AZAZ, Syria -- The national hospital in the northeast Syrian town of Azaz opened just five years ago, but today it lies in ruins; government aircraft bombed an entire wing in late December.
In nearby Aleppo, a barrel bomb, most likely shoved from a government helicopter, had forced the closing of the Dar al-Shifa hospital in November.
Those are just two examples of the heavy toll taken on Syria's hospitals, both public and private, in the nearly two years of war that's ravaged this country. Half of the hospitals are now out of service, according to the Syrian government.
International officials decry what they say is a government campaign against health care facilities and medical professionals that constitutes a war crime. Humanitarian aid workers call it the worst health care crisis on Earth. Legal experts say the assault on doctors and medical facilities has set back the clock of humanitarian standards by 150 years.
"This targeting of medical facilities is greater than we've seen in modern warfare," said Stephen Rapp, the U.S. ambassador-at-large for global criminal justice. The Syrian government, he said, is "conducting a campaign with total disregard for human life and a deliberate effort to harm civilians."
The toll goes beyond the buildings themselves, a special U.N. commission reported last week, citing examples of government hospitals' rejecting wounded civilians _ even children _ if they're thought to be opposition supporters. Field hospitals set up to treat wounded rebels also are routinely targeted, the commission reported, a violation of international law that dates to the first Geneva Convention in 1864, when European nations banned attacks on wounded soldiers, military hospitals and ambulances.
In Azaz, a town close to the Turkish border, the Syrian army seized the 200-bed national hospital last June and turned it into a military base, stationing tanks and other armored vehicles on the grounds, the U.N. commission reported. An eyewitness told the commission that snipers were on the roof.
Rebels fighting to overthrow President Bashar Assad captured the town about a month later and attempted to restore the hospital to its earlier purpose, said Muhammed Karkupi, a press officer at a nearby camp for people who've fled their homes. Those plans were never fully realized, however, in large part because the hospital was too near a government military base, and the government bombed it on Dec. 31.
According to Karkupi, a rebel leader, Ammar Bebekhi of the North Storm brigade, had been wounded in a battle to control a nearby air base, and the army may have eavesdropped on fighters saying over a walkie-talkie that he was being taken to a hospital. Not long afterward, a combat plane flew overhead and bombed the hospital twice. An entire wing was devastated, and windows were blown out all over the hospital. The rebel leader survived because he'd been taken to a different hospital.
Last week's U.N. report, citing interviews with refugees, listed more than a dozen attacks on hospitals and field clinics since last summer, almost all on facilities that had been treating wounded opposition fighters. It said hospitals and medical units had been targeted "to gain military advantage by depriving anti-government armed groups and those perceived to support them of medical assistance."
Among the war crimes the commission alleged are assaults on medical facilities that are protected under international law and attacks on people and facilities using the Red Cross or Red Crescent emblems.
It listed multiple instances of government snipers targeting staff members or ambulances of the Syrian Arab Red Crescent, whose leadership has ties to the Assad government -- in all probability a prosecutable war crime, it said.
The commission said it had no indications that the rebels had targeted civilians, but that they'd taken medical supplies and equipment from government hospitals and on one occasion exploded a car bomb outside a hospital. International aid workers say the opposition sometimes targets government ambulances.
Of Syria's 510 hospitals, 124 are state-owned and the rest are private. The government has reported that half the public hospitals are no longer functioning. An opposition group, the Syrian Network for Human Rights, claims that 225 private hospitals have stopped working because their facilities were damaged or destroyed or their medical staffs fear they'll be targeted.
The group says makeshift emergency rooms set up in schools, mosques and other buildings to treat rebel and civilian casualties have been attacked 185 times; on four occasions, both doctors and patients were killed, the group says.
The near-collapse of medical care was evident early this month at a field hospital set up to treat wounded rebels in Hama province, near the town of Karnaz, which government artillery and aircraft were pounding in an offensive to dislodge rebels who'd seized the town late last year. Government troops reportedly overran Karnaz on Feb. 8.
Other than an ambulance, the clinic had almost had no equipment, and its meager stock of medicines was stashed away nearby. After only four days, the staff of 10 was preparing to pack up and move.
The doctors, who asked not to be photographed or identified for their safety, said they'd moved seven times in the past month across the northern Syrian countryside. "We were in the Idlib area, but planes came overhead, so we decided to come here," one told McClatchy Newspapers.
Hospitals in Aleppo, Syria's commercial capital and the scene of fierce fighting since July, have been hit particularly hard. The U.N. commission said the barrel bomb attack on Dar al-Shifa killed civilians, significantly damaged the hospital's infrastructure and substantially reduced the hospital's ability to treat patients.
In the city's Ashrafiya district, which has seen months of fighting between rebel and pro-Assad forces, all five private hospitals have stopped functioning, opposition activists claim. "There are 300,000 people and not a single hospital capable of receiving patients," said Abdu Khalil, a 43-year-old electronics repairman who began delivering supplies to field hospitals last summer. He said that some of the hospitals had been bombed and others lacked drugs, equipment and medical personnel.
Medical workers tending wounded opposition soldiers or civilians have been targeted repeatedly, the U.N. and opposition activists claim. The Syrian Network for Human Rights has published a list of 143 medical workers it said had been killed by the government. It also reported that it had documented 3,000 arrests of medical staff and volunteers since the beginning of the anti-Assad uprising. Of them, 13 had been tortured to death while in custody, it said.
The U.N. commission told of a medical emergency worker in Aleppo who was shot by a sniper in early September "while in full medical uniform and holding a medical bag with a Red Crescent." An ambulance that was evacuating wounded rebels was hit five times by sniper fire.
The Syrian Network for Human Rights says it's documented more than 1,400 cases of injured people _ fighters and civilians _ who went into hospitals and were killed.
International agencies, among them the Geneva-based International Committee of the Red Cross, are able to deliver medical supplies to hospitals in government-held areas, but they're delayed for weeks, often months, when they attempt to deliver supplies to opposition-held areas.
That's taken a toll not just on treatment of the wounded, but also on those who need care for other medical conditions.
"The situation's catastrophic everywhere," said Dr. Mego Terzian, the emergency operations manager for the French-based Medecins sans Frontieres, or Doctors without Borders, the only international aid organization that's openly operating in rebel-held areas. "There is no capacity for blood transfusions. For chronic problems like asthma and cardiovascular illnesses, there is almost zero treatment available."
Terzian said the health system had declined in stages after what began as a government crackdown on opposition demonstrations devolved into open warfare.
"After the opposition armed itself, the regime started to arrest medical personnel everywhere, accusing them of treating terrorist groups. Then it started to bomb a lot of health structures," he told McClatchy.
Doctors without Borders views the collapse of the health care system as a reason that more Syrians are fleeing abroad.
"Last year, the focus was around the wounded and direct victims of violence. Now there is a more general collapse of the health system," said Bruno Jochum, the organization's director.
Raymond, a McClatchy Newspapers special correspondent, reported from Reyhanli, Turkey.