This was a joint investigation with Focus Aleppo.

Initial Summary

Place of Incident: Idlib: Ehsim
Location Hit: The Health Center in Ehsim
Date of the First Strike: 3 May 2019
Time of the First Strike: Between 9:30 AM to 10:00 AM Local Time
Date of the Second Strike: 1 June 2019
Time of the Second Strike: Between 08:14 AM to 08:50 AM Local Time
Date of the Third Strike : 14 June 2019
Time of the Third Strike: Between 10:50 AM to 11:14 AM Local Time
Deaths: N/A
Wounded: N/A
Type of Incident: Airstrikes
Potentially Responsible: The Syrian or Russian Air Force may be responsible for the airstrikes on the medical point in Ehsim.

Introduction

The Ehsim Health Center is a medical point in central Ehsim that provides emergency services to the wounded and sick free of charge. On the morning of May 3, 2019, during an air raid campaign on several towns in the Idlib countryside including Ehsim, the center was bombed temporarily halting the facility's operations. Continued bombing on June 1 and June 14, 2019 terminated the possibility of the center reopening as well as pushed civilians to flee the town. The investigations team examined the three airstrikes on the medical center using videos, pictures, and private interviews as well as open source information published online.

Methodology

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

Collecting, analyzing, and verifying 49 photos and videos directly from sources on the ground of the medical point before, during, and after the three strikes;
Analysing statements collected by the team on the ground from eyewitnesses or those who witnessed the immediate aftermath of the strikes;
Preserving, analysing, and verifying 30 videos and images uploaded to social media platforms that claim to show the incident.

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

Examining all information available on the incidents, the investigations team developed an understanding of the incidents and all potential parties responsible.

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

About the Medical Point

A picture showing the entrance to the medical point taken before it was pushed out of service.

The medical point in Ehsim is vital for the city whose population is estimated at 15,000 people. With a large number of civilians having fled neighboring areas and settled in Ehsim, the number of those living in the town has increased at times to 25,000, according to an interview conducted by the investigations team with the town's council.

Mustafa Bazaar, director of the Emergency and Ambulance Center as well as one of the nurses at the medical point in Ehsim, said in an interview with the investigations team that the center was established in 2012 by local medical staff and residents of the area. Bazaar stated that throughout its operation the medical point never received support from any external party. According to Bazaar, the medical point in Ehsim includes 3 male nurses, 3 female nurses, and two doctors.

The medical point itself is a two-story building with the first floor around 200 square meters large. The first floor is divided into a reception, an examination room, four inpatient rooms, and a pharmacy. The medical point houses a defibrillator, heart monitor, six nebulizer machines, four blood pressure monitors, four blood sugar monitors, a chair for donating blood, hospital beds, an ambulance, and medicine. In the June 14 strike, almost all these machines and supplies were destroyed rendering the facility inoperable and pushing it out of service.

A GIF taken from a video clip obtained by Syrian Archive from the facility's medical staff showing the medical point from the inside before the airstrikes.

Beneficiaries

A picture obtained by Syrian Archive from medical point staff showing nurses offering medical services before the airstrikes.

Providing emergency services to the sick and wounded without charge, the medical point sees around 40 to 50 patients a day, according to Mustafa Bazaar. One of the facility's nurses, Iftikar Al Milhem, added that they provide medical services both inside and outside the center including stitching wounds, applying bandages, and examining injuries before referring patients to a nearby hospital. Moreover, facility staff follow up with patients unable to reach the medical point from their homes treating elderly patients and those with chronic diseases through follow up examinations, lab tests, and the distribution of necessary medications.

Location

The location of Ehsim on Google Earth Pro.

The town of Ehsim is located southwest of Ariha in the center of the Jabal Al Zawiya region in the southern countryside of the Idlib governorate. Staff at the medical point in Ehsim provided the investigations team with the coordinates of the facility's location. Satellite imagery taken between April 26 and August 21, 2019 clearly shows the damage to the site.

Eyewitness Zaidan Al Qassem, owner of three shops near the medical point that were later destroyed by the airstrikes, told the investigations team that around ten homes and more than twenty shops nearby were destroyed by the airstrikes on the medical point. Al Milhelm, a nurse at the medical facility, confirmed to the investigations team that the area is residential and free of any military presence. Similar to Al Qassem, she also noted that many of the homes and stores, which included a food store, a mobile phone shop, a remittance office, and a pharmacy, were destroyed by the strikes. This was confirmed by Syrian Archive after analysing pictures and videos of the location from before and after the airstrikes.

Satellite imagery from Google Earth Pro showing the location of Ehsim Medical Point.

What Happened (and When)?

Between May 3 and June 14, 2019, a medical point in the town of Ehsim in the Idlib countryside was subject to several airstrikes pushing the facility out of service. Repeated airstrikes on the facility resulted in significant damage to the building and the area 200 meters around the facility. This investigation examines the repeated bombing of the medical point and its surrounding areas as well as the accompanying gradual destruction of the facility.

3 May 2019

A picture posted by the SY24 Twitter account showing the damage to the town of Ehsim as a result of repeated airstrikes.

On May 3, 2019, the town of Ehsim was heavily bombarded as local sources reported that more than 70 airstrikes hit the town. Paramedic and medical point personnel Mustafa Bazaar said in an interview with the investigations team that after an airstrike hit near the facility they evacuated the point and suspended work to ensure the safety of the medical staff. This contributed to the absence of injuries in this incident. Bazaar noted that the first missile strikes had hit near the center at 9 AM on Friday, May 3. The airstrikes on the town that repeatedly hit near the center caused the ceiling inside the facility to fall and damage equipment temporarily suspending the medical point's operations. At 10:00 AM, the Ehsim Today Facebook page posted a photo allegedly showing smoke from a bombing by helicopters on the town.

A pictured posted by the Facebook page Ehsim Today of the airstrikes by helicopter on Ehsim

A number of videos from local media sources document the moment of the airstrikes on Ehsim. Organizations such as Orient News, Smart News Agency, Al Durar Shamiya Network, Syrian Civil Defense, and On the Ground News show the damage to residential buildings and the attempts by Civil Defense volunteers to extinguish fires started by the strikes.

A geolocation of footage from a video published by Syria TV. The location of the bombing (in blue) is about 150 meters away from the medical point (in white).

Halab Today mentioned the Ehsim Health Center as one of 15 other health facilities that were pushed out of service by airstrikes on the Idlib and Hama countryside in early May 2019. Additionally in a video clip published by Syria TV, a Syrian Civil Defense officer states in an interview that regime helicopters targeted the center of Ehsim at 10:00 AM starting a massive fire, destroying public property, and killing a number of civilians. A number of videos posted on the day of the strikes, including a video published by SMART News, show a helicopter hovering over the town.

A still of a helicopter over Ehsim taken from a video posted by SMART News.

On May 4, a day after the strike, the Syrian government's SANA news agency published an article stating that "units of the army had destroyed, with concentrated and intense strikes, machines and ammunition belonging to the terrorist group Al-Nusra Front. Several of its members were dead and wounded in the strikes" on several areas in the southern countryside of Idlib, including the town of Ehsim.

1 June 2019

A GIF showing the moment of the airstrikes on Ehsim from a video posted by Anas Al Maarawi on Twitter.

At 8:38 AM on June 1, 2019, the Ehsim Today Facebook page posted a picture showing rising smoke from a distance which it claimed was caused by airstrikes on the town of Ehsim. Shortly thereafter at 8:55 AM, media activists Anas Al Maarwai posted a video on Twitter showing the moment several airstrikes hit Ehsim. On the same day, the Syrian government's SANA news agency published an article mentioning "concentrated strikes on the hideouts of the Al Nusra Front terrorists in the southern countryside of Idlib" near the villages of Kafr Awaid and Ehsim.

Orient News published a video on YouTube showing the widespread destruction to the market area hit by the airstrikes. The reporter in the video indicated that the strikes destroyed more than 10 civilian homes and 10 shops. He additionally noted that there were no deaths from the strikes as a large number of civilians already left the town because of the frequent airstrikes. In an interview featured in the video report, a witness describes a helicopter flying over the village of Al Barah and heading north towards Ehsim where it allegedly dropped what he described as an "explosive barrel."

The Syrian Network for Human Rights additionally published an alert on the targeting of the Ehsim medical point on June 1. It claimed the airstrike was by a fixed-wing aircraft belonging to Syrian government forces. According to the organization, the airstrike partially damaged the building and the medical equipment inside.

A picture taken by the investigations team showing the damage to the medical point after the first airstrike on the facility on June 1.

In an interview with the investigations team, Mustafa Bazaar noted that most of the damage to the medical point's building was from the bombing on June 1 as the point was hit by about 5 airstrikes consisting of both missiles and barrel bombs. According to Bazaar, these strikes destroyed the center and its equipment pushing it out of service. Bazaar additionally confirmed that the medical point, which is located on Ehsim's main street, is surrounded by shops, a pharmacy, and civilian homes, all of which were destroyed by the airstrikes.

14 June 2019

A GIF from a video posted by Orient News showing the widespread destruction to Ehsim and the medical point from the June 14 airstrikes on the town.

At 11:14 AM, an account tweeted alerting that Ehsim was hit by four airstrikes. About an hour later, the Facebook page Abilene Village posted a video taken immediately after the bombing showing the medical point and the surrounding area. The video shows that there was a crater from the airstrikes directly in front of facility. The Al Jazeera Syria Twitter account additionally posted a video showing the moment of the air raid on the town.

Later at 11:49 PM on the same day of the incident, Al Jazeera correspondent Milad Fadl posted two videos on Facebook showing the moment of the airstrikes on Ehsim. The first video shows a Su-24 aircraft, according to Fadl, carrying out two consecutive airstrikes on the town with another videoshowing the moment of the third airstrike.

A picture taken by the investigations team showing the location of a missile that landed near the medical point.

A geolocation of an image showing the location near the medical point where the missile landed.

A number of video reports documenting the extent of the damage to the town and its medical point were published by sources on the ground including Al Jazeera Mubashir, Orient News, activist Hadi Al Abdullah and the Ehsim Al Mankoubah Facebook page.

A picture taken by the investigations team showing the building of the medical point in Ehsim on June 14.

The same day of the strikes SANA news published an article mentioning "focused strikes" on the "Al Nusra Front terrorists" in the towns of Heish, Hashm, and Al Mastumah in the southern countryside of Idlib. SANA reports that the strikes destroyed their vehicles and equipment as well as killed some among their ranks.

Photos published by AFP photographer Omar Haj Qaddour, which show a crater from a missile immediately in front of the medical point in addition to the destruction to the surrounding buildings from the strikes.

The Syrian Network for Human Rights published a report on the airstrikes stating that a fixed-wing aircraft belonging to the Syrian regime bombed the medical point in Ehsim completely destroying the facility and pushing it out of service.

Destruction Analysis

3 May 2019

After the May 3 airstrikes, the medical point's building was still standing. Satellite imagery shows damaged houses around 75 meters away from the medical point.

Satellite imagery from before and after May 3.

1 June and 14 June 2019

Given there are no satellite images taken between both dates, it's difficult to ascertain the damage from each strike separately. However, the damage from the two strikes are clearly visible in satellite images captured in August 2019. The imagery shows multiple collapsed buildings surrounding the medical point as well as the destruction of the facility's building itself.

Satellite imagery taken before June 1, 2019 and after the June 14, 2019 showing the widespread damage caused by both strikes.

Pictures taken by the investigations team of the destruction to the medical point and the surrounding areas from the June 1 and June 14 airstrikes.

Flight Data Analysis

To further verify this incident, Syrian Archive cross-referenced information from open sources and pictures and videos taken by the investigations team with flight observation data from a spotter organization, which documents sightings of warplanes by partner observers in cities throughout Syria. These observers collect data about the aircrafts such as the type of plane and the direction the plane is flying. Although there may be misidentifications of aircraft in the flight data, additional information such as witness statements and social media posts can corroborate the identified aircraft and its course. Data for flights in the Idlib, Hama, Homs, and Lattakia regions occurring briefly before, during, and after the three strikes was analyzed.

3 May 2019

At 9:30 AM, Mi-8 helicopters were spotted taking off north from the Hama Military Airbase. Between 9:00 AM - 11:00 AM, 8 Mi-8 helicopters were additionally spotted taking off north from the Jeb Ramleh Airbase in Hama. At 09:36 AM, a helicopter was seen flying north over Kafr Zita (38 km south of Ehsim). Additionally at 09:53 AM, a helicopter was spotted flying north over Kafranbel (12 km south of Ehsim). At 09:56 AM and 09:59 AM, helicopters were spotted circling over the Jabal Al Zawiya region where the town of Ehsim is located. The common practice of circling by war zone aircrafts featured in this and previous data sets generally indicates a target acquisition and/or preparation for an imminent strike.

In addition to this flight observation data, the Idlib Governorate Observatory Telegram channel warned of a helicopter circling over Jabal Al Zawiya at 09:46 AM on the day of the incident. The channel also noted of three helicopters circling over the region two minutes later at 09:48 AM.

A screenshot of the posts on the Idlib Governorate Observatory Telegram channel.

Although this data matches allegations made online that the airstrikes were carried out by Mi-8 helicopters, there is no direct evidence available that one of the observed aircraft was directly involved in the strikes on Ehsim. However, planes above the town and surrounding areas increases the likelihood and further confirms that incident occurred at the specified date and time reported. Given that the majority of the aircraft spotted over Jabal Al Zawiya are primarily used by the Syrian Air Force, it is likely that the Syrian government is responsible for the May 3 airstrikes.

1 June 2019

At 08:09 AM and 08:20 AM, Su-24 fixed-wing warplanes were spotted taking off northwest from the T4 West Airbase in Homs. At 08:18 AM, a Su-24 was additionally spotted flying northwest over Khan Sheikhoun (31 km south of Ehsim). A minute later at 08:19 AM, a Su-24 was spotted flying northwest over Maaret Al Numan (15 km southeast of Ehsim). Lastly, at 08:19 AM, 08:32 AM, 08:37 AM, and 08:46 AM, Su-24 warplanes were spotted circling over the Jabal Al Zawiya region where the town of Ehsim is located.

In addition to Su-24 warplanes, a Su-22 fixed-wing aircraft was observed circling over Jabal Al Zawiya at 08:14 AM and Russian fixed-wing warplanes were observed circling over Jabal Al Zawiya at 08:32 AM and 08:55 AM. As mentioned earlier, the common practice of circling by war zone aircrafts featured in this and previous data sets generally indicates a target acquisition and/or preparation for an imminent strike.

Although this data matches allegations made online that the airstrikes were carried out by a fixed-wing aircraft, there is no direct evidence available that one of the observed aircraft was directly involved in the strikes on Ehsim. However, planes above the town and surrounding areas increases the likelihood and further confirms reports of the incident occurring at the specified date and time reported. The observation of Su-22 warplanes, used by the Syrian Air Force, and Su-24 aircraft, used by both the Russian and Syrian Air Force, indicates that either party is likely responsible for the June 1 airstrikes.

14 June 2019

At 10:26 AM and 10:42 AM, Su-22 warplanes were spotted taking off north from the Shayrat Airbase in Homs. At 10:31 AM, a Su-22 warplane was additionally spotted flying northeast over Muhradah (52 km southeast of Ehsim). One minute later at 10:32 AM, a Su-22 was spotted flying north over the town of Heish (20 km southeast of Ehsim). Between 10:50 AM and 11:06 AM, a number of Su-22 warplanes were spotted circling over Jabal Al Zaiwya, the region where the town of Ehsim is located.

In addition to Su-22s, a Su-24 fixed-wing warplane was spotted taking off northwest from the T4 West airbase in Homs at 10:46 AM. Two minutes later at 10:48 AM, a Su-24 was spotted flying north over Khan Sheikhoun (31 km south of Ehsim). At 10:51, a Su-24 was spotted flying north over Maaret Al Numan (15 km southeast of Ehsim). Lastly, between 10:51 and 11:06, Su-24 warplanes were spotted circling over Jabal Al Zawiya where the town of Ehsim is located. As mentioned previously, the common practice of circling by war zone aircrafts featured in this and previous data sets generally indicates a target acquisition and/or preparation for an imminent strike.

Although this data matches allegations made online that the airstrikes were carried out by fixed-wing aircraft, there is no direct evidence available that one of the observed aircraft was directly involved in the strikes on Ehsim. However, planes above the town and surrounding areas increases the likelihood and further confirms that incident occurred at the specified date and time reported. The observation of Su-22 warplanes, used by the Syrian Air Force, and Su-24 warplanes, used by both the Russian and Syrian Air Force, indicates that either entity is likely responsible for the June 14 airstrikes.

Conclusion

Using the information outlined above, Syrian Archive was able to confirm and verify that the medical point in the town of Ehsim as well as the area surrounding the facility was hit by at least three separate airstrikes often with multiple missiles on May 3, July 1, and July 14, 2019. The strikes destroyed the medical facility's building and equipment rendering it completely out of service as well as destroyed the residential homes and commercial stores surrounding the facility. Although Syrian Archive is unable to definitively identify the parties responsible for the strikes, open source information, witness testimony, and flight observation data points towards the Russian or Syrian Air Force as responsible for the airstrikes.

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Repeated Airstrikes on a Medical Point in Ehsim

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INVESTIGATIONS