After several months of relative calm this year, opposition-held Idlib province is under assault from the air once more.
On September 19, Russian and Syrian regime warplanes began conducting airstrikes across the northwestern province and nearby rebel-held areas in response to a rebel offensive against pro-government forces in the region.
The hardline rebel coalition Hay'at Tahrir a-Sham (HTS) controls Idlib province and led recent rebel offensives in the area.
In just the first week of the renewed air campaign against Idlib, the Syrian Network for Human Rights, a Britain-based monitor, documented 85 civilian deaths.
Now in its third week, the bombing campaign has also forced the closure of at least five hospitals across the province after they were hit, Dr. Mustafa al-Aido, deputy director of the Idlib Health Directorate, tells Syria Direct’s Noura Hourani.
“We are completely unable to construct a hospital that is safe and secure in the face of the destructive capabilities of Russia’s weapons,” he says.
A Sham Hospital ambulance in Kafr Nubl following an airstrike on September 26. Photo courtesy of Edlib Media Center.
Earlier this year, opposition health officials planned to build underground medical facilities, but funders pulled out and the plan was shelved, says al-Aido.
Now, the health directorate's strategy is to increase the number of medical facilities in Idlib to ensure that if one is bombed, "there are other hospitals where we can transport the injured," says al-Aido.
"That is the best solution available to us."
Q: How many hospitals have been hit during the latest regime air campaign in rebel-held Idlib province? How many hospitals are currently out of service?
Since the beginning of the campaign [on September 19] until now, five hospitals have been hit, and the number is rising with the continued bombardment.
The targeted hospitals are primarily in the southern countryside [of Idlib province]. Three hospitals suffered direct hits and were put out of service: al-Rahma Hospital, located in a cave in Khan Sheikhoun, Sham Hospital in Kafr Nubl, and the maternity hospital in the town of al-Tah.
Most Idlib hospitals had to stop operations at their outpatient clinics as well. They’ve stopped admitting those with chronic diseases for fear that the [clinics] could be hit and the medical staff injured.
Q: The last time Idlib’s hospitals sustained this sort of damage was at of beginning of 2017 during another Russian-backed regime air campaign. Have hospitals in the province taken any precautionary measures since that time to protect Idlib’s health sector, particularly during the last few months of relative calm?
Since that last offensive, we have tried to take precautionary steps in case attacks on the province resumed. Our plan was to build five underground bunker hospitals. We conducted a full study in order to implement the project, but we were not able to complete it because the supporting organization suspended [funding].
The health directorate tried its hardest to find alternate funding for the bunker hospital project—each of the five hospitals would cost one million dollars. We contacted many international organizations, but did not receive any offers.
[Ed.: Al-Aido told Syria Direct that he could not provide details about the cut in funding or why the supporting aid organization pulled out of the project.]
For now, we are not able to construct a hospital that is safe and secure in the face of the destructive capabilities of Russia’s weapons. The recently hit Sham Hospital was comprised of three floors of concrete, each 50 cm thick. One rocket penetrated all three floors before finally landing in the operating room.
Aftermath of an airstrike on maternity hospital in al-Tah, Idlib in September. Photo courtesy of Latakia News.
[Ed.: The airstrikes fired on Sham Hospital on September 26 did not cause any casualties, but resulted in heavy material damages to the building as well as two ambulances used by the hospital.]
Our strategy now is to increase the number of hospitals in Idlib—that is the best solution available to us. There are now 45 hospitals in the province. If a hospital is hit, then there are other hospitals where we can transport the injured.
Q: What is the main challenge faced by Idlib’s medical sector this year, and how does it compare with previous years?
The constant bombardment of medical facilities is bleeding the medical sector dry. We are constantly trying to provide the medical sector with medical staff and funds to coverage shortages.
The largest source of pressure, compared with previous years, is the increase in population that the province has undergone as a result of the continued displacement of residents [to Idlib] from different parts of Syria. The population in the province has reached 4 million people.
[Ed.: The Britain-based Syrian Network for Human Right provides a more conservative estimate of Idlib's population in a September 2017 report. The monitoring group estimates that the province’s population is now 2.9 million residents, many of them displaced to Idlib as part of reconciliation agreements with the Syrian regime.]
Q: The health directorate released a statement addressed to the United Nations last week, condemning the targeting of medical facilities in what it called a repeat of Aleppo. How would you characterize the response by the international community?
No international organizations have responded to [our calls] for an end to the airstrikes and the rescue of civilians. Since the beginning of the revolution, every appeal to the United Nations has gone unanswered, and we do not see any action to deter [bombardment].
Even after the chemical massacre in Khan Sheikhoun—which the United Nations and the Organization for the Prohibition of Chemical Weapons (UPCW) both acknowledge Assad’s regime was responsible for—we have not seen any accountability. We are faced with an international community that will not cooperate with us to save human lives in opposition-held areas.