On March 21, 2021, three artillery strikes hit al-Atareb hospital in the western countryside of Aleppo governorate. The missiles directly hit the hospital’s entrance and destroyed the orthopedic clinic that was in operation during the attack. Seven patients were killed, and 15 people were injured, including five medical staff. As a result of the attack, the hospital suspended all services for two weeks.
This latest attack on a health facility is part of an extensive record of violence against health care during the Syrian conflict. Since the conflict began in March 2011, parties to the fighting have carried out indiscriminate attacks on or direct targeting of health care facilities across the country. Physicians for Human Rights (PHR) has documented attacks on medical facilities and personnel in Syria throughout the 10-year conflict and has verified 600 attacks on medical facilities. Syrian government forces and their allies have perpetrated 90 percent of the attacks, with 541 attacks attributable to the Syrian army and/or Russian forces. These attacks have effectively transformed medical facilities into deadly spaces, both for health care workers and their patients, and decimated the health sector throughout the country. This is the first in a series of brief case studies that describe in detail attacks on health care facilities and the health impacts on the communities they serve. As discussed in the legal framework section below, the attacks appear to violate multiple international laws, including international humanitarian law, international criminal law, and the right to health.
This case study, a collaboration between PHR and the Syrian American Medical Society (SAMS), relies on a number of data sources, including desk research, internal documents of the organizations operating al-Atareb hospital, and interviews with five health care workers present during the March 2021 attack. Significantly, among the interviewees, three are also residents of al-Atareb town, including an orthopedic surgeon who lost the use of one eye in the attack, and two technicians. All interviews were conducted remotely by a bilingual researcher using the WhatsApp platform between April 15 and May 18, 2021, and informed consent was obtained.
Al-Atareb Surgical Hospital Location and Background
The town of al-Atareb is an important commercial center located on the main road that connects the Aleppo governorate with Idlib and the western countryside of Aleppo. It is strategically located 15 miles (25 kilometers) west of Aleppo city, the second largest city in Syria, and 15 miles (25 kilometers) southeast of the Turkish border.
The original “old” al-Atareb hospital was established in late 2012 by two Syrian NGOs (Hand in Hand for Aid and Orient Humanitarian). The facility included two operating rooms and eight outpatient clinics, including for reproductive health; pediatrics; ophthalmology; orthopedics; neurology; urology; ear, nose, and throat; and internal medicine. The caseload in 2013 was 6,000 patients a month.
By March 2021, the al-Atareb health care system, now supported by SAMS, was comprised of two separate facilities and a vaccination clinic, and served a regional population of 182,358 people, 40.4 percent of whom are internally displaced persons (IDPs). By early 2021, the population al-Atareb city was 22,220, nearly double the pre-conflict census. Almost 50 percent (11,208) of the town’s population is internally displaced. Because al-Atareb is close to the line of fighting, it is affordable for those internally displaced people with few resources.
As the conflict progressed, the al-Atareb hospital system became increasingly important for the region. This was particularly the case in 2016, after the Syrian government’s offensive in Aleppo city, which deliberately targeted health facilities and displaced the population. Unable to access health care services in Aleppo city, people in the surrounding villages sought health services in al-Atareb. Service provision in al-Atareb expanded enough that people have traveled from northern Hama governorate, a distance of approximately 60 miles (100 kilometers), to al-Atareb to seek medical care.