Over the past month, Syria and Russia have bombed 25 medical facilities in northwest Syria. We are appalled by the deliberate and systematic targeting of healthcare facilities and medical staff, which is a flagrant violation of international humanitarian law. Throughout the Syrian conflict, we have seen both Russia and the Syrian government attack hospitals prior to and during major offensives, their collective aims seeming to be the terrorising of civilians and reducing the ability of medics to treat sick and injured people.

Our letter couldn’t come at a more desperate time. Since 26 April, at least 270 civilians have been killed due to Syrian government and Russian attacks while a further 300,000 people were displaced. The continued escalation of airstrikes and other hostilities means civilians require medical assistance more than ever. But the repeated targeting of medical facilities by the Syrian government and Russia has forced the hospitals that remain to operate under a state of emergency, only treating the most urgent cases and unable to take in patients for routine care. These hospitals serve the 3.5 million residents of northwest Syria.

As doctors and medical workers and public health professionals from around the world, we condemn the Syrian and Russian governments in the strongest possible terms for their attacks on medical facilities. We stand in solidarity with our Syrian colleagues on the ground who are risking their lives to help those in need. We demand immediate measures to protect their lives and their work.

What is happening in Syria is unimaginable. We have watched in horror the footage of repeated airstrikes on hospitals and listened in shock to our colleagues on the ground who described patients fleeing bombed hospitals with IV drips still attached and choking on dust raised by the explosions. Rather than being a place of healing and refuge, hospitals are now some of the most dangerous places for civilians to be.

Many of the health facilities targeted by the Syrian government and Russia were based underground in secret locations to shield them from attack. As part of a United Nations deconfliction process, however, medical organisations shared their coordinates with the UN, which in turn shared them with Moscow and Damascus in a bid to shield them from attack. The decision to share coordinates was made after painstaking deliberations by medical staff and was ultimately adopted out of hope that it would protect their work and their facilities. The UN must immediately investigate the targeting of listed hospitals.

All armed parties in the Syrian conflict must respect medical neutrality and allow doctors, nurses and paramedics to treat their patients without violence, threatened or actual. International governments must reverse their decision to cut funding to medical facilities in northwest Syria and put pressure on Russia and its Syrian ally to stop targeting hospitals.

Healthcare in Syria has been under consistent attack since the 2011 uprising with medical workers forcibly disappeared and tortured and hospitals routinely bombed, killing dozens of doctors and nurses and patients. Between 2011 and December 2018, Physicians for Human Rights (PHR) has documented 566 attacks on medical facilities, 90% of them by Syrian and Russian government forces. Attacks have involved banned weapons including barrel bombs and chemical agents. In addition, PHR has gathered information on the killing of 890 medical personnel, primarily by the Syrian government and is allies. We cannot stand by and watch these same crimes continue to be committed against medical staff and facilities in the northwest. Their job is to save lives — they must not lose their own in the process.

Signed,

  1. Dr Aula Abbara, Doctor, United Kingdom
  2. Dr Nada Abdelmagid, Assistant Professor in Humanitarian Health Practice, London School of Hygiene and Tropical Medicine, United Kingdom
  3. Professor Peter Agre, M.D., Bloomberg Distinguished Professor and Director, 2003 Co-Recipient Nobel Prize in Chemistry, United States
  4. Ms Mahenur Ahmed, Sonographer, Barts health trust NHS, United Kingdom
  5. Dr Saleyha Ahsan, Emergency Medicine Doctor and Broadcaster, The Phoenix Foundation, United Kingdom
  6. Dr Ibrahim AlMasri, M.D. MSC student, Canada
  7. Dr Khuloud Alsaba, PhD student, Global Health Policy Unit, University of Edinburgh, United Kingdom
  8. Dr Deborah D. Ascheim, M.D., Physicians for Human Rights, United States
  9. Dr Melisa Martinez-Alvarez, Senior Scientist, MRC The Gambia, London School of Hygiene & Tropical Medicine, Senegal
  10. Dr Claire Bayntun, Director of Global Leadership Programmes and Clinical Consultant in Global Public Health, London School of Hygiene and Tropical Medicine / Public Health England, United Kingdom
  11. Dr Yamama Bdaiwi, Doctor, University of Oxford, United Kingdom
  12. Dr Chris Beyrer MD, MPH, Desmond M. Tutu Professor, Center for Public Health and Human Rights, Johns Hopkins University, United States
  13. Dr Hannah Blencowe, Assistant Professor, London School of Hygiene and Tropical Medicine, United Kingdom
  14. Sabah Boufkhed, Postdoctoral researcher, King’s College London, United Kingdom
  15. Professor David D Celentano, Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
  16. Sir Iain Chalmers, Health services researcher, James Lind Library, United Kingdom
  17. Professor Yaolong CHEN, Methodologist, Chevidence, China
  18. Professor Simon Cousens, Professor of Epidemiology and Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom
  19. Michelle Dennis, Nurse, United Kingdom
  20. Robert Dennis, Nurse, United Kingdom
  21. Dr Delan Devakumar, Associate Professor University College London, United Kingdom
  22. Dr Yazan Douedari, Dentist, United Kingdom
  23. Dr Maria Drakou, GP, United Kingdom
  24. Sir Terence English, Retired Cardiac Surgeon, United Kingdom
  25. Dr Abdulkarim Ekzayez, Research Assistant, King’s College London, United Kingdom
  26. Mr Nasser Fardousi, MPH, researcher, London School of Hygiene and Tropical Medicine, United Kingdom
  27. Dr Conrad Fischer, Professor of Medicine, Touro College of Medicine, United States
  28. Dr Severine Frison, Assistant Professor in Humanitarian Nutrition, London School of Hygiene and Tropical Medicine, United Kingdom
  29. Professor Heiner Grosskurth, Primary Health Care Specialist, Epidemiologist, London School of Hygiene and Tropical Medicine, United Kingdom
  30. Ms. Heidi Guttschuss, Public Health Professional, World Relief, United States
  31. Dr Amy Hagopian, Public Health Professor, University of Washington, United States
  32. Dr Jessica Hanlon, GP trainee, NHS, United Kingdom
  33. Dr Monika Hauser, Founder and Board Chair, medica mondiale e.v., Germany
  34. Dr Natasha Howard, Assistant Professor, London School of Hygiene & Tropical Medicine, United Kingdom
  35. Dr Vincent Iacopino, Physician, Physicians for Human Rights, United States
  36. Dr Samer Jabbour, Professor at the American University of Beirut, Lebanon
  37. Dr Blanchet Karl, Associate Professor, London School of Hygiene and Tropical Medicine, United Kingdom
  38. Dr Mohamad Katoub, Dentist and Advocacy Manager at SAMS, Syria
  39. Dr Kerem Kinik, Medical Doctor, Turk KIZILAY (Red Crescent), Turkey
  40. Dr Lisa Kiser, DNP, CNM, WHNP, Tucson, Arizona, United States
  41. Professor Emeritus Robert S. Lawrence, MD, MACP, Public Health, Johns Hopkins Bloomberg School of Public Health, United States
  42. Dr Jennifer Leaning, Professor, Harvard Chan School of Public Health, United States
  43. Dr Paul Lips, emeritus professor of Endocrinology, Amsterdam, the Netherlands
  44. Dr Rebecca Macfarlane, Speciality Doctor in Sexual and Reproductive Health, Sandyford Clinic, Glasgow
  45. Dr Duncan MacIntyre, retired physician and member of Medact, Scotland
  46. Amelia Reese Masterson, Research Consultant, CARE International in Lebanon, United States
  47. Dr Ona McCarthy, Associate Professor, London School of Hygiene and Tropical Medicine, United Kingdom
  48. Ms Maria McGrath, Registered Nurse, CARNA, Alberta Health Services, Canada
  49. Mrs. Gillian McKay, Doctoral Candidate — Public Health, London School of Hygiene and Tropical Medicine, United Kingdom
  50. Dr Sanaa Merimi, Physician and co-founder of Maison de Santé Albalsam, Morocco
  51. Dr Denis Mukwege, Medical Director, 2018 Co-Recipient of Nobel Peace Prize, Panzi Hospital, DR Congo
  52. Dr Lina Murad, Interventional Nephrology, United States
  53. Dr Elisabeth Murray, retired consultant oncologist, United Kingdom
  54. Dr Sanjay Nagral, Surgeon, Forum for Medical Ethics, India
  55. Professor David Nott, Professor of Conflict Surgery, Imperial College, London, United Kingdom
  56. Joanna Nowak, Physiotherapist, Poland
  57. Dr Maryam Omar, Medical Doctor, United Kingdom
  58. Dr Miriam Orcutt, Senior Research Fellow, Migration and Health, Institute for Global Health, University College London, United Kingdom
  59. Lord David Owen, Physician and Politician, United Kingdom
  60. Shefali Oza, Epidemiologist, London School of Hygiene and Tropical Medicine, United Kingdom
  61. Dr David Peters, Professor, Johns Hopkins University School of Public Health, United States
  62. Professor Mark S. Pian, MD, Professor Emeritus, University of California, San Diego School of Medicine, United States
  63. Diana Rayes, Health Systems Research Fellow, American University of Beirut, Lebanon
  64. Professor Bayard Roberts, Professor of Health Systems and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
  65. Professor Leonard Rubenstein, Professor of public health law, Johns Hopkins Bloomberg School of Public Health, United States
  66. Professor Tilman A Ruff, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Co-President, International Physicians for the Prevention of Nuclear War (Nobel Peace Prize 1985), Co-Founder, International Campaign to Abolish Nuclear Weapons (ICAN, Nobel Peace Prize 2017)
  67. Dr Neal Russell, United Kingdom
  68. Dr Zaher Sahloul, Critical Care Specialist and President of MedGlobal, United States
  69. Mrs Chelsea Scott Hafez, Sonographer, NHS, United Kingdom
  70. Dr Maureen Seguin, Research Fellow, London School of Hygiene and Tropical Medicine, United Kingdom
  71. Professor of the Practice Joshua Sharfstein, Physician, Johns Hopkins Bloomberg School of Public Health, United States
  72. Dr Neha Singh, Deputy Director of the Health in Humanitarian Centre and Assistant Professor, London School of Hygiene and Tropical Medicine, United Kingdom
  73. Dr James Smith, Doctor & Honorary Research Fellow, London School of Hygiene & Tropical Medicine, United Kingdom
  74. Professor Paul B Spiegel, Professor of Humanitarian Health, Johns Hopkins Center for Humanitarian Health/Johns Hopkins Bloomberg School of Public Health, United States
  75. Dr Kerry Sulkowicz, Clinical Professor of Psychiatry, Physicians for Human Rights
  76. Baraa Tahani, Student Nurse, Morocco
  77. Dr Thelma Thomas, GP, United Kingdom
  78. Dr Nazneed Uddin, United States
  79. Dr Annie Umbricht, Physician researcher, Johns Hopkins University School of Medicine, United States
  80. Emily van der Kamp, occupational therapist, Victoria, BC, Canada
  81. Josée van Oers, nurse & social worker, Rotterdam, The Netherlands
  82. Dr Michael VanRooyen, Emergency Physician, The Harvard Humanitarian Initiative, United States
  83. Dr Vasiliy Vlassov, Physician, Society of Evidence Based Medicine, Russia
  84. Professor Ron Waldman, Epidemiologist, Doctors of the World, United States
  85. Dr Sarah Wollaston, Chair of Health and Social Care Committee, UK Parliament, United Kingdom
  86. Dr Matthew Wynia, Professor of Medicine, Director, Center for Bioethics and Humanities, University of Colorado, United States
  87. Dr Eiad Zinah, Dentist, Elmfield House, United Kingdom

The Syria CampaignF

A version of this letter appeared in print in The Guardian on 2 June, 2019.