Syrian President Bashar al-Assad’s brutal campaign to suppress the Sunni opposition employs a tactic that improves upon his other weapons’ lethality —targeting those who treat the sick and injured.  While his campaign against healthcare infrastructure in opposition-held territory has been ongoing since 2011, it has become increasingly destructive in recent years because of the duration of the campaign and the implementation of new methods and techniques. The Assad regime’s attempts to undermine the opposition by launching over 200 attacks on medical facilities and personnel have had devastating consequences for the Syrian people. While Obama’s threat of a “red-line” for the use of chemical weapons is commendable, Assad seems to have found a loophole in U.S. policy by spreading death and disease through the use of conventional weapons.

In the first two year of the conflict in Syria (2011-12), according to a recent report by Physicians for Human Rights, government forces generally used light arms such as mortars and handheld weapons to inflict damage on the healthcare infrastructure. Over this two year period, 274 medical personnel were killed by Assad’s forces. In the past two years (2013-14), however, Assad’s forces began to increasingly use aerial bombardment, including barrel bomb attacks on hospitals, as a means to degrade medical facilities and kill health care workers—resulting in the deaths of at least 312 medical personnel. The regime’s disregard for human life in these types of attacks is blatantly obvious as barrel bombs are essentially oil drums filled with explosives and scrap metal dropped from helicopters to cause extreme and indiscriminate destruction.

The effects of this campaign undermine the health and security of the Syrian people on a number of levels. The immediate results of Assad’s assault on the healthcare system of opposition-held regions is that his forces have killed around 600 medical professionals and over 75% of medical professionals have been forced to flee from major urban centers. Syria now has a total of 15,000 doctors, or about half of its 2010 level. A February 2015 report from the Bloomberg School of Public Health of Johns Hopkins University reports that “only 13 surgeons and a total of about 30 doctors serve 300,000 people in Aleppo.” To give some perspective, Aleppo’s doctor to population ratio of 1:6,977 is about one-tenth of Syrian national average from 2010 and is well below the 2012 statistics for India and Myanmar.

In addition to bombing many of the hospitals and clinics to kill doctors, these attacks also destroy important equipment such as CT scanners, intensive care units, and ultrasound machines. Even though many medical treatment centers have moved to improvised or covert field hospitals, they have not entirely managed to evade government assaults. Also, ambulances are “deliberately and routinely targeted” to limit access to medical treatment. Yet, because ambulances are often subject to assaults at night, when they are most visible due to their headlights, ambulance drivers are faced with the dilemma of either driving into ambushes or turning off their headlights and driving with severely impaired vision.   Furthermore, physicians from Aleppo have described a two-stage attack plan in which government forces drop a barrel bomb and then wait for the first responders to come treat the wounded before dropping another, causing even more carnage.

The lack of basic resources, including electricity and anesthesia, has also had deadly or painful consequences for Syrians living in opposition-held territory. There are reports of newborn babies dying in incubators due to power cuts and the limbs of wounded patients being amputated because the medical staff was inadequately supplied to otherwise treat the injuries. Some reports even recorded patients opting to be knocked out with a metal bar rather than face painful procedures without anesthesia.

Yet, according to the Bloomberg School’s report, despite the extreme scarcity of critical supplies, it is actually the lack of trained medical personnel that poses the “biggest challenge to healthcare provision in opposition-controlled areas.”  Zaher Sahloul, president of the Syrian American Medical Society, explained that “although clandestine shipments of vaccines and medicines are being pushed through, the amount of skilled medical workers and nurses is minimal, so lots of medicines are being stockpiled without being used.”

Disease is also a growing concern as vaccination rates have dropped from 90 to 52 percent.  Polio has reappeared as of 2013-14, after many years in which Syria was polio-free; over 10,000 instances of the measles have been reported in Syria and Turkey; and hepatitis A, B, C, and D have become more prevalent. Non-communicable diseases (NCDs) have also become more deadly in the wake of the Syrian civil war—doctors estimate that such ailments have often gone untreated and caused the deaths of over 300,000 Syrians. According to Fouad Mohammad Fouad, of the Department of Epidemiology and Population Health at the American University of Beirut, NCDs “have generally been neglected due to a lack of system resources and access to medications as well as people being unable to afford them.”

In addition to the raging civil war that has claimed over 200,000 lives, about one-fifth of whom were civilian, Assad’s deplorable campaign to destroy the healthcare infrastructure in opposition-held regions of Syria have contributed to the reduction of the average life expectancy in Syria by two decades over the course of a few years (2010: 75.9; 2014: 55.7). He has found a small segment of society that is critical for the survival of the masses and he has targeted that element as a means to spread death, disease, and hopelessness among those living under the Syrian opposition.