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126 attacks on healthcare facilities in 5 years: AOAV analyses ‘new normal’ in warfare

With 51 health facilities damaged or destroyed in the Syrian region of Idlib in the last five months, AOAV examines the impact of explosive weapons on healthcare there and further afield.

The recent destruction of  51 health facilities damaged or destroyed in Syria is an increasingly common occurrence of explosive weapons in modern day conflict. Increasingly, hospitals and other medical infrastructure have become the target of brutal air and ground campaigns.

Over the last five years, October 2014 to September 2019, AOAV has recorded 2,128 civilian casualties from the use of explosive weapons in 126 attacks on hospitals. 17 countries were impacted by such attacks.

Further casualties have been recorded in attacks that hit both hospitals and other surrounding infrastructure such as homes or markets. Health personnel have also been killed or injured in further attacks, both targeted and untargeted, outside of medical facilities.

So problematic is this reality that, in June 2019, those in Syria’s Idlib region stopped sharing coordinates of health facilities to the UN in an effort to prevent targeting, as the health facilities whose coordinates had been shared with the UN came under consistent attack. The system of sharing coordinates of health infrastructure was designed in order to protect such buildings and those that use them. In most cases the targeting of hospitals is a breach of International Humanitarian Law.

Similarly, in the Sri Lanka civil war, a conflict that lasted from July 1983 through to May 2009, hospitals in rebel areas also stopped providing coordinates after being targeted. Nevertheless, by the last few months of the conflict it was reported that shelling between the government forces and the Tamil Tigers had destroyed the last functioning hospital in the North.

Indeed, recent years, it has been said that the targeting of hospitals has become ‘the new normal’. The impact is devastating, both physically and psychologically, preventing access to care for thousands. When the MSF hospital in Saada, Yemen, was hit in an airstrike in October 2015, it was reported that up to 200,000 people lost access to medical care.

In total, since beginning the monitor in October 2010, AOAV has recorded at least 3,397 civilian casualties from the use of explosive weapons on healthcare facilities, in 215 attacks. Such attacks were recorded in 23 countries from Afghanistan, to Ukraine, to Peru.

In Syria, AOAV has recorded 1,373 civilian casualties in health facilities from 88 attacks using explosive weapons since the conflict began. While this is far too many, AOAV’s data only refers to English-language media reports of explosive violence where at least one casualty was recorded – it is likely the impact of explosive weapons on healthcare facilities is far greater than these figures suggest. AOAV’s report on the reverberating harm from the use of explosive weapons in Syria, released early this year, highlighted that 60% of healthcare facilities in Syria have been damaged or destroyed. The consequences of such destruction will be pervasive and long-lasting.

In Sri Lanka, nine years after the civil war came to an end, many lacked suitable treatment, including operations to remove shrapnel, access to prosthetics and adequate mental health services.

It is clear that all too often health infrastructure is coming under attack, shattering the lives of local populations; those who are often already struggling through the consequences of conflict. Civilians are overwhelmingly impacted by such attacks, which can exacerbate already precarious humanitarian conditions and prevent recovery.

AOAV condemns the use of violence against civilians and the use of explosive weapons in populated areas. AOAV encourages all armed actors to stop using explosive weapons with wide-area affects where there is likely to be a high concentration of civilians.