Medical Facilities Under Fire: Kiwan Charitable Hospital

Initial Summary

• Place of Attack: Idlib: Kansafra
• Location Hit: Kiwan Charitable Hospital, supported by Syrian Expatriates Medical Association (SEMA), serves the 175,000 people of the surrounding areas with over 900 patients treated at the hospital every month.
• Date: 24 November 2019
• Time: Between 21:00 and 21:30, according to interviews with hospital staff conducted by the Syrian Archive’s investigations team in corroboration with online open source media and flight observation data.
• Deaths or Wounded: None
• Type of Attack: Airstrike
• Munitions Used: Unknown
• Potentially Responsible: Flight observation data, witness testimony, and open source information point towards the Russian Air Force as the potential perpetrator of the attack.

Introduction

On November 24, 2019 between 21:00 and 21:30, Kiwan Charitable Hospital in Kansafra, a town in the southern Idlib countryside, was hit with two airstrikes from a fixed-wing Russian aircraft forcing the medical facility out of service. Supported by the Syrian Expatriates Medical Association (SEMA), the hospital’s rooms and equipment in the facility’s women and children’s and surgical departments were severely damaged. No casualties or injuries were reported from the attack as staff evacuated the hospital half an hour before the strikes occurred. The report below examines Al Kiwan Hospital, its vitality to the southern region of the Idlib governorate, the attack itself, and the resulting damage to the facility.

Methodology

Syrian Archive conducted an investigation into the incident, based on three steps:

(1) A local investigation’s team collected testimonies from eye-witnesses or those who witnessed the immediate aftermath of the airstrike; (2) Securing, analysing, and verifying of 38 videos and images uploaded to social media networks purportedly showing the incident as well as examining flight observation data; (3) The combined analysis of these sources has culminated in the present investigation report. Complementing each other, they provide information regarding the attack’s date and time, location, casualties, and extent of damage.

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

For more details on Syrian Archive’s Methodology, please see our website.

The Background of the Hospital

An image from 2015 of Kiwan Hospital published by the Syrian Network for Human Rights.

Kiwan Charitable Hospital is a free medical facility that treats patients in the southwestern part of the Idlib province. The hospital houses a women and children’s wards and has a history of treating residents in the surrounding areas free of charge. Kiwan Hospital, according to its medical director Dr. Zahir Qarat, houses incubators, a patient reception ward, clinics, a nutrition department, a cesarean operating room, an ambulance department, as well as a laboratory, pharmacy, and radiology department. According to Qarat, daily the hospital performs around one hundred examinations of children, three cesarean sections (alongside normal deliveries) as well as admits four babies in incubators and seven into the children’s ward.

Location

An image taken from Google Earth of Kansafra and its neighboring villages.

Kiwan hospital is located in the Kansafra village, which lies in the southwestern region of the Idlib governorate around 33 km southwest of Idlib city and 17 km west of Maaret Al Numan. The medical facility is centrally located in the village with the next nearest hospital 7 km away in Kafranbel.

The investigations team geolocated civilian media showing the hospital by matching these videos and images with media taken by the team on the ground and satellite imagery of the location.

A geolocation of video reports by the investigations team and the Idlib Health Directorate of the hospital after the attack matched with satellite imagery taken from Google Earth.

Beneficiaries

Prior to the attack, the hospital provided services for the 175,000 residents in the surrounding areas treating around 6500 patients a month. Kiwan, according to its website, worked to serve those in Jabal Al Zawiya, parts of Jabal Al Arbaeen, parts of the Maaret Al Numan and Khan Sheikhoun countryside, and the city of Khan Sheikhoun.

The facility treated patients free of charge since 2011 with an exception in 2018 as a discontinuation in financial support forced the hospital to begin charging nominal fees. However, later that year, Kiwan was able to return to its original mission and provide free services again with the support of SEMA.

History of the Hospital

Kiwan Charitable Hospital was originally established in 2000 by Syrian businessman Adnan Kiwan who was living in Ukraine at the time. Before establishing the hospital, Kiwan studied engineering in the Soviet Union working as a lecturer while in a PHD program. Shortly after graduating, Kiwan began a career in woodwork later becoming a prominent businessman in the steel and irony industry in Ukraine.

Although living in Ukraine, Kiwan is originally from Tafas, a city in the Daraa governorate, and remains active in his home country through charitable acts including the establishment of Adnan Kiwan Charitable Hospital in Kansafra. Kiwan started the hospital with his friend Abdul Al Basit Hashoum, a native of Kansafra who now lives in Sweden.

When the hospital was first established, Kiwan worked to improve the facility through funding and new equipment. Although supported by Kiwan and Hashoum, the hospital was not completely free for patients until the conflict broke out as Kiwan worked to cover the basic costs of the facility. Recognizing the hospital’s mission, Munther Khalil, director of the Idlib Health Directorate, confirmed in an interview that the hospital since its beginning was largely charitable rather than private and was known as “Hospital of the Poor.”

In 2011 and 2012 with the beginning of the Syrian conflict and the closing of a significant number of private hospitals, Kiwan hospital in Kansafra played an important role in providing free treatment to the 300,000 residents in southern Idlib. Although Kiwan stopped supporting the hospital at this time, with most of his support solely administrative, many humanitarian organizations began funding the facility making it free of charge for patients. Since the hospital stayed open throughout the conflict, especially after the devestating Massacre of Al Mostumah in Idlib on May 20 2011, people began calling the facility the “Revolution Hospital.” Having so far withstood the war, the hospital became a symbol of hope for the residents in the area.

A screenshot of the Syrian government’s online registry of private hospitals from 2008, which includes Kiwan Hospital.

Having been established in 2000, Kiwan Hospital was registered online by the Syrian government as a private hospital in the Idlib province beginning as early as 2008. This indicates and further corroborates that the Syrian government was possibly aware of the hospital’s location at the time of the attack. Moreover, in 2016, the Syrian Government classified the hospital and its staff as “wanted.” This classification was based on a decision stating: “Adnan Kiwan Charitable Hospital, Maarat Al Numan, Kansafra Village is hiding weapons in the facility with full support of the medical staff. Director of Administration’s decision on the Northern Branch Book No. 6846 Date 27/5/2011, assigned Court of Administration with reference number 2053/1 and date 18/6/2011.” This, presumably, was decided to justify attacks on the facility and increases the likelihood that Russian or Syrian government forces are responsible for the attack. Moreover, given this status, Kiwan Charitable hospitial was and has been directly targeted by planes allegedly from the country that originally welcomed Adnan Kiwan in his youth.

A screenshot from the Baba Amr blog reporting the case against Kiwan hospital and its staff. Translation: “Adnan Kiwan Charitable Hospital, Maarat Al Numan, Kansafra Village is hiding weapons in the facility with full support of the medical staff. Director of Administration’s decision on the Northern Branch Book No. 6846 Date 27/5/2011, assigned Court of Administration with reference number 2053/1 and date 18/6/2011.”

Previous Attacks on the Facility

Although presumably protected from an attack as a medical facility, Kiwan Hospital has been targeted multiple times. The hospital was first attacked on September 18, 2012. Videos show shattered windows, broken hospital beds, and other damage to the facility’s interior. Thereafter, in early 2013, according to a report by the Syrian Network for Human Rights (SNHR), regime forces forcefully entered the hospital and killed medical personnel. Later that year on September 1, 2013, shortly after the hospital opened its women and children’s ward, the facility was attacked again. Strikes on the facility continued on September 15, 2015 with the Macro Media Center reporting on damage to the hospital from multiple missiles. Later on May 23, 2019, before the November attack on the facility, Kiwan according to SNHR was again damaged from another attack. This incident was additionally reported on by the Assistance Coordination Unit and was followed by the latest attack on November 24, 2019.

What Happened (and When)?

An image of the hospital taken after the attack by the investigations team.

Between 21:00 and 21:30 on Sunday November 24, 2019, Kiwan Charitable Hospital was directly targeted and hit by an airstrike that severely damaged the facility’s structure, equipment, and medicine pushing it out of service. There were no casualties from this strike as warnings of a potential attack permitted hospital staff to evacuate the facility before the airstrike.

Dr. Zahir Qarat, the hospital’s medical director, confirmed in an interview with the Syrian Archive’s investigations team that at 21:20 on Sunday November 24, the hospital was targeted directly by an airstrike that pushed it out of service. In the interview, Qarat reported the hospital was in service that day. However, with the village targeted earlier that afternoon between 16:15 and 17:00 and warnings from flight observatories of another potential attack, Qarat ordered the evacuation of half the staff and patients. According to Qarat, at 20:45 with the plane that would eventually target the facility attacking the neighboring village of Kafr Awid, staff completely evacuated the hospital before the airstrike at 21:20.

Satellite imagery from Digital Globe from before and after the attack corroborates the time of the attack as well as the extent of damage. The northern block of the facility, shown as destroyed and collaposed in images taken by the investigations team and found online, is visible in satellite imagery from before the attack and is gone in satellite imagery taken after the attack, further corroborating the severe damage to the hospital.

Corroborating Qarat’s estimates of the time of attack, posts by Syria TV, Effect Network, Aleppo Media Center, and the media activist Ubaida Dandoush at around 21:50 alert of an attack, some claimed by “Russian warplanes,” on Kiwan Charitable Hospital. Additionally, a video interview, posted by the Civil Defense, with a member of the local Civil Defense confirmed the time of the strike as on November 24 at 21:20. The team member mentioned that the time of 21:20 matches observations by the Civil Defense of a Russian aircraft above the village at 21:15. In the interview, the member additionally discussed the evacuation of hospital patients and staff as well as the extensive destruction to the facility from the attack.

In an additional interview conducted by the investigations team, Pharmacist Raed Khatib, who works in a private pharmacy near the hospital, Confirmed that an allegedly Russian plane targeted the facility on November 24 between 21:00 and 21:30 pushing the facility out of service. Mentioning the preceding attack on Kafr Awid and the subsequent warnings from flight observatories, Khatib also confirmed the evacuation of the hospital around a half hour before the attack.

A still from a video taken by the investigations team of inside the hospital after the attack.

Hospital staff member Abu Ayman confirmed the airstrike occurred between 21:00 and 21:30 on November 24 as well in an interview with the investigations team. Abu Ayman claimed that a Russian plane directly targeted the hospital. Arriving moments after the attack occurred, he described the hospital as destroyed and on fire. Ayman also detailed that the most vital equipment in the radiology, anesthesia, childbirth, and laboratory departments were all destroyed.

Images taken by the investigations team on the ground (featured later in the report) as well as posts on social media reveal the damage to the facility directly after the attack. Images uploaded by Al Hadath show the severe damage to the hospital’s interior as a result of the attack.

A GIF from a video posted by Abu Hamza Al Janobi of the hospital directly after the attack.

Further corroborating Abu Ayman’s reports regarding the extent of damage to the facility, videos and images such as those posted by activist Abu Hamza Al Janobi show Kiwan Hospital’s internal and external destruction. Additionally, a report from the Syrian Civil Defense of the Idlib Governorate around 5 hours after the attack confirms the damage to the hospital, which they claim was attacked by the Russian Air Force and is now out of service.

An image posted by the Civil Defense in Idlib on Facebook of the hospital’s pharmacy on fire.

Alongside human rights organizations and local news sources, Kiwan Hospital itself posted videos and images taken shortly after the attack onto its Facebook page showing the severe damage to the hospital and its equipment, including fires in various blocks of the facility.

A still showing damage to the facility from atop the hospital taken from a video report by Enab Baladi on the attack.

In the days after the attack, video reports emerged discussing the airstrike in more detail. Alongside a statement, the Idlib Health Directorate posted a video showing the damage to the hospital from the attack as well as an interview with Ali Hashoum, the director of Kiwan Hospital. In his interview, Hashoum said the attack came from a Russian plane and emphasized that it pushed the facility out of service. Additional video reports from Anadolu News Agency, Enab Baladi, and SyriaTV, SEMA, and Al Araby confirm the date and time of the attack as well as the severe extent of its damage.

Analysis of the Damage

The inside of the hospital’s laboratory after the attack as captured by the investigations team.

The damage to Kiwan Hospital from the attack was determined and analyzed by the Syrian Archive through open source media as well as interviews, videos, and pictures taken by the investigations team on the ground. The media taken by the team, alongside the open source media found online, corroborate and confirm statements that the hospital was directly targeted and pushed out of service.

External Damage

A GIF from a video taken by the investigations team of outside the medical facility.

As shown in the videos and images taken by the investigations team, the hospital suffered severe damage externally with the hospital’s structure almost fully collapsed. Although part of the hospital’s main building was left still standing, the northern block of Kiwan Hospital, which includes the medical warehouse and examination rooms, was completely destroyed with the roof collapsed and rooms crushed.

An image of the collaposed and destroyed northern block of Kiwan hospital taken by the investigations team.

An image taken by the investigations team of the hospital’s emergency/ambulance entrance after the attack.

Directly after the attack	Days after the attack

The image on the left was uploaded by the Civil Defense of the pharmacy on fire directly after the attack. The image on the right is a still from a video taken of the hospital’s pharmacy days after the attack by the investigations team.

An additional building to the right of the primary hospital building, which is the hospital’s ambulance entrance, also suffered significant external damage with its windows broken and rooms’ walls destroyed. The hospital’s pharmacy faced severe damage with the entirety of the pharmacy burned and one of its walls destroyed. The hospital’s severe external damage matches its devastating internal damage, which rendered the facility out of service.

Internal Damage

An image taken by the investigations team of the hospital’s entrance.

When first entering the hospital, large boulders from the hospital’s structure scattered on the floor reveal the severe extent of the damage from the attack on the facility’s interior. The reception and waiting rooms on the first floor are covered in concrete and splintered wood debris from the hospital’s walls, ceiling, and furniture.

Images taken by the investigations of the hospital’s reception, waiting room, and patient rooms on the first floor.

Images of the hospital’s basement or bottom floor taken by the investigations team.

Images taken by the investigations team of the hospital’s laboratory located on the bottom or basement floor.

The hospital’s ambulance room, on the basement or bottom floor, shows additional damage with remnants of the ceiling, the ceiling fan, and medical equipment covering the ground. Moreover, the hospital’s laboratory in the basement is left covered in debris after the attack with vital medical equipment destroyed from the missile’s impact. Debris from the facility’s collapsed roof additionally blocks access to the second floor. On the second floor, debris from broken windows, hospital equipment, and burnt medicine from the pharmacy obstruct the hospital’s corridors.

A GIF from a video taken by the investigations team of the hospital’s collapsed roof.

A still from a video of the hospital’s second floor medicine storage room taken by the investigations team.

A still from a video of the doctor’s clinic taken by the investigations team.

A still from a video of the hospital’s women’s drugs storage taken by the investigations team.

An image of the women’s second floor restroom taken by the investigations team.

Additional rooms on the hospital’s the second floor feature severe damage. The nutrition department’s windows shattered from the attack with glass covering the department’s floor and furniture. The majority of the equipment and medicine in the women’s drug store were burnt and ruined in the attack. The women’s restroom suffered similar damage with pieces of furniture and the ceiling covering the ground. The hospital’s administration room faced extreme damage with cracks in the wall, files strewn around the room, and its door ripped off. Moreover, the X-Ray room’s door and equipment broke in the blasts. Lastly, the pharmacy’s interior, like its exterior, burned with the medicine and equipment inside the pharmacy lost.

An image taken by the investigations team of the hospital’s x-ray room after the attack.

Images taken by the investigations team of medicine burnt inside the pharmacy.

This destruction of Kiwan hospital has left residents in the countryside of Idlib with increasingly less options for medical help. The extensive damage to the hospital corroborates its direct targeting, a prevalent feature of the Russian-Syrian military campaign.

Flight Data Analysis

To provide a further layer of verification, the Syrian Archive cross referenced findings from open source media and images/videos taken by the investigations team with flight observation data from a spotter organization. Data for flights occurring briefly before, during, and briefly after the time of the attack (21:00 - 21:30) on November 24, 2019 around Idlib and Hama was closely analyzed.

First in Latakia at Hmemim Airbase, a Russian fixed wing aircraft was seen taking off in the southeastern direction at around 20:35. At 20:52, a Russian fixed wing aircraft was then seen flying east near the village of Bara, which lies only around 6 km away from the hospital. Shortly thereafter at around 20:55, a Russian fixed wing aircraft was spotted circling over the Maarat Hurma, a village 13 km south of Kansafra. Lastly, and shortly before the airstrike, at 21:01 a Russian fixed wing aircraft is observed circling over Jabal Shahshabo, an area 18 km south of Kansafra. Although not circling over Kansafra itself, this common practice of circling by warzone aircrafts indicates target acquisition and/or preparation for an imminent attack. Furthermore, the circling by a fixed wing Russian aircraft over the neighbouring villages of Kansafra corroborates the estimated time of the attack of between 21:00 and 21:30 as mentioned in interviews conducted by the investigations team and in local news reports.

Although this data matches media and posts on social media that purport the attack as committed by the Russian Air Force, no evidence available shows the direct involvement of the observed aircraft in the attack on Kansafra. Nevertheless, the presence of these aircrafts above the neighboring villages and towns at the time that the attack most likely attack occurred, increases the possibility that the airstrikes were carried out by the Russian Air Force.

Conclusion

On November 24 2019 at between 21:00-21:30, Kiwan hospital, supported by SEMA, was attacked and pushed out of service. Providing free treatment to residents in the area, the hospital’s various departments including its women and children’s wards were destroyed. The time of the attack and the damage to the hospital was confirmed through open source media found online, media captured and interviews conducted by the investigations team at the attack site, and flight observation data. Witnesses, local news sources, and flight observation data points towards the Russian Air Force as responsible for the attack. However, given the limitations of open source information, the Syrian Archive is unable to definitively identify the perpetrators of this attack.