for Human Rights (SNHR) monitoring group made a request to the UN to reveal medical facilities that had been targeted, and which were also listed in the UN’s Humanitarian Deconfliction Mechanism. The aim was to identify the perpetrators of those attacks.

The request was met with deaf ears by the UN that "did not publicly request any investigation by the Office of the High Commissioner for Human Rights and the International Commission of Inquiry into the bombings of facilities listed in the mechanism,” even when the “failure to publicly expose the perpetrators of the bombing of medical facilities and personnel has contributed significantly to the perpetrators’ confidence in repeating these crimes blatantly and with apparent impunity.”

In the eyes of many Syrians and aid workers, what it does serve to expose is another example of the bureaucratic bubble within which the global institution hides form facing up to its mandate and duty to protect civilians from military giants within the Security Council.

As the UK representative at the security council put it: “What is happening in Idlib makes a mockery of P5 responsibility,” referring to the five permanent Security Council members.