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INVESTIGATIONS

Artillery shelling pushed the Primary Healthcare Center in Maaret Al Numan out of service

April 28, 2021

An investigation into the strikes on the Primary Healthcare Center in Maaret Al Numan

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Incident Summary

  • Place of Incident: Idlib: Maaret Al Numan
  • Location Hit: Primary Healthcare Center in Maaret Al Numan
  • Date: 3 October 2019
  • Time: Around 12:20 PM
  • Killed and Injured: 1 killed and 6 injured
  • Type of Incident: Artillery shelling
  • Munition Used: Unknown
  • Potentially Responsible: The Syrian government’s 25th Special Tasks Division (also known as the Tiger Forces) located at Tal Al Nimr, nearby Khan Sheikhoun, was likely responsible for the strike.

Introduction

Mrs.Shuaa Khadija died ten days after she sustained injuries from the bombing of the Primary Healthcare Center in Maaret Al Numan. Shuaa was receiving treatment in the dental clinic when the center was targeted. Shrapnel hit her chest and abdomen. She was taken to a safer part of the center where she waited fifteen minutes before first responders arrived and took her to a hospital in Bab Al Hawa. Shuaa later died in the hospital from severe bleeding.

Methodology

Syrian Archive conducted an investigation into the incident, consisting of three components:

  1. Collecting testimonies from 3 eyewitnesses or those who witnessed the moments immediately following the strike and taking pictures and videos of the incident site;
  2. The preservation, analysis, and verification of 42 videos and pictures of the hospital taken after attack, by Syrian Archive’s investigations team.
  3. Preserving, analysing, and verifying 25 videos and photos posted on social media allegedly documenting the incident;
  4. Analyzing satellite imagery showing the impact site after 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 the Primary Healthcare Center in Maaret Al Numan

maaret2 A picture of the Primary Healthcare Center in Maaret Al Numan, posted on Twitter by user Nibras Al Ard, after Syrian government forces captured the city.

The Primary Healthcare Center in Maaret A Numan is a medical center that provides free services to about 50,000 families in the area. With about 50 staff members ranging from specialists to administrators, the center serves around 10,000 beneficiaries each month. The center includes a variety of clinics with a number of specialties including obstetrics, gynecology, dental, vaccinations, and children’s health. The facility also has a pharmacy, laboratory, and equipment for mammograms.

The center was supported by the organization Syria Relief. However, such as with other medical facilities in the area, this support was discontinued on January 29, 2019 in, what director of the Primary Healthcare Center in Maaret Al Numan Mahmmoud Al Murr called, a public health disaster. Al Murr also mentioned that volunteer work has kept the center running without proper funding.

About Maaret Al Numan

maaret0 A satellite image of Maaret Al Numan from Google Earth

Maaret Al Numan is located in the southern countryside of Idlib and is a hub for civilians, both residents of the city as well as those displaced in the area, seeking medical care. The population of those living in Maaret Al Numan and the surrounding areas, such as the villages in Jabal Al Zawiya, in 2020 was around 150,000 people . Although Maaret Al Numan is densely populated with civilians, the medical facilities in the town have been the target of shelling and airstrikes since Syrian opposition forces took control of the city in October 2012.

In our Attacks Against Medical Facilities database, Syrian Archive has documented a number of strikes against hospitals in Maaret Al Numan including: 8 repeated attacks targeting Maaret Al Numan National Hospital, one strike targeting Orient Hospital, another strike hitting the Doctors Without Borders Hospital, and a strike hitting the Al Salam Hospital.

Alongside the targeting of healthcare providers in Maaret Al Numan, all medical facilities in the city were forced to shut down after government forces took control of the town on January 28, 2020. The closing of all medical facilities in the area deprived residents in the region of access to medical care, specifically during the spread of COVID-19.

The table below is the names of the medical facilities out of service in Maaret Al Numan and the surrounding villages in 2020:

HospitalsHealth Centers
Al Sham HospitalAl Tah Center
Orient HospitalAl Deir Al Sharqi Center
Nabd Al Hayat HospitalAl Ghadfa Center
Maryam HospitalAl Hobait Center
Talmanis HospitalHeish Center
Al Salam HospitalKhan Sheikhoun Center
Maaret Al Numan Central HospitalRakaya Center
Oudai HospitalMaasaran Center
Al Hayat HospitalKafr Roma Center
Al Ghadfa HospitalKafranbel Center
N/AMaaret Al Numan Center
N/AJarjanaz Center
N/AMaaret Hurmah Center
N/AQatrah Center
N/AAl Salam Kafr Roma Center
N/AKafr Aweed Center
N/AHizareen Center
N/AAl Hakim SDI Center
N/AAl Hakim Center (Maar Shoreen)
N/AOsama Al Baroudi (Maar Shimmareen)

What Happened (and When)?

Between 12:15 - 12:20 PM on Monday, October 3, 2019, the Primary Healthcare Center in Maaret Al Numan was targeted with artillery shells injuring patients and hospital staff in the center as well as later killing a patient who sustained serious injuries from the attack. The shelling also damaged the medical facility temporarily putting it out of service.

First reports of an attack on the healthcare center were posted online at 12:37 PM. The Facebook pages Aleppo Media Center, Baladi News Network, and Violations Documentation Center in Idlib posted initial reports of artillery shelling allegedly by Syrian government forces on the perimeter of the healthcare center. Initial posts provided early reports on the number of patients and staff injured in the attack. At 12:47 PM, journalist Raja Al Asaad reported of civilian casualties at the healthcare center from heavy artillery shelling. In her post, Al Asaad also shared a video showing smoke plumes over Maaret Al Numan with sounds of shelling in the distance. Names of those injured were mentioned in the comments section of the post.

The Facebook page for the Civil Defense in the Idlib governorate also posted photos showing Civil Defense teams arriving at the healthcare center and treating the injured, including the center’s dentist Youssef Al Hussein.

Syrian Civil Defense arriving at the Primary Healthcare Center in Maaret Al Numan A picture posted by the Facebook page Syrian Civil Defense - Idlib Governorate showing Civil Defense teams arriving at the Primary Healthcare Center in Maaret Al Numan shortly after it was hit.

A chronolocation of the shadows shown in the picture posted by the Civil Defense on Facebook Shadows shown in a picture posted by the Syrian Civil Defense correspond with the position of the sun, as calculated using the SunCalc tool, at 12:30 PM on October 3, 2019 in Maaret Al Numan. This further corroborates the timing of the incident as reported by journalists and collected in interviews conducted by Syrian Archive’s investigations team.

With photos of the attack site, the Al Hadath Syria, Rojev24, and Save Syria Facebook pages posted about the attack and the injuries sustained by those in the health center.

Later after the attack, the Primary Healthcare Center in Maaret Al Numan Facebook page, Syrian Network for Human Rights, Idlib Health Directorate, and the organization Syria Relief published reports on the attack mentioning that seven patients and hospital staff members were injured by the strikes. Reports claimed the facility was targeted with heavy artillery by Syrian government forces.

Pictures posted by the healthcare center’s Facebook page of where artillery hit the center.

Syrian Archive’s investigations team met with Youssef Al Hussein, a dentist at the Primary Healthcare Center in Maaret Al Numan and one of seven injured by the artillery shelling on October 3. Al Hussein told the team: “On Thursday October 3, 2019, we were shaken by the bombing of the center with ground-to-ground missiles from the Nimr checkpoint in Khan Sheikhoun. I was injured and the patient I was treating [at the time of the attack] died ten days later from her injuries. 5 others were wounded as well with injuries that ranged from light to moderate. The paramedics and Civil Defense took me to the National Hospital where I was treated for a fractured foot. My treatment continued for a whole month.”

Al Hussein added, “We didn’t hear any sounds at that moment [when the shells hit]. Immediately, with dust and smoke, shrapnel hit my feet. I noticed my foot bleeding. My patient shouted that she had been hit in her stomach and chest. I tried to help the patient, but the shrapnel broke through her bones so I couldn’t. We left the clinic for a safer place and the center staff called the paramedics. Within 15 minutes, the Civil Defense arrived and took us to the National Hospital. My injury has affected my work, but I have to continue my job temporarily because there are no other dentists at the center. The patient was seriously injured and bled a lot. She was taken to Bab Al Hawa where she began to receive treatment. However, she died 10 days later.”

Pictures posted by the healthcare center on Facebook show Dr. Youssef Al Hussein being treated by a paramedic after the attack on the clinic.

In an interview with the investigations team, the dental clinic nurse Khadija Al Qasim confirmed what was said by Doctor Al Hussein. She added, “Shrapnel and smoke entered through the windows and doors. The first strike hit the doctor then the patient was hit in the stomach. We took the patient to a safe place until the ambulances arrived. There were around 5 others injured. The dental clinic suffered from the most damage.”

The security guard at the Primary Healthcare Center in Maaret Al Numan confirmed that the center was targeted at 12:20 PM on October 3, 2019 resulting in injured medical staff and patients as well as later the death of Shuaa Khadija. He added, “six missiles hit around the center leading to its removal from service, even though it’s a medical center that has nothing to do with any military or militia.”

Killed and Injured

Online sources as well as interviews conducted by Syrian Archive reveal the number of those killed and injured by the artillery shelling of the Primary Healthcare Center in Maaret Al Numan. Pictures posted by the Civil Defense and the healthcare center’s Facebook page show Civil Defense teams arriving at the center to treat the injured, including Dr. Youssef Al Hussein. Pictures by Syria Relief organization also show the body of Shuaa Khadija on the floor covered in blood.

The names of those injured are mentioned by several sources including the journalist Rajaa Al Asaad and The New Arab in their reports on the incident.

The names of those injured are:

  • Wassim Al Tohmah
  • Ghazal Doudi
  • Shuaa Khadija
  • Lamia Al Rabie
  • Bilal Mazer
  • Youssef Al Hussein
  • Mohammed Melhem

About 12 days after the attack, Shuaa Khadija died from her injuries.

The Damage to the Primary Healthcare Center in Maaret Al Numan

Through photos and videos, the investigations team was able to examine the internal and external damage to the facility after it was attacked. The team compared the materials published online with photos and videos taken by the team on the ground. Moreover, the investigations team interviewed center staff after the attack for corroborating details about the damage to the facility.

Open source information and witness testimonies gathered by the investigations team reported artillery shells as hitting the wall of the health center and its surroundings, leading to damage that forced the facility to temporarily discontinue its services. The damage to the health center was not widespread. However, the shelling damaged the facility’s infrastructure including its electricity and water as well as its windows, fence, and trees.

Pictures taken by Syrian Archive’s investigations team a few days after the incident showing the damage to the Primary Healthcare Center in Maaret Al Numan and the surrounding area.

Pictures posted by the center’s Facebook page the day of the incident showing the damage to the center and the surrounding area.

Satellite imageries of the Maaret Al Numan healthcare center and the surrounding areas before and after the attack. One of the locations where artillery hit the center is visible in this satellite imagery.

Potential Perpetrators

Corroborating claims made online, Primary Healthcare Center staff stated in interviews conducted by Syrian Archive that the center was hit with artillery shells by Syrian government forces stationed in Tal Al Nimr. The investigations team worked with sources on the ground and searched open sources for information about Tal Al Nimr, the group controlling the area, and the weapons present in the area.

About Tal Al Nimr

maaret28 A satellite image of Tal Al Nimr from Google Earth.

Tal Al Nimr is considered a strategic military point in southern Idlib. It’s located at the northern entrance of Khan Sheikhoun, around 20 km south of Maaret Al Numan. The point overlooks the villages and towns in the southern countryside of Idlib. The groups that have controlled Tal Al Nimr have varied throughout the conflict.

On March 24, 2014, brigades of the Free Syrian Army took over the area from Syrian government forces. Videos posted online show dirt mounds and remnants of military equipment left by government forces. Tal Al Nimr remained outside of Syrian government control for over five years, until government forces regained control of the area on August 19, 2019 as a part of it’s military campaign in Idlib.

The Tiger Forces, whose name was changed on August 31, 2019 to the “25th Special Tasks Division,” has administered the Tal Al Nimr checkpoint. Sputnik News Agency published photos showing elements of the 25th Division in Maaret Al Numan during, what the article called, battles to cleanse the city and its surrounding areas from armed groups.

maaret23 Pictures from Sputnik News showing members of the 25th Division in Maaret Al Numan.

After Syrian government forces recaptured the area, Tal Al Nimr regained its position as a main source of artillery bombardment on the towns and villages in the southern countryside of Idlib.

Weapons Used in Tal Al Nimr

From sources on the ground, Syrian Archive obtained a list of some of the weapons located in Tal Al Nimr. This list was corroborated with information found online. Among the weapons in this list were: artillery launchers, multi-missile launchers, tanks, Gvozdika cannons, S-23 artillery guns, 130mm field guns, mortars, BMP infantry fighting vehicles, and anti-tank artillery.

Videos posted online show opposition forces destroying weapons on Tal Al Nimr. Videos show the destruction of a 130mm field gun, an armored personnel carrier, and a tank in the area.

maaret29 Satellite imagery from Google Earth showing the distance between Tal Al Nimr and the Primary Healthcare Center in Maaret Al Numan.

The Tal Al Nimr Checkpoint is around 21 km away from the Primary Healthcare Center in Maaret Al Numan. This distance can be covered by several weapons specified in the list above. Because of limited imagery showing remnants of munitions used in the October 3 strikes, Syrian Archive is unable to determine the exact weapon used to target the center. However, the distance between Tal Al Nimr and the center as well as the damage to the medical facility supports the likelihood that the center was targeted with one of the weapons found on Tal Al Nimr. This is corroborated by open source information and interviews by Syrian Archive, which claim that Tal Al Nimr was the source of the artillery strikes on cities in the southern countryside of Idlib around the time and day of the attack.

Moreover, photos show 25th Division members wandering around Maaret Al Numan in what Sputnik called a “cleansing” of the city. This suggests that the targeting of the center may have been a part of a military campaign by the 25th Division—stationed in Tal Al Nimr on the date of the incident. This campaign most likely occurred with the goal of regaining control of the city.

Conclusion

Through the information detailed above, Syrian Archive was able to confirm that artillery shelling hit the Primary Healthcare Center in Maaret Al Numan at around 12:20 PM on Thursday, October 3, 2019. The strikes partially destroyed the center and damaged its infrastructure forcing it temporarily out of service and injuring 7 patients and center staff. One of those injured later died from severe bleeding. Given the limitations of open source investigations, Syrian Archive is unable to definitively identify who was responsible for the strike. However, testimonies and open source information collected by Syrian Archive point towards the 25th Special Tasks Division at Tal Al Nimr checkpoint as likely responsible for this incident.

The Syrian Archive is fully independent and accepts no money from governments directly involved in the Syrian conflict. We are seeking individual donations to carry out our work. Please consider supporting our work through our Patreon page.

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