CAIRO—An airstrike, most likely by the Saudi-led coalition, struck near a rural hospital in northern Yemen, killing eight people including five children, according to the charity Save the Children, which supports the facility.

Tuesday’s attack was the latest of many attacks on non-military targets that have killed thousands of civilians in the Middle East’s poorest nation. But what made this assault remarkable was that it came on the fourth anniversary of the Saudi-led coalition’s entry into Yemen’s civil war to restore its internationally recognized government against northern rebels known as Houthis.

The Saudi-led coalition, which is backed by the United States, is the only party in the war using warplanes, mostly American and British-made fighter jets.

“We are shocked and appalled by this outrageous attack,” said Carolyn Miles, the head of Save the Children in a statement. “Innocent children and health workers have lost their lives in what appears to been an indiscriminate attack on a hospital in a densely populated civilian area.”

The morning airstrike struck a gas station, less than 50 yards from the entrance to Kitaf hospital, according to the charity. The facility, about 95 kilometres from the northwestern city of Saada, one of the main stronghold of the Houthis, had been open for only a half an hour. Patients and staff were just arriving, said the charity.

Those killed included a health worker who died along with her two children, said the charity. Two other children and a security guard were also killed, as well as two other people. The children ranged in age from eight to 14.

Two other adults are still unaccounted for, suggesting the death toll could rise. An additional seven people were wounded, said the charity, which demanded an immediate investigation into the deaths.

“Attacks like these are a breach of international law,” said Miles. “These children have the right to be safe in their hospitals, schools and homes. But time after time, we see a complete disregard by all warring parties in Yemen for the basic rules of war.”

On Wednesday, the coalition took the unusual step of announcing that its own Joint Incidents Assessment Team would investigate the attack to determine whether it was “an unintentional accident,” according to the Saudi Press Agency.

The attack came two days after the release of a Save the Children report that found that at least 226 Yemeni children have been killed and 217 injured in airstrikes by the Saudi-led coalition — a rate of 37 children a month.

The assault also came a day after the United Nations signed a memorandum of understanding with the Saudi-led coalition in the Saudi capital Riyadh, which pledged to enhance the protection of boys and girls trapped in Yemen’s war.

According to numbers released this week by the Yemen Data Project, an independent monitoring group, the Saudi-led coalition’s bombing campaign has claimed 17,729 civilian deaths and injuries in the past four years of war. These include 3,046 women and children. A quarter of all civilians killed in airstrikes have been women and children, the group reported.

The Saudi-led coalition has disputed civilian casualty figures by the United Nations and other groups, but amid international pressure has accepted blame for some attacks. In one rare admission, the coalition said it was responsible for an airstrike in August on a school bus, also in Saada province, that killed scores of people, including at least 40 children.

The Sunni Muslim coalition are wary of the Shiite Houthis rebels’ alignment with Iran’s Shiite theocracy, as is the United States which is providing billions of dollars in weapons, intelligence, training and logistical support to the coalition.

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The war has worsened a humanitarian crisis that has pushed millions of Yemenis to the edge of famine and displaced more than three million people.

The mounting civilian casualties have played a central role in recent votes by the U.S. Congress to end American support for the war, largely symbolic moves given that President Trump has said he would veto the measures.

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