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Violence against health care has been a defining feature of the Syrian conflict. Over the course of the conflict, Physicians for Human Rights has documented and corroborated nearly 600 attacks on health facilities and the killing of over 920 medical personnel. The scale of attacks has not been documented for any prior war. As part of a research stream of The Lancet-AUB Commission on Syria, we have described a strategy of ‘weaponisation of health care’ . This strategy, largely adopted by the Syria regime and its allies, has other components beyond attacking health facilities and targeting health workers such as criminalizing medical neutrality, , militarising health facilities, and blocking health humanitarian assistance. Violence against health care has profound consequences on the health system and on the health of affected population and communities through limiting availability of and access to vital services. One example is the resurgence of polio in 2013. Violence against health care in Syria has contributed to energetic international responses including the adoption of a landmark Resolution 2286 by the UN Security Council in 2016 emphasizing protection of health care during armed conflict. While the responses were not effective at stopping or even reducing the number of attacks, they strengthened the normative framework for action and raised global awareness of the seriousness of the issue. There were also innovative local responses to attacks on health care such as building hospitals underground. Future research directions in this area include understanding the violence, particularly through perpetrator studies, improving methods for investigating attacks and documenting their impact, and exploring options for preventing violence against health care.

Violence against health care in Syria: patterns, meanings, implications