The taboo around Russia bombing hospitals is fading and the WHO needs to do more, international legal expert says

• Russia may start to face consequences for bombing hospitals, according to an expert.
• Gissou Nia, an international human rights lawyer, said that the world is still moving too slow.

For decades, international human rights protocols were created and enshrined to protect the bombing of civilian hospitals during wartime – until the war in Syria, and more recently, in Ukraine.

"We see that that taboo is now gone," said Gissou Nia, an international human rights lawyer with the Atlantic Council, who co-authored a report in June urging the international community to do more to hold Russia to account for what international human rights groups have said is a cruel campaign of bombing hospitals in Syria and Ukraine.

In just the first 100 days of the war in Ukraine, Russian forces have attacked approximately 200 hospitals, according to the World Health Organization. In a grim parallel, during the Syrian war, 600 medical facilities were attacked, according to Physicians for Human Rights. The US, too has bombed medical facilities in Afghanistan, but Nia said the difference is Russia's systematic campaign of hitting medical centers.

Months into Russia's war in Ukraine, a top commander who oversaw bombing campaigns in Syria – dubbed the Butcher of Syria – was tapped to lead in Ukraine.

Russia has also targeted humanitarian corridors and employed "double-tap strikes" – bombing a healthcare facility and the subsequent rescue operation – in both Syria and Ukraine.

"I think this really shows that Russian forces and the Russian state really tested out the limits of what they could do in Syria," Nia told Insider.

Russia has denied that it has targeted hospitals in either country.

In their report, the Atlantic Council said that the pattern of attacking hospitals during wartime "undermines long-established and hard-won provisions under international humanitarian law that are intended to protect civilians during conflict."

Nia argues that with Russia's war in Ukraine, the problem is rapidly getting worse. And international organizations such as the World Health Organization, the International Criminal Court, and the United Nations are not responding quickly enough, the authors said.

Nia, who also works with the ICC around Iran's abuses of human rights, spoke to Insider about how the taboo around Russia's actions is fading and offered potential legal solutions for justice and prevention. This interview has been edited for clarity.

Based on the research that you've done and the strategy that Russia has taken in Syria and Ukraine, is Syria the first real conflict where those kind of attacks on medical facilities became systematic, or was there also, specific to Russia, a history of that before as well?

I think Syria is, unfortunately, the example of where these centuries-long protections in international humanitarian law were really eroded. It's definitely where we've seen, I think, the worst scale. One thing that really sticks out to me is that we know how grave the situation in Syria was in terms of the breadth and the range of crimes that were committed by the Syrian government, by its allies and also the non-state actors in the conflict. But there were more than 600 attacks on healthcare facilities in the course of that conflict, that of course involved the Assad Regime, but then later the Russians.

This is something that you also wrote extensively about in the report, but what recourse do you think the international community has, especially given that Russia has had the seat on the security council and blocked a lot of those efforts that would've gone through the security council?

I think it's no secret that obviously the international community has failed with respect to preventing atrocity crimes in Syria, and to some degree on the accountability side as well. We debated whether it was even worth putting a recommendation to the security council, given the structure and the challenges there. But what would be interesting is to really look at how some of the human rights bodies at the UN can elevate this issue.

There has to be more of a focus with respect to what the World Health Organization is doing. The WHO has their toe in starting to be a little more stern in language and posture on these attacks, but it's really quite something that they're stopping short of really calling out who the actual perpetrators are. I think they'll even say that it's because they're focused on humanitarian goals. But we think with the current state of play, that's not really acceptable. Certainly, from a data collection standpoint, there's a lot of things that could be improved and that doesn't cause problems for them in terms of detailed information about attacks, including the locations and descriptions, impact on the facility, and access to care.

I think the real reason that we wanted to put out this brief was to really focus on the accountability point, because there's been a lack of legal accountability for what happened in Syria since 2014 – that the Syrian government was attacked in healthcare. But over what is almost a decade, there's been little to no accountability. There's different reasons for that, including some of the evidentiary challenges in intentionality, because these are the crimes that are happening in conflict and the laws of war, as you know, they do permit death, right? So it's always a challenge. I think without direct admissions that Russian forces are actually intending to target hospitals, you have to prove that through the patterns. So that's why we spend a bit of time in the brief identifying the different patterns that seem to suggest that facilities are actually purposely being targeted as a method of warfare.

Then we go into how that could feed into different cases being built to actually hold some of these alleged perpetrators accountable, but also, some recommendations on the legal frameworks that exist in national systems. So in any jurisdictions that have universal jurisdiction-type laws or have civil litigation that has extra territorial application, we really need to ensure that those laws are able to prosecute and/or hold accountable perpetrators for these crimes. There's a lot of gaps in those laws.

I wanted to follow up on that point a little bit around universal jurisdiction and some of the trials that we've seen successfully prosecuted in Koblenz and the former Syrian intelligence officers. What has been stopping international war crimes trials around these attacks on hospitals, whether they be in Syria or Ukraine?

One of the biggest blockages has really been this inability to go after Russian perpetrators. Because even if you go after Syrian government perpetrators that were involved in attacks on healthcare, then the elephant in the room would be like, "Well, why are the Russians not on the dock for this?"

So any indictment really needs to reflect the full range of charges, including against what may have happened in Syria, if Wagner Group is involved, what happened in Libya. So I actually think that's the main reason that we didn't see accountability for this sort of crime from a political standpoint.

I think this is now a unique moment where European prosecutors who have opened up structural investigations in their countries, those that are working on joint investigative teams and the ones that are also working hand-in-hand with investigators from the International Criminal Court, they're specifically looking at alleged Russian perpetrators, and so there's an ability to now go after them for the full range of crimes. Some of those alleged Russian perpetrators who maybe were commanders and aerial forces that were bombing Mariupol, let's say might also bear responsibility for having bombed Aleppo in 2016.

One thing that I'll note that's connected to that, and it's something that we raise in the brief, is that there's obviously a lot of discussions around the freezing, the seizure, and the possible liquidation of Russian state assets and Russian oligarch assets. There's a big discussion around using that for Ukraine's reconstruction. We do believe that part of those monies if they are indeed liquidated ... needs to go to reparations for victims, and that is not only Ukrainian victims; that's also Syrian victims who have suffered violations by the same perpetrator groups. We think any mechanism that's established to do that needs to factor in that recovery. That could be for victims of hospital attacks.

What do you think is the boldest strategy being pursued right now? That could include the ICC inquiry as well. I know that ICC inquiry, when it comes to Syria, can be a little bit difficult because Syria's not a member.

Well, it's interesting that you mentioned the ICC because in terms of crimes against humanity of deportation, persecution, and other inhumane acts – if any of these crimes were completed in the territory of Jordan, there is a pathway.

So basically if Syrian refugees fled to Jordan, then the jurisdictional argument is that then jurisdiction applies, and so you're looking at a very narrow slice of the Syrian conflict, but those folks who flee, the argument is that there are coercive acts that were committed that forced them to flee. Coercive acts can include things like detention. It can also include attacks on healthcare, and so there is actually a way for the ICC Office of the Prosecutor to look at attacks on healthcare in the Syrian conflict, if those constituted the coercive acts that caused Syrian refugees to flee to Jordan.

In terms of other bold strategies, what we see with Ukraine is a really welcome development in terms of the justice response. We saw 43 member states of the ICC actually referring the matter to the prosecutor to get him to open an investigation into the situation in Ukraine – that's unprecedented. Prior to that, the highest number of state member state referrals was Venezuela. That was six or seven states, I believe, and that was seen as a lot.

So to have this kind of state involvement is a really good sign. It shows that the go-to response was a justice response and that's so important. As part of the strategies of European prosecutors, of Ukrainian prosecutors – because they're the ones that have already commenced and closed trials, right? – they're going to be doing a lot of these trials domestically. And that the ICC and other international justice players all look at attacks on hospitals and elevate that within the justice discussion, I think is key.

I guess that's a big difference between Ukraine and Syria too, is that within Syria, there was really no ongoing hope of trying any of those cases within the Syrian justice system, because it's allied with the Russians. But Ukraine is facing an occupying force, and is able to build those cases within Ukraine's borders, and within its own judicial system.

Yeah. It makes a big difference in a few ways. Ukraine could give a declaration of jurisdiction to the International Criminal Court. They did so back in 2014. They had two declarations and that was about Crimea. So it was about other things, but they've had this ongoing declaration of jurisdiction. They're not an ICC member state, but they are authorized to let the prosecutor have jurisdiction, so they did that. Obviously, you wouldn't see the Assad regime giving a voluntary declaration of jurisdiction.

It also allows access to crime scenes, so I think you see that international independent investigators are given access to visit Boucha and different crime scenes in Ukraine, that kind of access to independent international investigators is obviously not allowed in many regions of Syria, of course; some others maybe, but no government-held part of Syria. So that also affects the forensics that are collected and what evidence can be collected, so there are differences definitely. There's a range of reasons why this is being facilitated a bit more easily in Ukraine, but part of it is that the state is asking for this and cooperating.

What do you hope that readers understand about the effect of bombing healthcare facilities?

Attacking hospitals and healthcare more broadly just compounds the already existing pain of war. To attack them when they're at their most vulnerable, and then to attack the healthcare providers that are trying to mitigate the worst aspects of these conflicts, this is just really beyond the pale offense. So the globe does need to take this more seriously, because we should be doing everything we can to mitigate civilian harms. We completely failed to do that in Syria, and I do worry that in Ukraine, some of those patterns are repeating because that impunity was there. And the cycle needs to stop now.