Airstrikes on Al Shami Hospital in Ariha

Initial Summary

• Place of Incident: Idlib: Ariha
• Location Hit: Al Shami Hospital (also known as Ariha Surgical Hospital)
• Date: 29 January 2020
• Time: Between 22:30 - 22:40
• Reported Deaths: 13 people including women, children, and a hospital staff member
• Reported Wounded: 68 people
• Type of Attack: Airstrike with 3 missiles
• Munitions Used: N/A
• Potentially Responsible: A Russian fixed-wing aircraft possibly belonging to the Russian Air Force

Introduction

On January 29, 2020, the anesthesia technician Zakwan Tamaa was injured and later killed by an airstrike that targeted Al Shami Hospital (also known as Ariha Surgical Hospital) in the town of Ariha, Idlib. Tamaa originally worked at Al Bayan Hospital in Aleppo, but was then forced to flee to Ariha after the hospital was hit multiple times by airstrikes and pushed out of service. At Al Shami Hospital, Tamaa worked as both an anesthesia technician and the hospital’s managing director. However, the consistent bombardment of civilian populated areas and medical facilities has made work for Tamaa and other medical personnel in Idlib dangerous and unsustainable.

Tamaa and twelve other civilians in and around the facility died from this most recent airstrike on Al Shami Hospital. The majority of those killed as well as the 68 wounded were women, children, and hospital staff displaced from villages and towns around Jabal Al Zawiya. This airstrike is one of many airstrikes on medical facilities and other civilian populated areas in Idlib.

Methodology

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

1. A local investigations team collected 4 testimonies from eye-witnesses or those who witnessed the immediate aftermath of the airstrike and took photographs and videos of the impact site two days after the strikes;
2. Securing, analysing, and verifying 38 videos and images uploaded to social media networks purportedly showing the incident;
3. Analysing satellite imagery showing the locations after the incident as well as flight observation data revealing the planes over the towns at the purported time of the strike.

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.

Background on the Hospital

An image taken by the investigations team of Al Shami Hospital (Ariha Surgical Hospital) two days after the incident.

Al Shami Hospital (or Ariha Surgical Hospital) is located in the town of Ariha, around 12 km south of Idlib. As shown in an online government registry of hospitals in Idlib, Al Shami was one of many private hospitals existing in the governorate before the uprisings in 2011. On the registry, the hospital is classified as for general surgery and obstetrics. It was later converted in early 2015 into a public hospital for all the residents of Ariha and the surrounding villages.

Ariha and its surrounding major towns as shown on Google Earth. Al Shami Hospital is located in northeast Ariha.

Al Shami Hospital in a government registry from 2008 of hospitals in the Idlib governorate. The registry lists the hospital’s phone number, speciality, and town.

Interviewed by the investigations team, Dr. Wajih Qarat, the executive director of Al Shami Hospital, described the facility as a three-story building with multiple departments including emergency ambulance services, radiology, and general and orthopedic surgery. Alongside these departments, the hospital also houses a laboratory, a pharmacy, an operating room, and a psychiatric clinic. According to Qarat, the hospital holds 30 beds and serves around 200,000 people in Ariha and its surrounding countryside.

The organization Social Development International’s statistics of the beneficiaries served and operations completed by the hospital during the latter half of 2019.

According to Qarat, the hospital served around 200 patients a day before the incident. Al Shami Hospital, beginning in 2015, was first supported by volunteer doctors and medical staff and was later supported by Doctors Without Borders and the Idlib Free Health Directorate. Later in 2018, the organization Social Development International, a licensed civil society organization based in Istanbul, began supporting the facility.

The Social Development International’s logo can be found on the facility’s equipment and walls.

Statistics provided by Social Development International show the hospital as in service during the latter half of 2019. Published on January 21st 2020, these statistics report that the hospital treated 74,882 patients from July to December 2019. According to Social Development International, 1,175 of the patients seen in the latter half of 2019 underwent surgery and 20,142 were treated through other medical procedures. The most recent airstrike on Al Shami Hospital has prevented the facility from providing any of the necessary medical services to the community of Ariha and its surrounding villages.

What Happened (and When)?

A video showing the inside of the hospital directly after the airstrike.

According to open sources as well as interviews with witnesses and officials conducted by Syrian Archive’s investigations team, on Wednesday January 29, 2020 between 22:30 - 22:40 three airstrikes hit the neighborhood of Al Midan in Ariha damaging Al Shami Hospital. A missile first hit near the eastern side of the Hospital. Shortly after, two missiles directly hit the hospital on its southern and western sides, severely damaging the facility and pushing it out of service. Alongside destroying the medical facility, the air raid was said to have also damaged an oven near the hospital. These three strikes killed 13 civilians and injured 68 others while destroying not only the hospital but also the residential buildings within a 500 meter radius of the medical facility.

Mohammed Al Hashim, director of the Syrian Civil Defense in Ariha, confirmed in an interview with the investigations team that at 22:40 on Wednesday January 29, Russian warplanes targeted the hospital with three missiles that pushed the facility out of service. According to Al Hashim, the strikes killed 13 civilians and left 67 injured in addition to severely damaging the hospital and the surrounding residential areas.

A still from a video report uploaded by EuroNews showing the destruction inside Al Shami Hospital.

Posts on social media corroborate Al Hashim’s estimates of when the incident occurred. Quickly after the first airstrike at 22:40, a Facebook page titled the Coordination of the Syrian Revolution in the City of Idlib reported that a “Russian airstrike” hit the city of Ariha. This same page later reported the next day of three strikes hitting the hospital and the surrounding residential areas killing at least 10 and injuring over 40.

A still from a video uploaded by the Civil Defense documenting their arrival at the hospital after the incident.

Mustafa Halima, a volunteer of the Syrian Civil Defense team in Ariha and one of the first to arrive at the hospital after the strike, additionally confirmed three missiles hit Al Shami Hospital in an interview with the investigations team. Halima detailed that the hospital was hit at 22:40 on January 29 by Russian airstrikes. He commented further that the second strike on the hospital occurred as first responders were arriving at the scene. Then while first responders gathered the injured and recovered bodies stuck under rubble from the second strike, according to Halima, the hospital was hit again by a third missile. The first responder described rescuing an injured woman from under the rubble as well as the bodies of six children and their mother all killed from the blasts. According to Halima, search and rescue efforts by civilians and first responders continued well into the night after the third and final missile hit.

A geolocation of a video uploaded by Enab Baladi to the incident site.

Footage posted online shows the rescue efforts by the Civil Defense. The first responders group uploaded multiple videos taken during the strikes and the morning after the incident. The videos show the damage as Civil Defense volunteers confirm multiple strikes on the town and facility as well as the number of civilians killed and injured. The rescue efforts featured in the video uploaded by the Civil Defense match a video report posted by SY+, which shows the Civil Defense extinguishing fires started by the airstrike. Additionally, the Violet Organization, another first responder group, and other Facebook pages posted videos and images of the efforts to rescue those injured and killed.

Stills from a video uploaded by citizen journalist Anas Tracey showing the damage to Al Shami Hospital and the surrounding residential area.

Similar to Al Hashim, Halima, and the open source information outlined above, a receptionist at Al Shami Hospital told the investigations team that at around 22:35 on January 29 the hospital and its surrounding areas were targeted by three airstrikes which hit the hospital’s eastern, southern, and western sides. According to the receptionist, after the first blast, managing director of the hospital Zakwan Tamaa exited the facility to see where the missile hit. The receptionist recounted that Tamaa saw that the missile hit an apartment building directly east of the hospital. As he was looking, a second airstrike hit the hospital severely injuring Tamaa. In fear of a third strike, Tamaa took cover and was later rescued by first responders. Three days after the incident, Tamaa died from his injuries and Al Shami Hospital closed.

A still from a video uploaded by Anas Tracey showing Zakwan Tamaa injured on a table after the strike.

In a video taken directly after the strikes and posted online by Anas Tracey, Zakwan Tamaa is shown on a hospital operating table and is noted as one of many severely injured by the strikes. In the video, hospital staff treat Tamaa as other injured civilians are placed into ambulances by first responders. The video additionally shows the internal destruction to the medical facility’s corridors, patient rooms, equipment, and ambulances.

An image uploaded unto Facebook by the Violet Organization showing first responders arriving at the scene of the hospital.

A still from a video uploaded by the Civil Defense in Idlib showing the search and rescue efforts in and around Al Shami Hospital.

In the days after the incident, reports by Al Jazeera Mubashir, Enab Baladi, Euronews, and the Syrian Network for Human Rights confirmed the incident, some featuring interviews with first responders and hospital staff who witnessed the strikes.

Mentioning the victims of the strikes, those interviewed by the investigations team emphasized that Al Shami Hospital was the only medical facility operating in Ariha and the Jabal Al Zawiya area at the time as other hospitals, medical centers, and medical points in the immediate surrounding areas had been hit and forced out of service by airstrikes.

Killed and Injured

A still from a video showing Civil Defense teams recovering a body from under a semi-collapsed building.

Open sources reveal the number of those killed and injured in the strikes. Videos posted by the Civil Defense and others show the search and rescue efforts to retrieve those trapped under rubble. Later, a Civil Defense video report on the incident, posted before the death of Tamaa, details 12 killed and 68 injured from the airstrikes. The death of Zakwan Tamaa increased the total killed to 13 civilians.

Verifying those killed and injured was difficult for the investigations team as first responders were forced to disperse those injured to a number of different and distant medical points outside Ariha.

Nevertheless, five women, a child, and the managing director of the hospital were the 7, amongst the reported 13, identified by name on social media as killed by the blasts.

Killed

Destruction

Posts on social media initially revealed the damage to the hospital and its surrounding residential areas. Around 20-30 minutes after the strikes, the YouTube channel Min Ard Al Sham posted a video showing the destruction and fire inside the hospital from the second airstrike. Additionally, a video posted onto Facebook by citizen journalist Ibrahim Tarisi shows the hospital directly after the incident. Throughout the video, Tarisi describes the first, second, and third floors of the hospital as completely destroyed along with the surrounding residential areas. Matching other open source media, footage from Shaam News and civilian Journalist Jamil Al Hassan show the damage to Al Shami Hospital and the Al Midan neighborhood. These open sources are complemented by pictures and videos taken by the investigations team on the ground of the hospital and its surrounding areas two days after the strikes.

Satellite imagery of the hospital and the surrounding areas before and after the strikes. Multiple collapsed or destroyed buildings shown in videos posted online are visible in this satellite imagery.

Damage to the Hospital

An image taken by the investigations team of the front of Al Shami Hospital.

Struck three times, Al Shami hospital suffered severe damage to its medical equipment, patient rooms, and corridors ultimately pushing the hospital out of service. Videos taken by Syrian Archive’s investigations team reveal the extent of the internal damage to the facility. Stored medicine and medical supplies are shown scattered on the ground with lights and wires hanging from the ceiling. Video shows doors broken, cracks in the walls, and holes in the ceiling from the strikes. The corridors of the hospital are additionally shown filled with destroyed furniture, ruined medicine, and concrete rubble.

Images taken two days after the strikes by the investigations team that show the internal damage to Al Shami Hospital.

According to the team on the ground, the hospital’s pharmacy, radiology room, operating room, and cellar were severely damaged by the strikes. The hospital’s devastating internal damage matches the destruction of the surrounding Al Midan residential neighborhood.

Damage to the Surrounding Areas

A still from a video taken by the investigations team of outside the hospital.

According to the investigations team on the ground, four buildings surrounding the medical facility in Al Midan were completely destroyed by the strike. The team reported buildings within 500 meters of the hospital as damaged and marked by shattered windows and fallen concrete. The facades of buildings facing the direction of the hospital were severely damaged.

Images taken two days after the strikes by the investigations team of the areas surrounding Al Shami Hospital.

Al Hurra News published aerial footage of the hospital and its surrounding areas showing collapsed buildings and streets full of rubble. From the ground, a Syria TV video report features the damage to the Al Midan neighborhood showing broken electricity poles and the shattered windows of five to six-story buildings. A video report by Shaam News Network shows similar damage. Residents interviewed in the Shaam News video report describe some Civil Defense teams as arriving an hour after the targeting due to the multiple strikes on the facility and the surrounding areas as well as claim the Russian government as responsible for the strikes.

A still from Al Hurra News’ aerial footage of Al Shami Hospital and the surrounding areas.

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 occurring briefly before, during, and after the time of the incident around 22:35 near Ariha was analyzed.

Flight observation data shows two Russian fixed-wing aircraft spotted taking off from Hmemim Airbase (75 km southwest of Ariha) at 22:17 and 22:20. Shortly after, another Russian fixed-wing aircraft was spotted circling over Ariha at 22:22. The common practice of circling by warzone aircrafts featured in this data set generally indicates a target acquisition and/or preparation for an imminent strike. Closer to the moment of the strikes, at 22:36, a Russian fixed-wing aircraft was spotted flying south over Ariha. Lastly, at 22:46 and 22:47, Russian fixed-wing aircraft were spotted circling above Ariha. This data corroborates open source information and witness testimony of the strike having occurred at or around 22:30 and conducted possibly by the Russian Air Force.

However, there is no information available indicating that one of the observed aircraft was directly involved in the strike detailed above. Nevertheless, the presence of Russian fixed-wing warplanes above Ariha at or around the time of the strike further confirms the purported times the missiles hit Al Shami Hospital as well as indicates the Russian Air Force as a party potentially responsible for the strikes.

Conclusion

From the information outlined above, Syrian Archive concludes that the Al Shami Hospital (Ariha Surgical Hospital) in Ariha was hit by an airstrike with multiple missiles between 22:30-22:40 on January 29, 2020. The missiles hit the hospital’s eastern, southern, and western sides severely damaging the facility and pushing it out of service. According to the Syrian Civil Defense, the strikes killed 13 civilians and injured 68 others. Those killed included the hospital’s managing director Zakwan Tamaa. Although Syrian Archive is unable to definitively identify the party responsible for the strikes, social media posts, witness testimony, and flight observation data points towards the Russian Air Force as the party potentially responsible for the incident.