Attacks on medical workers in Syria: Implications for conflict research
Authors: Michael Spagat
Journal: PLoS Medicine (2018)

The ongoing war in Syria has raged for seven years with no end in sight.Through news media and social media, the rest of the world learns of horrific attacks on health workers and medical facilities, but a complete account of these events does not escape Syria.Journalists operating in Syria also face great dangers; consequently, journalistic coverage of the Syrian war is patchy, compromising our ability to collect event data that can underpin a robust research program on the human costs of the war (though there are some strong research studies, including [1][2][3][4]).Social media plugs some of the coverage gaps, but we lack validated tools for separating reliable social media posts from unreliable ones.Due to these limitations, research into the Syrian war often must rely on relatively random fragments of information of unknown quality.In this week's PLOS Medicine, Rohini Haar and colleagues [5] describe an extraordinary field-based data collection effort conducted amidst the ongoing war in Syria, spearheaded by the Syrian American Medical Society (SAMS) and supported by a team of mainly United States-based researchers.The resulting database records the deaths of 112 health workers and 185 patients that occurred as part of more than 200 attacks on healthcare facilities and transport vehicles in the governorates of Aleppo, Idlib, Hama, and Homs in 2016.The paper also matches the SAMS-documented events against those recorded in a separate but similar database maintained by Physicians for Human Rights (PHR) using open-source methods [6].The SAMS-PHR overlap is substantial but not complete, suggesting that there are further events not captured by either data-gathering project. Attacks on health facilities in SyriaHaar and colleagues show that violent, often lethal, attacks on health infrastructure, workers, and patients were very common in northern Syria in 2016 [5].Though the scope of this study was limited to four governorates, this violence almost certainly continues to the present throughout much of the country.Moreover, such attacks occurred more frequently than we might reasonably have believed based on the prior evidence that was available [6].These carefully documented events represent serious and widespread violations of International Humanitarian Law (IHL) with tragic and morally reprehensible consequences.To be sure, the 297 deaths documented in the paper constitute a small percentage of total violence in Syria in 2016 (see, for example, the database of the Violations Documentation Center in Syria [7] and the analysis of [2]).Indeed, attacks in Syria frequently kill children [1,3,4], with the widespread use of explosives in densely populated areas posing a particular hazard [3,4].Children, medical units, and personnel are all specially protected under IHL [8,9,10], so the violations documented in the paper and [1,3,4] have special salience.Moreover, these attacks on health infrastructure might have exacerbated effects on health by impeding people in a conflict-affected environment from seeking and providing medical care.Indeed, a striking observation of Haar