Ambulances under siege in Syria

Abstract

BackgroundHealthcare is under attack in Syria with repeated air strikes on hospitals and ambulances and the largest death toll of health workers in any recorded conflict.1 Ambulances in Syria have been bombed, shot at, stolen, looted and obstructed, significantly impeding their ability to safely evacuate the wounded and provide medical aid.MethodsThis article presents the summary of a literature review on attacks against ambulances in Syria from 2011 to 2018, as well as a descriptive secondary data analysis on individual attacks reported by the Syrian Network for Human Rights from January 2016 to December 2017. A peer-reviewed literature search included three databases (PubMed, ProQuest and Embase), and a grey literature search included reports from groups involved in the Syrian health response or human rights monitoring.FindingsFrom 2016 to 2017, there were 204 individual attacks involving 243 ambulances. Half (49%) were either heavily damaged or put out of service. The main perpetrators were the Syrian regime (60%) and the Russian armed forces (29%). Half (52%) of ambulances were directly targeted. The peer-reviewed literature search yielded 18 articles, from which the following themes were drawn: targeting of ambulances, ‘double-tap’ attacks, delays to care, obstruction and other forms of violence, and long-term consequences.InterpretationAmbulances have been intentionally and repeatedly targeted throughout the Syrian conflict as part of a war strategy. Real challenges in monitoring and systematically tracking attacks on ambulances exist, but as a result, they are understudied and likely under-reported.

Caught in crossfire: health care workers’ experiences of violence in Syria

“…The GoS and the GoR were the foremost perpetrators of violence. This is in accordance with many reports and studies (Fouad et al 2018; Physicians for Human Rights 2019; Security Council 2016; Wong and Chen 2018). HCWs also experienced targeted violence by IS, NSAGs and the Kurdish Forces when Syria fragmented between these different factions and lines of battle were formed.…”

“…Anyone can live without food for a month, but if there is a bleeding artery, he can't live for more than ten minutes. (participant 16) Notes 1. see for example Wong and Chen (2018); Elamein et al (2017a). 2. see Footer et al (2018); Fardousi, Douedari, and Howard (2019).…”

Violence against healthcare in conflict: a systematic review of the literature and agenda for future research

“…For instance, the bombing of the MSF hospital in Kunduz, Afghanistan in October 2015, which brought widespread international attention to IHL and the culpability of the US military, is explicitly studied in four papers [34,62,80,82]. Similarly, six papers focus on attacks on health in Syria [24,49,53,60,75,85]. Other conflicts characterized by frequent attacks on health have been less well studied in the literature (i.e.…”

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