New York, 17 May 2019
Thank you very much, Mr President.
The last three weeks have seen a deadly escalation of the conflict in northwestern Syria.
The Secretary-General has been warning about this for months. Last September, he stressed that it was “absolutely essential to avoid a full-scale battle in Idleb,” and warned that that would “unleash a humanitarian nightmare unlike any we have seen” in Syria.
When I briefed you here on 18 September, I said a full-scale military onslaught could result in the “worst humanitarian tragedy of the 21st century.”
Despite our warnings, our worst fears are now coming true.
As Rosemary has just summarized, the United Nations estimates that three million people live in the area of the de-escalation zone in the northwest of the country. Even before the recent escalation, these were among the most vulnerable people in Syria, particularly the 1 million children, and the 1.3 million people who have fled to Idleb from other parts of the country. The area is now largely controlled by Hayat Tahrir al-Sham, a proscribed terrorist group. The innocent civilians of course hugely outnumber the men with guns.
We have briefed you every month as the conflict has escalated.
On 27 March, my Director of Operations alerted you to the alarming spike in civilian casualties and displacement due to fighting, noting that 90 people had been killed and nearly 90,000 displaced.
On 24 April, my deputy briefed you here on a further increase in airstrikes and shelling, with attacks both in the de-escalation zone and from the zone into government-controlled areas. She described how some 200 people had been killed since February, and the number of newly displaced had grown to 120,000.
Just days later, the pace of attacks increased even further, with some of the most intense hostilities in almost a year.
My Director of Operations briefed you again last Friday on the effect of the air strikes, the barrel bombs, the ground attacks and the shelling.
And yesterday the Deputy Regional Humanitarian Coordinator updated the Humanitarian Task Force in Geneva on yet a further spate of barrel bombs from helicopters, airstrikes, heavy shelling, ground attacks and counter attacks.
In the last three weeks we have reports that up to 160 people have been killed. At least 180,000 people have been displaced, and millions of people are crammed into an ever smaller area. 180,000 in three weeks.
While many people have moved to camps, more than 80,000 people have found themselves with nowhere to go, so they are simply parked in open fields or sheltering under trees.
We now have reports of three IDP settlements being attacked. Three days ago, an attack near a market place in Jisr Al Shoghour reportedly killed at least eight civilians and injured three others.
Some 17 schools have been damaged or destroyed, and many more are closed, with more than 400,000 students unable to sit for their exams.
Areas in government-controlled western Aleppo and northern Hama have also been affected by hostilities, resulting in civilian casualties and injuries. On 14 May, rockets hit the densely populated Neirab camp for Palestine refugees in Aleppo, killing at least nine civilians and wounding 11.
Humanitarian agencies are trying to help people caught up in the fighting, but the response is already stretched. Prepositioned stocks of food have been given to 100,000 people since the start of this month. Tents and other shelter items for 25,000 people are being distributed.
But as we have told you before, a full military incursion would overwhelm all ability to respond.
We are rapidly approaching that scenario.
I am most of all concerned about the number of attacks damaging or destroying medical facilities. I need not remind you that medical facilities are specially protected under international humanitarian law.
Since 28 April WHO and health actors have identified at least 18 facilities that have been damaged or destroyed by air strikes, shelling or other fighting. All of them are inside the socalled de-escalation zone. Almost all, following the attacks, are currently unusable, including:
• Latmana Hospital, in Hama Governorate, attacked on 28 April
• Madiq Castle Hospital, in Hama Governorate, attacked on 28 April
• Hbeit Primary healthcare center, in Idleb Governorate, attacked on 30 April
• Qastun primary healthcare center, in Hama Governorate, attacked on 1 May
• A WHO-supported surgical unit in Kafr Nbodah area, in Hama Governorate, attacked on 1 May
• Al Madiq primary healthcare center, in Hama Governorate, attacked on 2 May
I know this Council appreciates brevity, but I could continue listing these attacks for some time.
The trend has continued, day after day.
In total, the WHO and health actors have reported 20 attacks on these 18 facilities. Almost one a day over the last 3 weeks. Some facilities have been hit twice. Other hospitals are closing for fear of being attacked.
A total of 49 health facilities have partially or totally suspended activities. Between them they provided an average each month of at least 171,000 medical outpatient consultations and 2,760 major surgical operations. They helped more than 1,400 women deliver their babies every month.
Now they are not doing those things.
The 20 attacks are confirmed attacks, using WHO’s global methodology for cataloging attacks on health facilities.
This system relies on WHO’s global reporting system and a specialized network of partners on the ground to triangulate and confirm what has happened. In the case of a reported attack, these partners on the ground provide a detailed incident report. That is then verified by WHO and it is checked against additional sources. Only those which are fully vetted and confirmed by a variety of sources are included in the list of confirmed attacks. (This system, by the way, is the one used for reporting on such attacks from Afghanistan to Yemen. It is widely respected).
My office and I have, in the light of the events of the last three weeks, been asked a lot of questions by Member States, by NGOs operating in the area, by doctors in the hospitals, and by families affected by the fighting. Let me tell you some of these questions, and what I can say in answer to them:
Who is bombing all these hospitals? I can’t say. But at least some of these attacks are clearly organized by people with access to sophisticated weapons including a modern air force and so called smart or precision weapons.
Are hospitals being deliberately targeted? I don’t know. The people who do are the ones dropping the bombs. What I can tell you is that there are a lot of attacks on these health facilities.
Is it true that you provide details of where hospitals are, in order to protect them? Yes. The obligation to protect civilian objects – including hospitals – comes from international humanitarian law. We give details of some hospital locations to the parties to the conflict so that they can comply with those obligations.
Is the information being provided about the locations of hospitals in fact being used not to protect hospitals but to target them? I don’t know. Again, the people who can answer that question are the ones dropping the bombs. Many deconflicted sites which are not hospitals have not been attacked.
Has this kind of thing happened before during the Syria conflict? Yes. The then Special Envoy, Staffan de Mistura, and I last year raised concerns about similar attacks in eastern Ghouta with Council Members who we thought might have relevant information and who we thought could prevent a recurrence.
Did you get satisfactory answers at that time? We have yet to receive full answers to the questions we raised last year.
If I were an NGO running a hospital, why would I want to give you give you details of my location if that information is simply being used to target the hospital? That is a good question. We are thinking about what conclusions to draw from recent events in respect of the deconfliction system in so far as it covers health facilities.
What is your advice to parents of children who live in the de-escalation zone – should they take their children to the hospital in the case of an illness or injury? That is a very difficult question. I am deeply concerned about the impact on the health of children, and their safety, when so many medical facilities are being attacked.
What would you do if you were the parent of a child needing hospital care in the so-called de-escalation zone in Idleb right now? I am sorry to say that I just don’t know. I feel desperately sorry for parents in that horrible position.
Hasn’t the Security Council passed a resolution reinforcing that countries shouldn’t bomb hospitals? Yes. Security Council Resolution 2286, passed in 2016, specifically covered that.
Finally, I am asked: What is the point of the Security Council passing resolutions like that if States are not going to comply with them?
That, Mr President, is also a very good question. It is, of course, not really addressed to me.
- UN Office for the Coordination of Humanitarian Affairs
- To learn more about OCHA's activities, please visit https://www.unocha.org/.