Guided artillery shells force the Al Atarib Surgical (Al Magahra) Hospital out of service

Incident Summary

• Place of Incident: Aleppo: Al Atarib
• Location Hit: Al Atarib Surgical (Al Magahra Hospital)
• Date: 21 March 2021
• Time: 08:41 - 08:45 AM
• Killed: 7 people, including 2 children
• Injured 17 people, including 5 hospital staff
• Type of Incident: Artillery shelling with three artillery missiles
• Munition Used: Krasnopol artillery shells
• Potentially Responsible: Syrian or Russian forces

Introduction

On Mother’s Day March 21, 2021, Mohammed Abdul Hamid Haji Ahmed took his mother in the morning to Al Atarib Surgical Hospital for treatment. That same morning, a number of patients were outside in the hospital yard—above the underground hospital-waiting to enter the orthopedic clinic near the facility’s main door. The hospital was hit by 3 artillery shells killing Mohammed and injuring his mother who was transferred to a hospital in Bab Al Hawa for treatment.

Mohammed was only 18 years old when he was killed. He had been married for about ten months and was awaiting his daughter’s birth. She was born five days after the attack. Mohammed follows his father who was also killed in a bombing of Al Atarib in 2014.

In addition to Mohammed, the targeting of the hospital killed six others including two children. More than 17 people, including 5 hospital staff members, were injured in the attack. The bombing also caused significant damage to the medical facility prompting the hospital directors to announce the facility as out of service for the time being.

Methodology

Syrian Archive conducted an investigation into the incident consisting of:

1. Statements from the hospital director, engineer Omar Hallaq, and a first responder from the Syrian Civil Defense.
2. The preservation, analysis, and verification of 37 videos and 84 pictures of the hospital taken, within 24 hours of the attack, by Syrian Archive’s investigations team.
3. The preservation, analysis, and verification of 54 videos and pictures uploaded online that allegedly document the incident and its victims. This includes a video clip showing the moment the hospital was targeted as well as a video taken by a drone, and published on a Russian Telegram channel, that is said to show the moment the hospital was targeted by artillery.
4. The analysis of satellite imagery showing the location after the incident as well as data showing any planes over the town at the alleged time of the incident.

The combined analysis of these sources has culminated in the present investigation report. Complementing each other, they provide information regarding the incident’s date and time, location, casualties, and extent of damage.

Examining all information available on the strike, the investigations team developed an understanding of the incident and potential perpetrators.

For more details on Syrian Archive’s methodology, please see our site.

About Al Atarib Surgical Hospital

A picture of the entrance to Al Atarib Surgical Hospital taken by the investigations team.

Al Atarib Surgical (Al Magahra) Hospital is located around two kilometers away from the city of Al Atarib in the western countryside of Aleppo. The hospital is the only medical facility in the area that provides services to the around 150,000 resident in Al Atarib in addition to the other seventeen villages nearby. As a result of the systematic targeting of hospitals in Idlib, Al Atarib Surgical Hospital was built underground in 2017 with the support of the Syrian American Medical Society (SAMS). The hospital has not been previously attacked.

According to Omar Hallaq, the director of the hospital, the medical facility houses several departments including ambulance and emergency, bandage and dressing, operations, laboratory, and radiology departments. The hospital also includes a staff accommodations wing. The hospital conducts general as well orthopedic, urologic, and ENT operations. The average number of hospital beneficiaries ranges from 5,000 - 6,000 patients a month.

According to a statement posted on Facebook by SAMS, Al Atarib Surgical Hospital is one of the largest hospitals in northwestern Syria providing a number of specialty services—as listed above—including obstetrics. The statement additionally confirms that the hospital is currently out of service as a result of an attack on March 21, 2021 with staff and patients evacuated from the facility.

What Happened (and When)?

A picture taken by the investigations team of Al Atarib Surgical Hospital’s yard after it was hit by artillery shells.

Between 08:41 - 08:45 AM on March 21, 2021, three artillery shells hit Al Atarib Surgical Hospital in the western countryside of Aleppo, according to interviews conducted by Syrian Archives’ investigations team, online sources, and hospital surveillance cameras.

The first artillery shell hit near the hospital’s emergency room entrance. Two shells followed hitting the orthopedic clinic and the waiting area in the hospital yard as well as the hospital roof near the obstetrician room and hospital staff accommodations. Syrian Archive collected conflicting reports regarding the exact number of shells that hit the hospital. However, collected videos and testimony indicate that three artillery shells most likely hit the medical facility.

The attack killed 7 people, including 2 children, and injured over 17 others. Those injured include five hospital staff members. Many of those injured were treated in nearby hospitals, while four victims with critical injuries were treated in Turkish hospitals. The strikes significantly damaged the hospital entrance and orthopedic clinic. It additionally damaged the hospital’s underground building, pushing the facility presently out of service.

In an interview with Syrian Archive’s investigations team, director of the hospital Omar Hallaq confirmed that 3 artillery shells targeted the hospital on the morning of March 21, 2021 at around 08:30. Hallaq stated that the attack coincided with patients’ visits to the hospital’s orthopedic clinic. He said the attacked killed 7 and wounded more than 17 people including the hospital’s orthopedic specialist, Nawar Kurdieh.

Hallaq estimated around 1 minute between shells hitting the hospital. He reported the first shell as hitting the hospital’s outer wall and waiting room. Hallaq additionally stated that the second hit the orthopedic clinic and the facility’s bandage and dressing department. Lastly, Hallaq detailed the third shell as hitting the hospital’s generators.

In an interview with Syrian Archive, a member of the Syrian Civil Defense, who was among the first to respond to the attack, reported that the hospital had been hit by four shells killing and injuring visitors and medical personnel. Alongside the timing and the date of the attack, the Civil Defense Member confirmed that patients and hospital staff were evacuated after the strikes.

Screenshots from a video posted by the Al Atarib Media Office showing the efforts to rescue the injured and evacuate civilians from the hospital moments directly after the attack.

Reports of an attack on Al Atarib Hospital began circulating on social media at 09:23 AM on March 21. The Al Atarib Media Office posts an alert, reporting the hospital as completely out of service.

Minutes later, user Ibrahim Al Darwish Mohammed tweeted about the attack, noting the hospital was forced out of service. Bilal Abu Al Leith, a staff member of the humanitarian relief organization IYD, also posted news of 7 dead and several injured in an attack on the hospital. The Al Atarib city Facebook page posted about the attack at 09:58. Later at 10:02, the same page posted a video showing first responders and Civil Defense members as well as initial reports of the numbers of those killed and injured in the attack. At 10:04, the Syrian government affiliated Latakia News Network posted on Facebook confirming an attack on the hospital. The network claims warplanes targeted the facility killing and injuring members of the Civil Defense.

The same day of the attack, the Al Atarib Media Office YouTube channel published a video showing the moments immediately following the attack including the efforts to rescue the wounded and the evacuation of civilians from the hospital.

On Facebook, the Al Atarib Media Office published footage from a surveillance camera showing the moment the hospital was hit. The timestamp shown on the surveillance camera footage shows the date of filming as on March 21, 2021 at 09:03 AM. This conflicts with initial reports and witness testimony confirming the time the facility was first targeted.

Pictures taken by the investigations team and from a surveillance camera of artillery shells’ impact sites around Al Atarib Surgical Hospital

Determining the exact timing of the strikes, Syrian Archive matched the landmarks shown in the CCTV footage with pictures of the hospital’s roof, targeted in the third strike. Syrian Archive additionally contacted SAMS’ media representative who confirmed what was shown in the CCTV footage as well as noted that the camera’s timestamp is off by around ten minutes. The representative additionally stated that the hospital’s surveillance cameras, except for the one which captured the footage of interest, were cut off after the first shell. The camera which captured the shelling of the hospital’s roof was cut off after the third artillery shell hit the hospital.

Twitter user Adrienne Shaw posted a schedule of planes above Al Atarib on March 21, noting Syrian government forces as shelling the hospital at 08:41. The schedule additionally shows the attack was preceded and followed by reconnaissance aircraft and warplanes flying over Al Atarib.

With online reports matching witness testimonies, Syrian Archive can confirm that the hospital was most likely hit between 08:41 - 08:45 AM on March 21, 2021.

In the days after the attack, the Al Atarib city Facebook page, Syria TV, Syrian Civil Defense, Orient News, Syrian Press Center, Violations and War Crimes in Syria Observatory, Macro Media Center (MMC), Zeitoun Media, Halab Today, journalist Jamil Al Hassan, journalist Omar Al Bam posted videos and pictures documenting the damage to Al Atarib Surgical Hospital as well as confirmed the date and time of the strikes and the number of deaths and injuries from the attack.

Munition Used

A video posted by the YouTube channel “iranwire arabic” shows the remnants of the munition used in the targeting of Al Atarib hospital. The video cites Syrian National Army general Major Youssef Al Hammoud in the analysis of the weapon type. The video reports that these remnants are rounds from a dual guidance weapons system that uses laser positioning and guidance.

A picture of the munition remnants shown in a video posted by the “iranwire arabic” YouTube channel

Syrian Archive’s investigations team analyzed and verified the video on YouTube linking it to a video taken by drone and published on the “REVERSE SIDE OF THE MEDAL” Telegram channel. The channel claims that the video shows the moment the hospital was targeted. Distinct landmarks shown in videos of the hospital match with what’s shown in the video clip from Telegram. Moreover, the timing between the shells mentioned by witnesses matches with the shelling shown in the drone footage.

video taken by drone shows the moment the hospital was targeted

Distinct landmarks shown in the video posted on the Telegram channel match the hospital structure shown in footage from a surveillance camera and in satellite imagery

Charles Lister, a senior fellow at MEI and director of its Syria Program, posted several tweets showing pictures of munition remnants from the targeting of Al Magahra Hospital in Al Atarib. Lister’s investigation into the type of weapon used in the attack concluded that the missile used was a “Krasnopol” laser-guided missile often used in tandem with a UAV drone. Pictures tweeted by Lister show electrical circuits collected from the hospital’s rubble. According to Lister and a team of munition and geospatial analysts, the wreckage from the attack can be directly linked to Krasnopol missiles as the remnants belong to that specific type of laser-guided artillery shell.

Lister added that the remnants in Al Atarib closely matches munition remnants discovered at the site of artillery strikes in Ukraine using the laser-guided “Krasnopol” shell. Video shows that this type of missile has been previously used in Syria—not against hospitals—and is openly used by Russian forces in the country.

Pictures posted by Charles Lister of munition remnants from the targeting of Al Atarib Surgical Hospital

Sputnik Arabic published an article in February 2020 with a photo showing what appears to be four Syrian soldiers, one which is holding a “Krasnopol” shell. In its article, Sputnik reports that the possible use of “Krasnopol” 152 mm shells was announced in Syria at the end of the summer in 2016 and was shown to be used in November 2017. According to Sputnik, the missile won the admiration of military experts because of its accuracy, flying to its targets under the directives of a corresponding drone.

A photo from Sputnik Arabic’s article of a “Krasnopol” shell carried by Syrian soldiers. The image was first shared by the account “ZOKA” on Twitter.

The “Krasnopol” shells are Russian laser-guided artillery designed to hit tanks, armored vehicles, buildings, bunkers, field fortifications, water targets, and more. The missiles require external laser markers. The target must be illuminated with a laser in order to achieve an accurate strike. Once the laser signal is detected, the guidance system on board the missile directs it towards its target.

The “Krasnopol” 152 mm, previously announced as used in Syria, weighs about 45 kilograms and contains 10 kilograms of explosive content. The missile has a range of 25 kilometers and an accuracy rate of 80 - 90%. There are several updated variants of the “Krasnopol” missile type. However, Syrian Archive was unable to determine the exact version of the artillery shell that hit Al Atarib Hospital.

Online sources discovered, analyzed, and verified by Syrian Archive corroborate the type of weapon used. Sources show the 46th Regiment near Al Atarib, around 5 km away from the hospital. This may be the artillery shell’s potential launch point. Sources claiming the shell was launched from the Artillery School are inaccurate as the location of the school, about 27 km away from the hospital, exceeds the reported range of “Krasnopol” shells.

Satellite imagery from Google Earth showing the distances between the hospital and both the Artillery School and 46th Regiment

The Damage to The Hospital

Videos and photos taken by Syrian Archive’s investigations team, further verified using open sources, show significant damage to the hospital’s yard and roof. The bandage and dressing department as well as the orthopedics office near the hospital’s entrance were completely destroyed by the strikes. In addition to the damage to the front of the facility, one of the missiles penetrated the roof of the obstetrics department as well as damaged the hospital’s water tank and generator.

Videos and pictures also show shattered glass and broken doors inside the underground hospital as well as traces of blood along the hospital corridors and dust in the inpatient and emergency rooms. Pictures additionally show damage to the hospital’s ambulances.

Photos taken by the Syrian Archive’s investigations team show the internal and external damage to Al Atarib Surgical Hospital from the attack by guided artillery shells

A screenshot from a video posted by the Al Atarib city Facebook page showing the damage to Al Atarib Surgical Hospital’s ambulance from the attack

Killed and Injured

A picture posted on Facebook by journalist Omar Al Bam showing someone being treated after the attack on Al Atarib Surgical Hospital

In addition to Mohammed Abdul Hamid Haji Ahmed, six other people—including two children and their uncle—were killed in the attack. Uncle Mustafa Ahmed Ayoub who worked as a teacher at the Wajdu Al Tariq School in Al Atarib and the children Ahmed Abdullah Al Ayoub—who was a student at the Imam Al Shafii School for Orphans—and Ahmed Abdel Qadir Ayoub all died in the attack. They are among the seven total killed in the attack:

In a statement posted on Facebook, the Directorate of Education in Aleppo announced the death of two of its teachers and one of its students in the attack on Al Atarib Surgical Hospital. The directorate named student Ahmed Abdullah Ayoub (known as Ahmed Rajab Hallaq) and the teachers Mustafa Ahmed Ayoub and Ahmed Khattab Khattab as having died in the strikes.

The identity of those killed and the location of where they were killed were confirmed by Syrian Archive though witness testimony, open sources, and the matching of photos taken of them after the attack with photos previously posted of them online.

In addition to those killed, more than 17 others were injured in the attack. Most were transferred to hospitals near the Bab Al Hawa border crossing. Among them were Doctor Nawar Kurdieh, a doctor at the Sakan Specialist Hospital for around six years, the director of the Free Aleppo Health Directorate in western Aleppo countryside, and an orthopedic specialist. Dr. Kurdieh lost one of his eyes in the attack.

Mahmoud Khalifa, a maintenance technician at Al Atarib Surgical Hospital, was also injured in the attack. SAMS’ Facebook page published Mahmoud’s retelling of the incident. He was at the hospital entrance the moment the first shell hit. He felt shrapnel hit his entire body. He fell to the ground and began to crawl towards the emergency room when the second and third shells hit. He then, with extreme difficulty, moved himself to the operations room. “No one can describe this incident,” Mahmoud recounts. “The dust, destruction and screams, the scenes of those killed. I will never forget them. How can medical facilities withstand the pressures of these missiles?”

International Positions and Statements

In a statement, the United Nations condemned the targeting of “a hospital in western Aleppo Governorate,” which it said had received United Nations support. United States Secretary of Defense Anthony Blinken tweeted that the United States condemns the attack on Al Atarib Hospital, stressing the protection of medical facilities and personnel and a stop to the violence.

Mark Cutts, deputy regional humanitarian coordinator for the UN, additionally tweeted about the hospital’s targeting, posting an artist’s rendering of a child who was killed in the attack as well as a video of the hospital days before the strikes.

In a statement published on the organization’s site, SAMS President Dr. Mufaddal Hamadeh emphasized that “after 10 years of active conflict, efforts by the United Nations Secretariat and Security Council have proven unable to prevent these heinous violations of international law.”

In an additional statement, SAMS called for an immediate investigation into the incident noting that the hospital’s coordinates were shared with the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) in order to confirm its status as a humanitarian facility and avoid attacks.

Lastly, Physicians for Human Rights’ director of policy Susannah Sirkin said in a statement, “The United Nations Security Council has abandoned Syria’s nurses, doctors, and patients. After a decade of failure, the international community must step up to stop these attacks and hold perpetrators of these unthinkable acts accountable for the bloodshed.”

Characteristics of a Targeted Attack

Certain observable characteristics of attacks against medical facilities constitute circumstantial indicators of an attacker’s apparent intent to deliberately target what should be legally protected civilian objects. First, Al Atarib Surgical Hospital is remotely located, meaning it is situated distinctly separate from main centres of population and is not near to or surrounded by many other, unrelated (non-medical) structures. In this incident, the hospital was also directly hit in three strikes. Repeated strikes in quick succession like this, or multiple targeted strikes against the same location or same approximate coordinates, is an attack tactic reflective of apparent intent to both ensure successful targeting and inflict maximum damage to the targeted site. Finally, the hospital’s location and protected status should have been known to the attacking party: SAMS reports that the facility’s coordinates were shared with the United Nations, to be included on the ‘no strike list’ produced under the Office for the Coordination of Humanitarian Affairs’ deconfliction mechanism.

In this attack, the munition used is also a strong indicator of targeting intent. Because the Krasnopol missile is laser-guided, its strikes are preceded by a drone functioning as an external laser marker, illuminating the intended target. The well-established accuracy of this munition type combined with multiple, direct hits on Al Atarib Surgical Hospital point to clear targeting.

Details on our full methodology and its application for evaluating the intentionality of attacks against medical facilities are available on Syrian Archive’s Targeting Health website and database.

Conclusion

Through the information detailed above, Syrian Archive confirmed that Russian laser-guided Krasnopol missiles (accompanied by a UAV drone) targeted and hit the Al Atarib Surgical (Al Magahra) Hospital in the town of Al Atarib between 08:41 - 08:45 AM on March 21, 2021. In addition to destroying parts of the hospital and presently forcing it out of service, the missiles killed 7 civilians, including children, and injured more than 17 others. Given the limitations of open source investigations, Syrian Archive was unable to definitively identify who was responsible for the strike. However, open source information, media, and testimonies collected by Syrian Archive point towards Russian or Syrian forces as likely responsible for this incident.