The United Nations has come under fire for sharing the coordinates of hospitals in rebel-held areas of Syria with Russia, only for one of them to be bombed days later.
The organisation gave the GPS locations supplied by NGOs operating in Idlib and Eastern Ghouta to Russia and the US as part of a new “notification system”.
One of the hospitals whose details were shared with the UN on March 12 – in the Arbin neighbourhood of besieged Ghouta – was targeted in a direct strike on March 20.
At least one patient was reported to have been killed by what medics suspected to be a “bunker-buster” bomb. It was not immediately clear whether it was a Syrian or Russian attack, however Moscow is known to use the more precise bombs, which burrow deep underground before exploding.
The Syrian government and its Russian backer, which intervened in the war in support of President Bashar al-Assad in 2015, have systematically targeted hospitals and clinics during assaults on opposition strongholds.
In recent weeks, dozens of facilities in Eastern Ghouta have been put out of service, most others have been forced to move underground.
The UN had hoped making the locations public would either act as a deterrent or at least better enable them to establish intent should they later be attacked.
“There were 120 attacks on hospitals and medical facilities in Syria last year,” Jan Egeland, UN humanitarian adviser on Syria, told the Telegraph. “Syria is one of the worst wars on medical workers in recent history and part of the problem is there has been no functioning notification system to protect them.”
He said there had until now been a reluctance among doctors on the ground to share their location, but they have been left with few other options. “‘We’ve been attacked for so long,’ they tell me, ‘I can’t see how it could be worse’,” Mr Egeland said.
He said some NGOs had in the past provided their coordinates to the UN and reported a subsequent drop in the number of air strikes on its services.
The initiative was led by the Syrian American Medical Society (SAMS), which has seen a number of the hospitals it supports hit in recent months.
However, others warned the strategy could backfire given Russia has shown little deference for international law on the targeting of medical facilities.
“They have bombed hospitals with little thought, and have always given the excuse that they were harbouring terrorists, which is untrue,” said Hamish de Bretton-Gordon, director of Doctors under Fire and adviser to the Union of Medical Care and Relief Organisations (UOSSM). “They act with impunity as there has been zero consequence so far.
“Until there is, why would they stop?” he told the Telegraph. “It’s an extremely high-risk move.”
Mr Egeland said Russia had offered assurances they would not target any of the facilities identified, while the UN in turn provided Moscow assurances they were not being used by any armed groups.
However, there could be no real guarantee that the Syria regime would not use any information shared with them by Russia to carry out their own strikes.
Mr Egeland said the UN was investigating the March 20 attack.
Mr Bretton-Gordon said UOSSM, along with Medecins Sans Frontieres (MSF), stopped publicising the locations of its hospitals “years ago” after their medical facilities in eastern Aleppo began being targeted.
“Every time we did, shortly after they’d be hit,” he told the Telegraph.
He said every UOSSM clinic in Eastern Ghouta, an enclave outside Damascus where regime forces are attacking rebels, has been put out of service in recent weeks.
Doctors there say they have seen much more sophisticated weapons used since Russia joined the war, such as the bunker-buster bombs..
Earlier this week the Telegraph reported that a British doctor helping surgeons in rebel-held Aleppo in 2016 may have had his computer hacked and the information retrieved from it used to carry out an air strikes on the hospital.
Dr David Nott was giving instructions from the UK over Skype to doctors in an underground theatre of M10 hospital in 2016 when he believes that his computer was infiltrated, revealing the operating room’s coordinates.
The hospital was struck with a bunker-buster days later. Experts said that only Russia could have dropped it.
“The grim reality is that we have reached a stage in the war where the international community is unable to offer protection to civilians or humanitarians,” said Emma Beals, an independent Syria analyst. “So policies are decided based on possible future accountability for inevitable loss of life.
“That’s astonishingly macabre, even within the context of the Syrian war.”