Medical Facilities in Syria Still Under Fire

Six Months On

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<ul>
<li>Location: Maarat al-Numaan (Idlib governorate, Syria)</li>
<li>Claimed targets: Al-Salaam hospital</li>
<li>Date: 03 January 2018</li>
<li>Reported killed: 2 killed (including one infant who was 1 year old)</li>
<li>Reported injured: 10 injured, as reported by Thiqa News Agency</li>
<li>Potentially responsible: Russian or Syrian Air Force</li>
</ul>
<h2>Background of Maarat al-Numaan</h2>
Maarat al-Numaan (also known as al-Maarra) is a city located 33 km south of Idlib. It is the second largest city in Idlib, with a population of roughly 58,008 (2004 census). Maarat al-Numaan has a long history, and its museum has <a href="http://www.esyria.sy/eidleb/index.php?p=stories&category=ruins&filename=200801071848011">mosaics from the Dead Cities</a>, dating from the 1st to 7th centuries.
The city saw demonstrations early on in the Syrian uprising. <a href="https://www.youtube.com/watch?v=ptgRwJ0tGq8">One of the first demonstrations</a>, dating from 24 April 2011, documents demonstrators chanting for freedom and Daraa. Security forces <a href="https://www.youtube.com/watch?v=Z_8a7FlJMAU">often intervened</a> to break up demonstrations. The city has seen a <a href="https://www.youtube.com/watch?v=sp29oYjAGRQ">number of defection of military officers</a>, and as a result, swiftly became an important hub for <a href="https://www.youtube.com/watch?v=mfLaZ1G3s20">organizing protests</a>. In October 2012, Maarat al-Numaan fell under <a href="https://www.youtube.com/watch?v=5aralZ54lXs">control by the Free Syrian Army</a> (FSA), since which it has ceased to be controlled by the Syrian government.
On 13 March 2016, al-Nusra Front and Jund al-Aqsa <a href="https://apnews.com/5eefe3dd4c2045c3b2277fcb8276bda9">attacked the Free Syrian Army&#39;s Division 13</a> in Maarat al-Numaan, overrunning their depots, killing seven combatants and wounding as many as 20 others. Two of Division 13&#39;s storage facilities which were filled with US manufactured anti-tank TOW missiles were surrendered to al-Nusra. At the time, Ahmad al-Saaoud, a Syrian rebel commander, said the attackers had seized light weapons and ammunition from his group but had not managed to capture any TOW anti-tank missiles.
Civilian opposition against al-Nusra <a href="http://stepagency-sy.net/archives/94904">continued for several months</a> in Maarat al-Numaan until 6 June 2016 when clashes broke out again. On 9 June, <a href="https://twitter.com/jenanmoussa/status/873483701140811776">an agreement was signed</a> between the Free Idlib Army and Tahrir al-Sham. This agreement requires the Division 13 to be stripped of power and all headquarters of Division 13 to be managed by the Free Idlib Army with the exception of one to be managed by Tahrir al-Sham.
<h2>Background about Al-Salaam Hospital</h2>
Al Salaam Hospital is a maternity hospital in Maarat al-Numaan founded in 1995. It contains all medical departments, including women&#39;s clinics, orthopaedics, and general surgery. The hospital served approximately 500,000 people.
Prior to the attack on 3 Jan 2018, the hospital treated approximately 8.000 to 9.000 patients per month. In December of 2017, the <a href="https://www.sams-usa.net/press_release/maternity-hospital-maarat-al-numan-city-destroyed-following-three-attacks-four-days/">hospital delivered 674 babies</a> and <a href="https://www.facebook.com/alsalam.Hospital2/photos/a.390735564429659.1073741860.182840021885882/870621066441104/?type=3">the total number of beneficiaries</a> from its services reached 8670 patients, including 1789 in the internal clinic, 3356 in the paediatrics clinic, 2668 in the women&#39;s clinics, and hundreds of other patients in different clinics. See below:
<img src="/uploads/al_salaam00_e04e4abf86.jpg" alt="al-salaam00.jpg">
Al Salaam Hospital is the only maternity hospital in Maarat al-Numaan that provided emergency services, medical consultations, as well as deliveries.
<h2>What Happened?</h2>
On 03 Jan 2018 between 11:38 AM and 12:00 AM (in Damascus local time), al-Salaam hospital in Maarat al-Numaan was attacked allegedly by the Russian air force. The Syrian American Medical Society (SAMS), who supported the hospital, published a <a href="https://www.sams-usa.net/press_release/maternity-hospital-maarat-al-numan-city-destroyed-following-three-attacks-four-days/">report</a> stating that the latest airstrikes resulted in the &#39;killing [of] five people, including a newborn baby girl and her father, and injuring many more.&#39;
On their Facebook page, <a href="https://www.facebook.com/sams.arabic/videos/1209630115836875/">SAMS published a video</a> showing the hospital from the inside, immediately after the attack. That evening <a href="https://www.facebook.com/sams.arabic/videos/1209757322490821/">SAMS later reported</a>: &quot;Al-Salaam hospital in Maarat al-Numaan was becoming out of order, after violent attacks against it caused significant material damage, and its medical staff and patients were evacuated. A newborn baby girl was killed two hours later after she has been born in the hospital and another was injured as a result of the shelling.&quot;
Thiqa News agency <a href="https://www.youtube.com/watch?v=kKJi6vdRAmM">also published a video on their YouTube channel</a> showing the destruction of the hospital. See still below:
<img src="/uploads/al_salaam01_9296fee82a.png" alt="al-salaam01">
The video includes an interview with one of the medical staff who stated: &quot;Russian aircraft targeted al-Salaam hospital after the Duhur prayer [noon prayer]. The hospital is out of service now as a result of this attack, we have ten injuries, including three children.&quot;
Hadi Alabdallah <a href="https://www.youtube.com/watch?v=Y6LrgHofQB4">also published a video</a> showing destruction of the incubators section of the hospital. See below:
<img src="/uploads/al_salaam02_19f414b27f.png" alt="al-salaam01">
Another still from the Alabdallah video shows destruction outside of the hospital. The Syrian Archive has identified similar objects between Alabdallahs video and Thiqa News Agency video. See below:
<img src="/uploads/al_salaam11_4e8743593b.jpg" alt="al-salaam01">
In the same video, Alabdallah conducted an interview with one of the hospital doctors who stated: &quot;We were in the operations room when we were surprised by a huge explosion caused by two missiles. We went out immediately to check the casualties. We had five victims and a number of wounded, in addition to extreme physical damage.&quot;
RFS Media <a href="https://www.youtube.com/watch?v=RH0g4bxbbAQ">also published a video</a> showing the destruction in the front of the hospital. The video also features an interview with a member of Syria Civil Defence rescue team, who stated: &quot;The warplanes launched heaviest attacks on several areas in the southern countryside of Idlib. We are now in al-Salaam hospital in Maarat al-Numaan, a civilian hospital, which was targeted by airstrikes, resulting in five victims and ten wounded.&quot;
Maara Media Center (MMC) <a href="https://www.youtube.com/watch?v=sVU982I06rY">published a video</a> by Mohamed Aldaher showing additional destruction outside of the hospital from a different perspective. See stills below:
<img src="/uploads/al_salaam04_4ec6d34612.jpg" alt="al-salaam01">
<img src="/uploads/al_salaam05_74f37f6792.png" alt="al-salaam01">
The video contains an interview with one of Syria Civil Defence members who stated: &quot;Russian warplanes targeted Maarat al-Numan city with two air strikes targeting al-Salaam hospital and some shops surrounding it. A city inhabited by civilians.&quot;
Eye on Homeland (EOH) <a href="https://www.youtube.com/watch?v=9l9hy36AbZo">published an Additional video</a> on their youtube channel showing the outside of the hospital, where the attack caused destruction of nearby shops surrounding the al-Salaam hospital. See below:
<img src="/uploads/outside01_4ef818ad0a.jpg" alt="al-salaam01">
The Syrian Archive identified objects contained in both the Maara Media Center video and the Eye on Homeland video to confirm both videos were filmed in the the same location. See below:
<img src="/uploads/al_salaam12_d880bd48a6.jpg" alt="al-salaam01">
Edlib Media Center also published a video <a href="https://www.youtube.com/watch?v=Ht_bbjEXEUg">showing the first moments after the attack</a>. See below:
<img src="/uploads/outside07_e2436c9b8f.png" alt="al-salaam01">
<h2>Where did it happen?</h2>
Al Jazeera published a video after the attack <a href="https://www.youtube.com/watch?v=J1NBfJU5r7M">showing rubble removal activites around the hospital</a>, by Syria Civil Defense.
The Syrian Archive was able to geolocate several landmarks and building using the above video and satellite images, thus confirming that the targeted location was the al-Salaam hospital and its surroundings. The below stills were taken from inside and outside the hospital:
<img src="/uploads/B_0b2b4c95ef.png" alt="al-salaam01">
<img src="/uploads/A_0c5700d61b.png" alt="al-salaam01">
These landmarks and buildings were then compared with the following satellite image taken from Digital Globe, confirming the location:
<img src="/uploads/BB_2_fb670390aa.png" alt="al-salaam01">
<h2>When did it happen?</h2>
According to some testimonies in the videos above, the airstrike took place after the noon prayer, <a href="https://timesprayer.today/6045-month01-year2018-%D8%AC%D8%AF%D9%88%D9%84-%D9%85%D9%88%D8%A7%D9%82%D9%8A%D8%AA-%D8%A7%D9%84%D8%B5%D9%84%D8%A7%D8%A9-%D8%B4%D9%87%D8%B1-%D9%8A%D9%86%D8%A7%D9%8A%D8%B1-%D9%85%D8%B9%D8%B1%D8%A9-%D8%A7%D9%84%D9%86%D8%B9%D9%85%D8%A7%D9%86.html">which was held around</a> 11:38 AM on 03 Jan 2018.
At 11:48 AM on 03 January, a citizen reporter, based in Maarat al-Numaan, <a href="https://www.facebook.com/100010399271536/videos/543910859298885/">Anas Al Marwai, published a video</a> on his Facebook page showing destruction around the al-Salaam hospital. See below:
<img src="/uploads/anas_alsalam_03cb6b6cb9.jpg" alt="al-salaam01">
Another Citizen reporter Mutie Jalal also <a href="https://twitter.com/shamalmjd1/status/948492991605411840?ref_src=twsrc%5Etfw">published a tweet</a> at 11:55 AM about the attack, stating: &quot;Two Russian airstrikes on Sarakib and one on Maarat al-Numaan and another one on Muharram.&quot;
Hadi Alabdallah <a href="https://www.youtube.com/watch?v=5LIEMU7tMIQ">published another video</a> showing the destruction of shops around the hospital. See below:
<img src="/uploads/al_salaam10_5d537f5fff.jpg" alt="al-salaam">
In the same video, Alabdallah stated: &quot;Although it&#39;s raining and the sky is full of clouds, the Russian warplanes do not stop flying and bombing the areas of Idlib countryside.&quot; Through comparing Alabdallah&#39;s description of the weather at the location to recorded data of the <a href="https://weather.com/en-GB/weather/monthly/l/SYXX0099:1:SY">weather on 03 January in Maarat al-Numaan</a>, the Syrian Archive was able to confirm the weather was rainy and cloudy, corroborating claims made in the videos. See below:
<img src="/uploads/al_salaam13_13bb4f366a.jpg" alt="al-salaam01">
<h2>Flight Data Analysis</h2>
To provide a further layer of verification, the Syrian Archive cross-referenced findings from the videos and witness testimony with flight observation data from a spotter organisation. This process necessitated analysing observation data for flights between 11:00 and 14:00, the period directly before and after the reported attack between 11:30 and 11:45 as was claimed by media activists. See below:
<iframe height="800" src="https://public.tableau.com/views/03012018_marrat_al_numan/Sheet1?:showVizHome=no&:embed=y&:display_count=yes" width="100%"></iframe>

<a href="https://public.tableau.com/views/03012018_marrat_al_numan/Sheet1?:embed=y&:display_count=yes">View full visualisation</a>
Through comparing where flights were observed, the type of aircraft observed, the time flights were observed, and the direction flights were heading, and comparing this data to geolocation conducted in earlier steps, the Syrian Archive was able to identify several flights potentially responsible for the attack (several fixed-wing Russian aircraft), seen circling in the immediate vicinity of the geolocated attack site starting from 11:41 AM. Previous research has found that circling flights typically indicate target acquisition and/or preparation for an imminent attack.
While there is no direct evidence available that one of the observed aircrafts was involved in the attack on Maarat al-Numaan, the presence of these aircrafts increase the likelihood that an air attack occurred at this location and the time stated by the citizen reporters as well as humanitarian groups, and estimated also using imagery from the attack.
<h2>Casualties</h2>
On his Facebook page, Anas Al Marwai <a href="https://www.facebook.com/photo.php?fbid=544037762619528&set=a.115427455480563.1073741828.100010399271536&type=3&theater">published a photo of a newborn baby girl from Ma&#39;ar Shamareen</a> named &quot;Tal Firas Al Omar&quot;, stating that she died an hour after she was born in Al Salaam Hospital as a result of the bombing.
Mukhils Kahttab, a citizen-based in Maarat al-Numaan, <a href="https://www.facebook.com/photo.php?fbid=2018781351743914&set=a.2016163322005717.1073741829.100008362053367&type=3&theater">published a photo</a> on his Facebook page of what he claimed was &quot;his nephew, who was killed as a result of the al-Salaam hospital targeting.&quot;

Joint report of medical facilities attacked in Idlib

Bombing Al Salam Medical Facility

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<ul>
<li>Location: IDLIB : Saraqib</li>
<li>Hospital: Oudai (Ehsan) Hospital</li>
<li>Beneficiaries: ~36000 people in a year</li>
<li>Date of the attack: 29/01/2018</li>
<li>Time: 07:40am (potato market) 08:10am (hospital attack)</li>
<li>Attacks: 1 airstrike</li>
<li>Reported injured: 3 injured from the medical facility staff</li>
<li>Potentially responsible: Russian or Syrian air force</li>
<li>Previous attack on the hospital: 21/01/2018</li>
</ul>
<h2>Background about Oudai (Ehsan) Hospital</h2>
Oudai (Ehsan) Hospital is located in Saraqib city in the southern countryside of Idlib city; it provides medical services such as surgical operations, first aid and health care to the people of Saraqib. The hospital receives roughly 3000 patients a month, two surgical rooms, a department of intensive care, a section for incubators, and a building for clinics.
<h2>Previous attacks on Oudai (Ehsan) Hospital</h2>
Idlib health directorate <a href="https://www.facebook.com/Idleb.Health.Directorate/posts/1190245281078825">reported that Oudai hospital was attacked</a> on 21/01/2018 with an airstrike that resulted in structural damage to the hospital and its equipment.
<img src="/uploads/pre_attack_oudai_5805e4cb2e.png" alt="Idlib health directorate FB post">
<h2>What Happened</h2>
On 29 January 2018 local sources reported that Owdai Hospital in Saraqib was targeted by an airstrike, following an earlier airstrike that damaged the hospital on 22 January 2018.
Edlib Media Center <a href="https://www.youtube.com/watch?v=wQAVO0VECTs">published a video</a> showing what they claim to be the first moment of the attack that bombed the Oudai Al Hussein hospital. See below:
<img src="/uploads/first_moment_8a0d6b7c3f.png" alt="first moment of the attack">
The <a href="http://sn4hr.org/sites/news/2018/01/29/russian-forces-shelled-oday-saraqeb-hospital-saraqeb-city-idlib-suburbs-january-29/">Syrian Network for Human Rights reported</a> that the hospital was treating victims of an earlier bombing at the new potato market in Saraqib January 29th 2018 when the hospital was attacked.
Assi Press <a href="https://www.facebook.com/assipress/posts/1752369028149274">published photos at 9:35</a> of injured people being treated as a result of the attack that targeted the potato market.
Citizen journalist Hadi Alabdallah <a href="https://www.youtube.com/watch?v=DHf5r3aPhgU">published a video</a> showing the Syrian Civil Defense rescuing the injured as a result of the attack on the Saraqib potato market.
<img src="/uploads/potator_market_1_0a86a9b7af.png" alt="potato market">
Alabdallah stated in the video: &quot;11 killed and many injured in a new massacre committed by the airforce which bombed the potato market.&quot;
Edlib Media Center <a href="https://www.youtube.com/watch?v=kEh1xqI9UJ8">published a video</a> about the potato market bombing showing those killed and injured people as a result of the airtsrike, as well trucks damaged in the attack. The photo clearly shows a possible crater as a result of the airstrike that targeted this location.
<img src="/uploads/crater_potato_market_35e148a330.png" alt="potato market-2">
Geolocation of the impact site (the potato market) was possible through using the video published by Alabdallah. Three banners standing in the main street can clearly be seen both in the video still and in the satellite imagery. See below:
<img src="/uploads/geollocation_potato_market_1bcf72c3f2.jpg" alt="potato market-3">
According to witness testimonies collected by the Syrians for Truth and Justice, the killed and injured people from the potato market attack were moved to Oudai hospital, which was then subsequently bombed by airstrikes.
The Syrian Archive has identified stills from the <a href="https://www.youtube.com/watch?v=TBoFbO0YiYE">Smart News Agency video</a> as well as from the <a href="https://www.youtube.com/watch?v=qi_h0TDek5A">Thiqa News aAgency video</a> showing the Oudai hospital before and after the attack. In the still above, dead bodies as a result of the potato market attack can clearly b seen. In the second still below shows damage of the same location after the airstrike that targeted the hospital.
<img src="/uploads/before_after_oudai_93f797189f.jpg" alt="before-after-Oudai">
Alabdallah <a href="https://www.youtube.com/watch?v=R1LYNZ5-1BA">published another video on the same day of the potato market attack on 29 January</a> showing damage to the Oudai hospital as a result of an airstrike following the airstrike on the potato market. See below:
<iframe width="560" height="315" src="https://www.youtube.com/embed/R1LYNZ5-1BA?rel=0" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>

He stated in the video: &quot;After the morning massacre that was committed by the airforce in the potato market, which resulted in the death of 11 people and in many injured, those injured were transferred to Oudai (Ehsan) hospital in Saraqib to be treated. But after this, the Russian airforce targeted this hospital, resulting in the hospital becoming completely out of service. A large crater resulted from the munition used by the airforce. A few of the medical staff were injured as a result of this attack. Some of those injured from the potato market that were transferred to be treated in this hospital were killed as a result of the airstrike. As of now, some of those killed remain under rubble. This is the only hospital in this city which was not out of service. Ambulances were damaged as well.&quot;
Aljisr TV <a href="https://www.youtube.com/watch?v=dmcvVs1l3LY">published a a video of an interview</a> with Dr. Ali Al Faraj, the Deputy of Oudai hospital. Al Faraj stated: &quot;This morning the potato market was bombed, then the emergency centre. Afterwards, the blood bank and the Oudai hospital were bombed on the same day. Those injured from the potato market attack were all transferred to the Oudai hospital, which was then bombed as you can see here. As a result of this attack, the hospital is now completely out of service. Three medical staff were injured. Renovating the hospital building will be very difficult after this attack.&quot;
Edlib Media Center <a href="https://www.facebook.com/EdlibEmc1/photos/pcb.2020739931472899/2020739648139594/?type=3&theater">published photos</a> showing rescue operations outside the hospital after the attack. See below:
<img src="/uploads/EMC_overview_damage_ce2f103065.jpg" alt="oudai-2">
The bomb landed in front of the main hospital building, leaving a large crater as <a href="https://www.youtube.com/watch?v=qi_h0TDek5A">shown in a video published</a> by Thiqa News Agency, and resulting in the collapse of a warehouse containing medical supplies. The video shows the Syrian Civil Defence digging an adult male who died in the attack out of the debris after the initial rescue operation.
<img src="/uploads/crater_oudai_7aadb0ae9f.png" alt="oudai-crater">
<h2>Where did it happen?</h2>
The Syrian Archive team created a Panoramic image using the <a href="https://www.youtube.com/watch?v=9H0OWyzd8jo&t=1s">video of Sham News Network</a> which was published after the attack. The hospital building and another building were identified through comparing the image with Google earth satellite imagery. See below:
<img src="/uploads/oudai_geolocation_1_0f1d8ff468.jpg" alt="geolocating Oudai Hospital">
<h2>Munitions identified</h2>
Sham News Network published a video showing remnants of a munition that is claims was used during the potato market attack. The remains of the rocket indicates it would have been launched by a <a href="https://twitter.com/EliotHiggins/status/563393370413105153">BM-30 multiple rocket launcher</a>, a type of surface to surface rocket launcher. If this was the munition used in the attack, it would contradict claims the attack was launched from the air.
<img src="/uploads/weapon_f49a2b2658.png" alt="weapon">
<h2>When did it happen?</h2>
Witness statements of the attack were provided by Syrians for Truth and Justice.
Ahmed al-Asaad, a doctor who was in the hospital at the time of attacking it, spoke to Syrians for Truth and Justice about what happened:
&quot;At about 8:00 am on 29 January 2018, Russian military aircraft shelled the potato market in Saraqib, which resulted in dozens of civilian casualties. Immediately afterwards, the ambulance teams transported those injured and killed to Uday al-Hussein Hospital, but the warplanes again attacked the hospital with two vacuum rockets, resulting in the hospital becoming completely out of service, killing a civilian and wounding some members of the medical staff at the hospital in the process. Anyway, the shelling also destroyed the room where the dead had been transported from the potato market. So Saraqib now is without any medical points to provide services to those injured and to the locals as well.&quot;
Hassan Al-Hassaan, a Syrian Civil Defense worker in Idlib province, told Syrians for Truth and Justice: &quot;The observatories monitoring air traffic in the skies of Saraqib informed them on the morning of 29 January 2018 that warplanes believed to be Russian shelled the city&#39;s potato market. As a result, Syrian Civil Defense teams were directed to move the injured and lift the dead from rubbles. There were about 13 killed, in addition to dozens of wounded, and then I transferred them to Uday al-Hussein Hospital in the city. He continued:
“Almost half an hour after we transferred the dead and wounded to the hospital, the warplanes shelled Uday al-Hussein Hospital at about 8:00, leading to massive destruction. Immediately after, the rescue teams again went to the impact site to evacuate the injured out of fear of another raid. This resulted in the hospital becoming completely out of service.
In another testimony by Abu Arab, the supervisor of a military aircraft observatory in Saraqib, spoke to Syrians for Truth and Justice. He stated:
&quot;At 7:35 on 29 January 2018, a warplane took off from the Hmeimim Military Base in Latakia province, flew toward north of Syria at 7:40, and targeted the city&#39;s potato market with explosive rockets. This led to a massacre, and we immediately informed the Civil Defense teams to go to the bombing site. But the same warplane targeted the hospital of Uday al-Hussein with two vacuum rockets after about half an hour. This resulted in the hospital becoming completely out of service.
Safi al Hammam, an activist from Saraqib, also spoke to Syrians for Truth and Justice, stating:
“The day of 29 January 2018 was a bloody day in every sense of the word, as the city was shelled with various kinds of weapons by Russian aircraft from Sokhoi, which targeted the potato market with several rockets, resulting in dozens of civilian casualties whom were later transferred to Uday al-Hussein Hospital in Saraqib. These warplanes targeted the hospital with two vacuum rockets, killing one civilian and injuring dozens, in addition to resulting in the hospital becoming completely out of service. And then the Russian warplanes targeted it once again with dual raids, injuring several media personnel. The city has also witnessed a massive wave of displacement towards the border areas north of the province, due to the violent shelling of the city.&quot;
According to a Syrians for Truth and Justice reporter, who was in the hospital at the time of the attack, a state of panic and horror controlled all the sick and injured in the hospital after they became aware that the military aircraft observatory had tracked warplanes, believed to be Russian, approaching toward Uday al-Hussein Hospital on the morning of 29 January 2018. Everyone was transferred to the ground floor of the hospital. In the meantime, fighter jets dropped two vacuum rockets, directly targeting the hospital building. This resulted significant damage to the building, as well as several injuries among members the medical staff and media who were outside hospital campus.
<h2>Flight Data Analysis</h2>
To provide a further layer of verification, the Syrian Archive cross-referenced findings from the videos and witness testimony with flight observation data from a spotter organisation. This process necessitated analysing observation data for flights between 7:00 and 10:00, the period directly before and after the reported attack between 7:30 and 8:30 as was claimed by media activists. See below:
<iframe height="800" src="https://public.tableau.com/views/29012018_saraqib/Sheet1?:showVizHome=no&:embed=y&:display_count=yes" width="800"></iframe>

<a href="https://public.tableau.com/views/29012018_saraqib/Sheet1?:showVizHome=no&:embed=y&:display_count=yes">View full visualisation</a>
Through comparing where flights were observed, the type of aircraft observed, the time flights were observed, and the direction flights were heading, and comparing this data to geolocation conducted in earlier steps, the Syrian Archive was able to identify several flights potentially responsible for the attack (several fixed-wing Russian aircraft), seen circling in the immediate vicinity of the geolocated attack site starting from 7:45 AM. Previous research has found that circling flights typically indicate target acquisition and/or preparation for an imminent attack.
While there is no direct evidence available that one of the observed aircrafts was involved in the attack on Saraqib the presence of these aircrafts increase the likelihood that an air attack occurred at this location and the time stated by the citizen reporters as well as humanitarian groups, and estimated also using imagery from the attack.

Bombing the Oudai Hospital

EMC-overview-damage.jpg

<ul>
<li>Location: IDLIB : Kafranbel</li>
<li>Hospital: The Kafranbel (Orient) Hospital</li>
<li>Beneficiaries: ~3,000 people</li>
<li>Date of the attack: 5 February 2018</li>
<li>Time: 08:45 am</li>
<li>Attacks: 4 airstrikes</li>
<li>Potentially responsible: Russian or Syrian air force</li>
<li>Date of previous attacks on this hospital: 19/09/2017</li>
</ul>
<h2>Background about the Kafranbel surgical (Orient) Hospital</h2>
<a href="https://www.google.com.tr/maps/place/Surgical+Hospital+Kafr+Nabl/@35.6245444,36.5500508,698m/data=!3m2!1e3!4b1!4m5!3m4!1s0x152459bbafa257f7:0xfbcc252cc06eea0d!8m2!3d35.6245444!4d36.5521021">Orient Hospital or known as &quot;Kafranbel Surgical Hospital&quot;</a> is located in the northern part of the city of Kafranbel, in the southern countryside of Idlib, provides services covered the entire towns and cities of the southern countryside of Idlib, with a population of more than 400,000. The hospital has about 156 workers, including 18 doctors.
<h2>Previous attacks on Kafranbel surgical (Orient) Hospital</h2>
Orient hospital in Kafranbel was attacked on 19 September 2017 with three airstrikes that resulted in injuries to several people, structural damage to the building, as well as to the equipment of the hospital. <a href="https://syrianarchive.org/en/investigations/Three-Idlib-Medical-Facilities-Attacked.html">A detailed report titles about this previous incident</a> was published by the Syrian Archive and by <a href="https://www.stj-sy.com/uploads/pdf_files/Syria%2520Medical%2520Fcilities%2520excluded%2520from%2520de-escalation%2520zone%2520agreement.pdf">Syrians for Truth and Justice</a> in 2017.
<img src="/uploads/orient03_b157a99ed0.png" alt="orient03">
It was additionally attacked previously on 25 March 2017. Qasioun News Agency <a href="https://www.youtube.com/watch?v=srgCm-W_gqM">published a video</a> showing the damage to the building and fire after the attack. See below:
<img src="/uploads/march_attack_kafranbel_dd431b912a.png" alt="march attack">
<h2>What Happened</h2>
On 5 February 2018, local sources including <a href="https://youtu.be/_dJphbuMm1E?t=31s">Muaz Al Shami reported</a> that Kafarnabel Surgical Hospital, also known as Hand in Hand Hospital and Orient Hospital, was struck by multiple airstrikes causing significant material damage and resulting in the entire hospital becoming completely out of service.
<a href="https://www.youtube.com/watch?v=WzFAjvqC9uw&list=PLPC0Udeof3T4QmV4f9tEhDmQzr2Z_vTKZ&index=1">Footage filmed during</a> and after the 5 February 2018 attack clearly shows the hospital was attacked directly, with one <a href="https://www.youtube.com/watch?v=WzFAjvqC9uw">geolocated video</a> capturing a bomb as it fell through the air and struck the east side of the hospital building. See below:
<iframe src="https://giphy.com/embed/26xo5DvcJlJ73tTsQ" width="560" height="315" frameBorder="0" class="giphy-embed" allowFullScreen></iframe>

<a href="https://giphy.com/gifs/26xo5DvcJlJ73tTsQ"></a>

<img src="/uploads/Impact_hospital_92e73a8773.jpg" alt="moment of attack">
<a href="https://www.facebook.com/maaramediacenter/posts/365657123900918">Maara Media Center</a> and other reporting from the ground blamed Russian aircraft for the attack.
<img src="/uploads/fb_marra_ef0fc5f941.png" alt="fb-post-marra">
Footage filmed after the airstrikes shows clear damage to the hospital building and to the surrounding area. Damage to the northeast corner of the building, consistent with footage of the airstrike, can be seen clearly as well. The corner of the building is badly damaged and the windows, bricked up in footage from 19 September 2017, have been completely blown out:
Below is <a href="https://www.youtube.com/watch?v=2a1eWc0xRqo">a video publish</a> by &quot;Nidaa Syria&quot; that shows the damage to the northeast corner of the hospital building:
<img src="/uploads/orient04_dc2d252aa3.jpg" alt="orient04.jpg">
The Syrian Archive compared images between previous attacks 19 September 2017 and this attack (5 February 2018) through videos of <a href="https://www.youtube.com/watch?v=2RJ-k5jXopQ">Maara Media Center</a> and <a href="https://www.youtube.com/watch?v=lP2SGkCAYgM">Baladi news agency</a>.
<img src="/uploads/before_after_corner_damage_d446185911.jpg" alt="before and after">
<a href="https://www.facebook.com/maaramediacenter/posts/365657123900918">Maara Media Center published photos</a> that show the small building in-front of the main hospital building completely destroyed.
<img src="/uploads/orient099_8c3febaf7c.jpg" alt="orient09">
The satellite image below shows the exact location of the impact site and damage, from Digital Globe.
<img src="/uploads/orient_sattelite_2_89d028ffed.jpg" alt="sat-image">
Damage to the entrance of the building and an ambulance provided by the “UK 2 Syria” campaign can be seen in <a href="https://www.youtube.com/watch?v=YwhGjgql7IU">a video published</a> by Sham News Network:
<img src="/uploads/orient06_1d4f80fb50.jpg" alt="orient06">
Edlib Media Center <a href="https://www.youtube.com/watch?v=JEKPnfVrVQE">published video</a> showing also the damage to the interior of the hospital:
<img src="/uploads/orient12_c606efc29a.jpg" alt="orient12">
Muaz Al Shami <a href="https://www.youtube.com/watch?v=_dJphbuMm1E">published a video</a> showing three floors damage as a result of the munition that targeted the building.
<img src="/uploads/internal_damage_3_floors_0981281043.png" alt="3-floors">
<h2>When did it happen?</h2>
Witness statements of the attack was provided by Syrians for Truth and Justice.One of the nurses, who was at Orient Hospital at the time of the attack, spoke to Syrians for Truth and justice about the details of the incident, stating:
&quot;On the morning of February 5, 2018, while I was checking the patients in the hospital, a warning came from the security and safety team that the hospital should be evacuated, particularly that Russian warplanes had raided Al-Ma&#39;ra Central Hospital a day earlier. So the wounded and the reviewers were immediately transferred to the basements. At 8:45 a.m., the warplanes carried out four raids on the hospital, causing panic and fear state among the sick and the medical staff as well. However, dust and fragments scattered everywhere. Thank God there were no injuries among the medical staff or reviewers as the damage was limited to material, the upper floors were entirely damaged and the hospital was completely out of service.&quot;
In a cross-checked certificate, a reviewer, who was also at the hospital at the time of shelling, said that at 8:45, while he was in the hospital with a view to visiting one of his sick relatives, warplanes believed to be Russian carried out four air strikes on the hospital, causing destruction in the building specially the upper floors, he continued saying:
&quot;It was a very difficult moment when fear and panic dominated all those in the basements, and the dust filled the place, there were fragments of rubble flying around. It&#39;s hard to describe the horrible scene in a few words. The raids caused the hospital to be completely out of service, due to falling a rocket in the operating room causing entire destruction. Then the Civil Defense teams worked to extinguish the fires that had been erupted as a result of the shelling, and they evacuated the sick and the medical staff out of the hospital in case they shelled it again.&quot;
Obayda al-Othman, the director of the Syrian Civil Defense Center in Kafranbel, spoke to Syrians for Truth and Justice explaining what happened:
&quot;A day before targeting Orient Hospital, specifically on February 4, 2018, the Russian planes flew in all the liberated areas, where a Russian warplane bombed Kafranbel with highly explosive rockets targeting the popular market and houses of civilians, causing death of 9 civilians and dozens of injured. Anyway, the following day, Russian warplanes bombed Kafranbel Surgical Hospital or known as Orient Hospital with more than 3 air raids, causing destruction of the upper floors, in addition to a rocket dropped in the operating room and the intensive care room. So, immediately the Civil Defense teams rushed to the hospital to evacuate patients and reviewers to other medical points. However, these raids caused the hospital to get completely out of service, without having human damage.&quot;
<h2>Flight Data Analysis</h2>
To provide a further layer of verification, the Syrian Archive cross-referenced findings from the videos and witness testimony with flight observation data from a spotter organisation. This process necessitated analysing observation data for flights between 8:00 and 10:00, the period directly before and after the reported attack between 7:45 and 8:00 as was claimed by media activists. See below:
<iframe height="800" src="https://public.tableau.com/views/05022018_Kafranbel/Sheet1?:showVizHome=no&:embed=y&:display_count=yes" width="800"></iframe>

<a href="https://public.tableau.com/views/05022018_Kafranbel/Sheet1?:showVizHome=no&:embed=y&:display_count=yes">View full visualisation</a>
Through comparing where flights were observed, the type of aircraft observed, the time flights were observed, and the direction flights were heading, and comparing this data to geolocation conducted in earlier steps, the Syrian Archive was able to identify several flights potentially responsible for the attack (several fixed-wing Russian aircraft), seen circling in the immediate vicinity of the geolocated attack site starting from 9:00 AM. Previous research has found that circling flights typically indicate target acquisition and/or preparation for an imminent attack.
While there is no direct evidence available that one of the observed aircrafts was involved in the attack on Kafranbel the presence of these aircrafts increase the likelihood that an air attack occurred at this location and the time stated by the citizen reporters as well as humanitarian groups, and estimated also using imagery from the attack.

Bombing the Orient Hospital

Impact-hospital.jpg

<ul>
<li>Location: IDLIB : Maarat al-Numan</li>
<li>Hospital: The National Hospital of Maarat al-Numan</li>
<li>Beneficiaries: ~500,000 people a year</li>
<li>Date: 4 February 2018</li>
<li>Time: around 20:40</li>
<li>Attacks: 6 airstrikes according to Osama Eido (Hospital x-rays department)</li>
<li>Munitions identified: One photo acquired by the Syrians for Truth and Justice</li>
<li>Potentially responsible: Russian or Syrian air force</li>
</ul>
<h2>Background of The national hospital of Marret al-Numan</h2>
The National Hospital of Maarat al-Numan is a hospital located on the Aleppo-Damascus international highway. It sits between three governorates: 60km north of Hama city, 80km south of Aleppo and 50km southeast of Idlib.
The hospital was <a href="http://www.esyria.sy/eidleb/index.php?p=stories&category=round&filename=201003101520125">founded in 1984</a> and was supplied with medical equipment worth 6.9 million Euro. The hospital sits on an area of 70 thousand square meters, consists of three floors, contains all medical departments and has an annex building for doctors, and another building of outpatient clinics and it serves about 30.000 monthly beneficiaries.
On Feb 4th, 2018, local reports <a href="https://www.youtube.com/watch?v=d6oF9r2oFv0">including videos published</a> by the Syrian Civil Defense, claim that the National Hospital was targeted by multiple airstrikes.
<h2>Previous attacks</h2>
The National Hospital of Marrat al-Numaan was previously attacked on 2 April 2017. The Syrian Archive has <a href="https://syrianarchive.org/en/investigations/Medical-Facilities-Under-Fire/Incident-1.html">published an in-depth open source investigation</a> regarding that attack.
<h2>What Happened</h2>
On 4 February 2018 at 21:19, a citizen journalist named Anas Al Marwai (who lives in Maarat al-Numaan) <a href="https://www.facebook.com/100010399271536/videos/559320804424557/">published a video</a> on his Facebook page in which he states: &quot;A huge explosion as a result of Russian warplanes missiles at the national hospital in Maarat al-Numan.&quot;
Idlib Health Directorate separately published <a href="https://www.facebook.com/Idleb.Health.Directorate/posts/1200613503375336">a post on their Facebook page</a> at 21:21 stating: &quot;Russian warplanes directly targeted the National Hospital in Maarat al-Numan, and the aircraft monitors interception calls between the driving room in Hameimim base, heard the air force stating they would repeat the targeting of the hospital.&quot; See below:
<img src="/uploads/national07_dc594af901.png" alt="national07">
Syrian Civil Defense in Idlib <a href="https://www.facebook.com/SyrianCivilDefenceIdlibWhiteHelmets/posts/1562499310515786">published photos</a> on their Facebook page at 22:41 saying &quot;Civil Defense teams evacuated the patients from the national hospital in Maarat al-Nu&#39;man to nearby hospitals after the hospital was targeted with four air strikes.&quot; Photos show destructions as a result of the attacks, as well as of the Civil Defense evacuating injured people. See below:
<img src="/uploads/national06_c75de86968.jpg" alt="national01">
On their YouTube channel Civil Defense published several videos additional in which members can be seen fighting fires outside the hospital. See below:
<iframe width="560" height="315" src="https://www.youtube.com/embed/V4Nt8JWXVcQ" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>

<a href="https://www.youtube.com/watch?v=de7N2n7eYJc">A second video shows</a> Syrian Civil Defense rescuing a newborn child. In the video, the paramedic asked someone to bring him a Laryngoscope, and after several seconds another man came and said &quot;go to the car now, the tanks might explode.&quot; At this point, the paramedic took the child and went to a car.
Another video from Syria Civil Defense <a href="https://www.youtube.com/watch?v=Q4DboRpV9L0">presents a summary</a> of what happened, stating that the National Hospital is out of service as a result of the attack, and shows stills from incubators room. See below:
<img src="/uploads/national08_a3823cd159.png" alt="national08.png">
The label is from a baby called Abdullah Amir Sarjawi, 13 days old, the date of his admission was 04 February, and his parents live in Aleppo.
<img src="/uploads/national15_ddce0fc898.jpg" alt="national15.jpg">
An exclusive photo to Syrians for Truth and Justice shows the location where one of the missiles downfall
Hadi Alabdallah, a citizen journalist, <a href="https://www.youtube.com/watch?v=HcMurYLYlEo">published a video on his YouTube channel</a> showing destruction inside the hospital, injured (including elderly men and women), fires outside of the hospital as a result of the attack, as well as the evacuation of babies and injured from the hospital by the Syria Civil Defense members. See below:
<img src="/uploads/national07_4a61b9d271.jpg" alt="national06">
In Alabdallah&#39;s video at 0:29 somebody asks the Syria Civil Defense members while they were carrying babies, &quot;Where are you taking babies?&quot; Someone can be heard answering: &quot;To the incubators, Syria Civil Defense is taking them to the incubators.&quot;
In the same video at 0:49, Alabdallah stated: &quot;A little while ago, Russian warplanes targeted the National Hospital in Maarat al-Numan, resulting in the hospital to become out of service. There are martyrs, wounded and trapped under the rubble as a result of targeting of the National Hospital by these aircrafts. This hospital containing large numbers of injured, patients, and babies. The babies who were inside the incubators were evacuated, some of them may have died due to being evacuated under abnormal harsh conditions. Most parts of the hospital were damaged and destroyed.&quot;
At 1:47 in the same video, Alabdallah stated: &quot;Many medical facilities in Idlib have been attacked. The air force is now flying over us and maybe it&#39;ll target this area in any moment because this hospital was attacked with more than ten airstrikes so maybe it gets targeted again.&quot;
<img src="/uploads/national16_136bb8e285.jpg" alt="national16.jpg">
An exclusive photo to STJ shows a part of the destruction that has done in the hospital.
In a separate video, published by citizen reporter Moaz Alshami while they were standing in front of the hospital, Syrian Civil Defense members are seen working to put out fires. Moaz stated: &quot;After the massacre carried out by Russian aircrafts in Kafranabel city, the National Hospital in Maarat al-Numan has now been targeted with more than six air strikes. It is the only hospital operating here. It contains dozens of injured people who were injured in Kafranabel and taken here.&quot;
<iframe width="560" height="315" src="https://www.youtube.com/embed/fRHSrvXJLDs?rel=0" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>

After that Alshami entered the hospital and said: &quot;The Civil Defense evacuate the incubators. A few hours ago, a massacre in Kafranabel and before it in Khan al-Sabeel and before it in Maazran, every day there is a new targeting of civilians.&quot;
At 4:31, Moaz Alshami conducted an interview with two women standing beside an injured. One of the women said: &quot;We are from Khan Sheikhan. We were in the hospital there, when it targeted. We came here and now this hospital has been targeted too. Where are we going?&quot;.
SMART News Agency <a href="https://www.youtube.com/watch?v=-GA92EyURH8">published a video</a> on their YouTube channel as well, containing a testimony from the Head of Radiology Department. He stated: &quot;The hospital was targeted last night 4 Feb 2018 by six strikes from Russian warplanes. As a result, the hospital is now completely out of service, which was the only hospital in this region, serving more than 20 thousand patients per month.&quot;
The following day, 5 February 2018, the Syrian American Medical Society (SAMS) - who supported the hospital - <a href="https://www.facebook.com/sams.arabic/photos/a.1188236591309561.1073741829.1174443599355527/1230201110446442/?type=3&theater">published a post</a> on their Facebook page stating that the National Hospital in Maarat al-Numaan had become out of order as a result of being targeted by six airstrikes. See below:
<img src="/uploads/national13_a2c6ae9269.png" alt="national13.png">
<h2>Where did it happen?</h2>
The Syrian Archive team was able to match several objects between Alshami&#39;s video and SMART News Agency&#39;s video which confirms both documented the same location. See below:
<img src="/uploads/national08_96086a3ed3.jpg" alt="national08">
Other objects were identified from a different angle of the same location using the same videos above:
<img src="/uploads/national09_f25e1fdb1a.jpg" alt="national09">
We also identified objects that were shown in Smart News Agency&#39;s morning video about this incident:
<img src="/uploads/national13_fd557261e0.jpg" alt="national13.jpg">
The Syrian Archive team was also able to geolocate several landmarks and objects using SMART News Agency&#39;s video and a satellite image for the National Hospital in Maarat al-Numaan, confirming it was the same location. See below:
<img src="/uploads/national12_9feca40123.jpg" alt="national12.jpg">
Seems from inside the hospital were also able to be cross referenced. In a video <a href="https://www.youtube.com/watch?v=d6oF9r2oFv0">from the Civil Defense</a>, the evacuation process for children and women can clearly be seen. It also documents two Syrian Civil Defense members walking in a hospital corridor. At 1:19 of the video, a banner can be seen on the floor that states: &quot;Children&#39;s Division.&quot; See below:
<img src="/uploads/national02_c7df81e009.jpg" alt="national02">
<img src="/uploads/national05_bfe8c906f4.jpg" alt="national05">
A separate vdeo was <a href="https://www.youtube.com/watch?v=IicAGAWhD_E">published by Moaz Alshami</a> in which a sign reading &quot;Emergency Operation&quot; can be seen:
<img src="/uploads/national11_56479c9d94.jpg" alt="national11">
<img src="/uploads/national10_9d08d6de84.jpg" alt="national10">
<h2>When did it happen?</h2>
According to several testimonies collected by Syrians for Truth and Justice the first attack happened around 20:40. Jamil Jaafar, a member of the medical staff who was in the National Hospital at the time of the attack, spoke to Syrians for Truth and Justice:
&quot;At 8:40 p.m. on Sunday, 4 February 2018, while I was at the hospital treating the patients, a Russian warplane raided and injured many patients as well as the medical personnel. We immediately evacuated the injured people who were in the emergency department, in the surgery rooms, and in the incubator section. Moments later, the warplane targeted the hospital once again with high-explosive rockets, as well as a percussion (concussion) rocket that could penetrate the surgery room. The airstrikes concentrated on the emergency department.&quot;
Another testimony by a member of the Syrian Civil Defense who was in the hospital at the time of the attack, stated:
“On Sunday evening, 4 February 2018, at around 8:45 p.m while we were at the hospital, a warplane raided on the hospital, so we were forced to move the patients to the lower floors. However, the warplanes bombed more than four airstrikes with high-explosive rockets, one of which was a percussion rocket.&quot;
Abu Bahar, the supervisor of an observatory that monitors the movement of the warplanes in the city&#39;s skies, spoke to Syrians for Truth and Justice, stating:
“On February 4, 2018, a squadron of warplanes took off from Hememim Military Airbase in Latakia province, flied towards the north of Syria, and then rotated on bombing our areas. However, at 8:40 p.m. on the same day, one of these aircrafts raided Maarrat al-Numan Central Hospital, followed by five more raids, which caused the hospital to be completely out of service.”
<h2>The weapons used</h2>
Syrians for Truth and Justice was able to obtain a photo shows the remains of one of the missiles that fell in front of the National Hospital. See below:
<img src="/uploads/national14_7395ff8ab9.jpg" alt="national14.jpg">
The Syrian Archive was unable to gather additional information regarding munitions used in this attack.
<h2>Flight Data Analysis</h2>
To provide a further layer of verification, the Syrian Archive cross-referenced findings from the videos and witness testimony with flight observation data from a spotter organisation. This process necessitated analysing observation data for flights between 19:00 and 22:00, the period directly before and after the reported attack between 20:45 and 20:51 as was claimed by media activists. See below:
<iframe height="800" src="https://public.tableau.com/views/04022018_marrat_al_numan/Sheet1?:showVizHome=no&:embed=y&:display_count=yes" width="800"></iframe>

<a href="https://public.tableau.com/views/04022018_marrat_al_numan/Sheet1?:showVizHome=no&:embed=y&:display_count=yes">View full visualisation</a>
Through comparing where flights were observed, the type of aircraft observed, the time flights were observed, and the direction flights were heading, and comparing this data to geolocation conducted in earlier steps, the Syrian Archive was able to identify several flights potentially responsible for the attack (several fixed-wing Russian aircraft), seen circling in the immediate vicinity of the geolocated attack site starting from 11:41 AM. Previous research has found that circling flights typically indicate target acquisition and/or preparation for an imminent attack.
While there is no direct evidence available that one of the observed aircrafts was involved in the attack on Maarat al-Numaan, the presence of these aircrafts increase the likelihood that an air attack occurred at this location and the time stated by the citizen reporters as well as humanitarian groups, and estimated also using imagery from the attack.

An investigation about attacking Syrian hospitals

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Six Months On

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Six Months On

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INVESTIGATIONS