AMMAN: Two waves of airstrikes on Sunday seriously damaged north Hama’s “Cave Hospital,” an underground medical center built directly beneath 50 feet of solid rock, eyewitness sources told Syria Direct.

The first attack—an airstrike of purportedly Russian origin—occurred at approximately 3:00pm Sunday afternoon, Ahmed a-Talfah, a spokesman for the north Hama Civil Defense told Syria Direct on Tuesday.

“I’ve witnessed a number of hospital attacks in the line of duty, but this one was different,” a-Talfah added. “The bomb pierced through the layers of stone and bedrock overhead before finally detonating inside the hospital.”

While Syria Direct cannot confirm the exact type of missile, the description closely resembles the accounts of “bunker busters” that have been used across Aleppo city in recent days.

Construction of Kafr Zeita Cave Hospital in 2014. Photo courtesy of UOSSM.

Shortly thereafter, in the early evening, the warplanes circled around to deliver a second strike after civil defense first responders had evacuated around 35 patients and medical staff from the wreckage of the attack.

“Fighter jets fired six additional airstrikes—both vacuum missiles and cluster bombs—which caused critical damage to the hospital’s infrastructure and medical devices,” Dr. Abdullah al-Darwish, the hospital’s director and head of Hama’s Healthcare Directorate, told Syria Direct on Monday.

Neither Russian nor Syrian official state media have commented on the attack.

No casualties, only minor injuries, were reported; however, the strike caused irreparable damage to the hospital, destroying the emergency room and critical medical equipment. Hospital administrators announced the facility’s indefinite closure on Sunday night.

‘We felt safe doing our job’

Located just outside the Syrian town of Kafr Zaita, the Dr. Hassan al-Arej Hospital, known by locals as the “Cave Hospital,” opened in October 2015 amidst the early day’s of Russia’s intervention in the war. The hospital’s opening largely came through the support of the Union of Medical Care and Relief Organizations (UOSSM), a France-based coalition of humanitarian, non-governmental and medical organizations.

Kafr Zaita is battleground territory, straddling the frontlines which separate rebel-controlled Idlib province from the regime-held Hama heartland.

Since 2012, government aircraft have reportedly dropped more than 1,800 barrel bombs and launched 600 airstrikes on Kafr Zaita alone, targeting “essential facilities such as schools, hospitals and bakeries,” Syria Direct’s partner website the Syrian Voice reported in August.

In turn, both residents and certain public facilities have turned underground, seeking shelter and reprieve from the bombs overhead, Syria Direct reported in August

Even in the midst of ongoing fighting, the north Hama Cave Hospital was believed to be one of Syria’s safest facilities.

Sunday airstrike damages Kafr Zeita Cave Hospital. Photo courtesy of UOSSM.

“Before Sunday, we felt safe doing our job,” hospital director Abdullah al-Darwish told Syria Direct. “Even when the bombings were taking place, we were able to go about our business with peace of mind.”

More than a year of deliberate targeting of north Hama’s medical infrastructure destroyed the majority of the province’s medical facilities, meaning that the underground north Hama Cave Hospital was the only remaining major medical center for more than 30 kilometers, Syrian Voice reported.

Prior to the attack, the hospital served more than 200,000 residents, around 3,000 patients per month, and conducted more than 160 operations per month, said hospital director al-Darwish.

Today, north Hama’s sick and injured residents must travel long distances—either into Idlib province or across the Hama countryside—to seek medical treatment.

Until the north Hama Cave Hospital can be rebuilt, “there is a total reliance on improvised medical centers in the area,” civil defense spokesman Ahmed al-Talfah told Syria Direct. “These locations are equipped to do little more than simple procedures and basic emergency care.”

“These vicious and atrocious campaigns are literally choking the life out of civilians,” Dr. Khaula Sawah, CEO of UOSSM USA said in a written statement on Sunday. “They are deplorable and unacceptable…[and are] a war crime.”

This is not the first time that the hospital has been targeted. On April 13, an airstrike hit the facility, killing Dr. Hassan al-Arej, the previous head of Hama’s Healthcare Directorate and the person for whom the hospital is posthumously named.

Although the hospital is indefinitely closed, the facility’s staff said they plan to rebuild.

“Had such a strike hit an above-ground hospital, the facility would have been totally devastated,” said al-Darwish.

“By the grace of God, we didn’t sustain any casualties…and it’s still possible to rebuild and refortify this underground hospital.”