Syria escalation: Deadly attacks continue, healthcare and access compromised

Renewed fighting last week led by the terrorist group Hay’at Tahrir al-Sham (HTS) and other armed factions has engulfed parts of Aleppo, Idlib and Hama, destabilising frontlines that had remained unchanged since 2020.

UN human rights office (OHCHR) spokesperson Jeremy Laurence told reporters in Geneva of “a number of extremely concerning incidents resulting in multiple civilian casualties, including a high number of women and children, stemming from attacks by both HTS and by pro-Government forces”.

“The hostilities are resulting in destruction and damage to civilian objects, including health facilities, buildings hosting institutions dedicated to education, and food markets,” he added.

University dorms hit

OHCHR has already begun the process of verifying deadly attacks impacting civilians including the deaths of four civilian men on 29 November, “reportedly as a result of multiple ground-based strikes by HTS” hitting an area hosting Aleppo university’s student dorms, the OHCHR spokesperson said.

“According to information gathered by our Office, all victims were students of the university and, following that, many other students fled the university complex,” he added.

Aid access remains ‘fluid’

Jens Laerke, spokesperson for the UN Office for the Coordination of Humanitarian Affairs (OCHA), stressed that the situation in the area is “fluid and constantly changing”. While OCHA runs “very solid” coordination mechanisms within Syria and across the border with the humanitarian hub in Gaziantep, Türkiye, it has been forced to put its operation on hold “because of the insecurity,” as active fighting is ongoing and many roads are closed.

However, “it's not the entire area that is locked down,” he said. “There are still places where we can respond, for example, in the reception centres in Idlib” for people uprooted by the violence.

According to OCHA, some 16.7 million Syrians were already in need of humanitarian assistance at the start of 2024.

Airstrike victims

OHCHR spokesperson Mr. Laurence also highlighted an incident on 1 December in which 22 civilians were killed, including three women and seven children, and at least 40 others were injured, “reportedly as a result of multiple airstrikes by pro-Government forces in Idlib” which hit a local market and five residential areas in the city.

“We remind all parties of their obligations and responsibilities under international human rights law and humanitarian law: civilians and civilian infrastructure must be protected,” he stressed.

Echoing this call, the UN Commission of Inquiry on Syria warned in a statement on Tuesday that “the brutality of past years must not be repeated, or Syria will be driven onto a new trajectory of atrocities”.

Healthcare overwhelmed

Turning to the dire health situation in the northwestern regions, the UN World Health Organization (WHO) Representative in Syria, Christina Bethke, said that referral hospitals, to which scores of patients are being evacuated from Aleppo by “brave first responders” such as the Syrian Arab Red Crescent, are “overwhelmed” with trauma cases.

“Thousands of injuries have already been admitted in the last four days alone,” she said, while doctors and nurses “are working around the clock to save lives, even at great personal risk to themselves and their families, choosing to stay instead of to flee”.

Speaking from Damascus, Ms. Bethke highlighted that “insecurity and restrictions on movement have forced around 65 non-governmental organizations that were previously operational in Aleppo and Idlib to suspend their activities”, leaving health facilities overwhelmed or out of service.

“That includes one of Idlib’s largest hospitals, Bab al-Hawa, and Al Razi Hospital in Aleppo, both now reduced to serving emergency cases only and “leaving countless patients in limbo”.

Aleppo hospitals mostly shut

In Aleppo City, home to over two million people, more than 100 health facilities were functioning just a week ago. “Today, fewer than eight hospitals continue to operate at minimal capacity,” Ms. Bethke said.

She added that Monday’s airstrikes in Idlib caused significant damage to healthcare facilities including the University Hospital, the Maternity Hospital and the local health administration.

Since 27 November, WHO has received reports of at least six attacks on health care in Syria. Ms. Bethke reiterated that medical facilities are protected under international humanitarian law.

Conflict’s dire legacy

Syria’s health system has been battered by almost 14 years of armed conflict and the WHO official said that public health concerns are “escalating” amid the crisis, including an increased risk of waterborne diseases and respiratory illness in overcrowded shelter settings. Aleppo and Idlib were at the centre of the 2022-2023 outbreak of cholera in Syria and the 2023 earthquake further damaged already-fragile water and sewer networks, she stressed.

Many families in Syria have experienced repeated displacement, including the estimated half a million people who entered the country from Lebanon over the past two months, fleeing the deadly conflict there.

Some of them are on the move once again due to the rise in fighting in the northwest and their situation is growing desperate with the onset of winter. At the start of 2024, 7.2 million people were internally displaced in Syria, almost half of them in the northwest, where the current armed escalation presents challenges to the delivery of life-saving aid.