The Path Forward is a CSIS Humanitarian Agenda series of reflections from humanitarian organizations on the challenges in food security, disrupted health systems, humanitarian access, civilian protection, and, ultimately, recovery for the Syrian people.
I was on a shift when it was subjected to four airstrikes. The building was razed to the ground. We all got out from underneath the rubble to find that there were a lot of injuries . . . Honestly, at the time of the attack, it was a catastrophe. There was no time for us to be able to do anything. We all were underneath the rubble.
- Dr. Abu Sam, general surgeon at SAMS
Indiscriminate violence against civilians has defined the past decade of conflict in Syria. Schools, water pumping stations, and health facilities have routinely been attacked in violation of international humanitarian law (IHL). Over one-third of schools have been damaged or destroyed, and half of sewage systems are not functional. Attacks on health facilities are among the most egregious violations of IHL; the Syrian American Medical Society (SAMS) has recorded 157 attacks on health facilities since 2017, while the International Rescue Committee (IRC) and its partners endured two dozen attacks between September 2018 and 2020 alone. This systematic targeting of health infrastructure has knocked roughly half of Syria’s health facilities offline.
These attacks are not unintended side effects of conflict but part of a scorched-earth strategy that has displaced 11 million and killed an untold number of Syrians—the United Nations even stopped updating the number of civilian deaths after 2013 due to limited information. The United Nation’s attempts to deconflict health and humanitarian sites from military targets by sharing their coordinates with parties to the conflict have instead put a target on aid workers, making Syria the most dangerous country for aid workers in 2019.
While all parties have committed abuses, the bulk of these IHL violations have been committed by the allied Syrian, Russian, and Iranian forces, according to the findings of various UN investigations. For instance, the UN High Commission for Human Rights pointed out that 93 percent of civilian deaths in northwest Syria in January and February 2020 were caused by the Syrian government and its foreign allies. This month, the Independent International Commission of Inquiry on Syria released its latest report on the crisis and noted, “from the outset of the armed conflict, government forces have indiscriminately bombarded civilian populated areas and deliberately targeted protected objects, in particular hospitals and medical facilities.”
Parties to the Syrian conflict have used the deprivation of civilians—whether by direct attacks, the decimation of infrastructure, siege, or reduced humanitarian access—as part of a deliberate strategy to wear down populations and force an eventual surrender and mass displacement. In East Ghouta, a Damascus suburb, 400,000 civilians were trapped under siege for five years, from 2013 to 2018, leading to catastrophic shortages of food and medical supplies. The UN Commission of Inquiry identified it as the longest running siege in modern history and attributed it to pro-government forces. All the while, aerial and artillery attacks continued, including the use of chemical weapons. Eastern Aleppo similarly experienced periods of siege between 2012 and 2016 in addition to being subject to continued attacks. By December 2016, the World Health Organization reported that every hospital in eastern Aleppo had been hit at least once.
While the brutality against civilians once shocked the international community, this strategy has continued even as global attention has waned. Idlib, in the northwest, once a relative safe haven for Syrians displaced from other parts of Syria, is now in the crosshairs. The northwest saw the largest displacement in the war—1 million Syrians were displaced in just three months between 2019 and 2020. Today, only a fragile and temporary ceasefire stands between 4 million Syrians in the northwest and a new military offensive. As seen elsewhere in Syria, civilian infrastructure has been systematically destroyed. In a recent survey that the IRC and its Syrian partner organizations carried out in the northwest, 78 percent of health workers reported witnessing at least one attack on a health facility—and some witnessed up to 20. Repeated attacks have taken a serious toll on Syrians’ mental health. Among the health workers surveyed, 74 percent indicated harm to their well-being, while half of patients reported being afraid to access healthcare.
The international community has failed to meaningfully address this unrelenting harm to civilians. The scale of destruction means that humanitarian response efforts are a critical lifeline for Syrians, particularly cross-border operations that have facilitated aid in the most effective and sustained manner for civilians in the northwest and parts of the northeast since their authorization in 2014. Yet in 2020, the UN Security Council reauthorized only one of the original four border crossings. The authorization for the last crossing in the northwest is set to expire in July. The UN Security Council should reauthorize cross-border operations to ensure lifesaving aid reaches those most in need regardless of their location.
While the UN Security Council reinforced the specific protections of health in conflict by passing Resolution 2286 in 2016, accountability for attacks in Syria has been in short supply. With the Security Council deadlocked on Syria, other bodies have tried to fill the void, such as the UN Human Rights Council’s Commission of Inquiry and the UN General Assembly’s International Impartial and Independent Mechanism. But these mechanisms are unable to hold those responsible to account without the political will of the Security Council.
Last year, the UN secretary-general established an internal UN Board of Inquiry into attacks on health in northwest Syria, but it was tasked with looking into only seven attacks and neglected to decisively attribute responsibility. While follow-up is necessary, the secretary-general’s recent short-term appointment of an Independent Senior Advisory Panel on Humanitarian Deconfliction is doomed to fail unless existing resolutions and mechanisms are enforced to address these attacks. UN Security Council members should include the protection of health workers and health facilities in UN resolutions and official discussions and enforce existing resolutions such as 2286. The UN secretary-general should also expand the mandate of the initial Board of Inquiry to investigate and attribute responsibility for all attacks on civilian and humanitarian infrastructure.
A decade’s worth of flouting international humanitarian law in Syria has already cost hundreds of thousands of lives and displaced millions. Without meaningful accountability, civilians in Syria will continue to come under deliberate attack, and the country will be left with simmering injustice and limited prospects for sustainable peace. If impunity prevails, the conflict’s effects will not be contained to Syria—it will set a dangerous precedent for the conduct of conflicts around the globe. Syrians cannot wait another decade for accountability, and civilians in other conflicts around the world cannot be subjected to the same fate.
Rehana Zawar Ali is the country director for northwest Syria at the International Rescue Committee (IRC). Mazen Kewara is the Turkey country director at the Syrian American Medical Society (SAMS).
Commentary is produced by the Center for Strategic and International Studies (CSIS), a private, tax exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).
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