The first airstrike hit at 9:02 on the morning of Feb. 15. As rescue teams dashed to the scene, warplanes circled back for a “double tap,” pummeling the isolated hospital in northwestern Syria a second time, minutes later. And a third. And a fourth.

Twenty-five people died, including nine health care workers and five children. Staff and volunteers who survived the onslaught at the Doctors Without Borders-supported facility rushed victims to the next closest emergency center in a nearby town. The bombs followed.

It’s an utterly grim and tragic irony: Hospitals are now among the most dangerous places in Syria. There have been 252 attacks on Syrian health care centers in 2016 so far, according to the Syrian American Medical Society, a nonprofit organization. Countless men, women and children suffering from injury or illness in the war-torn country have endangered their lives simply by seeking treatment. Many of the brave doctors who voluntarily walk into hospitals to help those in need ― dismally aware of the grave personal risk ― never come back out.

“Perhaps one of the defining facets of the conflict since its outset has been making attacks on medical care a part of the war strategy,” Jason Cone, executive director of Doctors Without Borders’ U.S. branch, told The WorldPost. “In this day and age, [going to a hospital in Syria] is a very risky endeavor,” Cone added. “Some of our colleagues in Syria have reported that people don’t want to stay in the hospital for any longer than they have to. Many seek to be discharged before their treatment is completed because they don’t feel safe in hospitals.”

Muhammed Karkas/Anadolu Agency via Getty Images A rescue worker searches the debris of a collapsed hospital in Idlib Province on Feb. 15, 2016.

The rate of assaults doubled after Russia’s military intervention in the conflict in September 2015, the medical society’s figures show. And nearly 200 occurred after May 3, when the United Nations Security Council adopted a resolution strongly condemning violence against those providing and receiving medical treatment in the country.

In July alone, the U.N. recorded 44 attacks on Syrian hospitals ― a rate of one every 17 hours ― including 15 in eastern Aleppo. Not a single medical facility in the formerly besieged region of the city has gone unscathed.

Two of Aleppo’s largest hospitals were bombed out of operation on the same day in September. When a reporter asked Syria’s ambassador to the U.N. Bashar Jaadari at a press event if his government had launched those deadly attacks, he simply laughed and walked away. In fact, Damascus and Moscow have repeatedly denied that hospitals are being targeted.

That’s hard to believe.

From the beginning of the conflict in March 2011 through July 2016, Physicians For Human Rights tracked 400 onslaughts against at least 269 separate medical centers in Syria, killing 768 health care workers. The humanitarian group acknowledges that its method of corroboration often leads to significant undercounting, requiring rigorous review of each reported incident and at least three independent sources to add an assault to its list.

“There are far more attacks than we’re able to document,” PHR research coordinator Elise Baker told The WorldPost. Even so, more than 90 percent of the documented attacks and deaths came at the hands of Syrian President Bashar Assad’s government and its allied forces ― including the two assaults that Jaadari scoffed at.

The U.N. holds an even higher count. Secretary General Ban Ki-moon strongly denounced more than 600 “horrific attacks” on Syrian hospitals and clinics In 2014 and 2015 alone, resulting in 959 deaths and more than 1,500 injuries.

Health care structures in Aleppo have fallen victim to a particularly devastating number of attacks. In October, U.N. Under-Secretary-General for Humanitarian Affairs Stephen O’Brien called the city’s health care system “all but obliterated,” with medical facilities “being hit one by one.” By mid-November, there were no more functioning hospitals left to demolish there. Days of intense airstrikes forced every last one out of service, leaving some 275,000 people without access to health care.

“When you have that population also subject to hundreds of airstrikes, that leads to a rate of death we can’t even begin to imagine,” Baker said.

One of Aleppo’s main trauma centers was completely destroyed after it was hit four times in less than three weeks earlier this year. The SAMS-supported hospital had already endured at least seven earlier attacks between 2014 and 2015, according to PHR. Syrian and Russian warplanes were responsible for all of them.

“We’ve noticed a pattern of attacks targeting the same hospital multiple times,” Dr. Ahmad Tarakji, president of SAMS, told The WorldPost. “We’ve also noticed that attacks on facilities are not just individual attacks ― airstrikes will hit many facilities at the same time in the same region to paralyze the medical response in that area, which will increase the casualties and death because of inability to treat even mid-level injuries.”

SAMS operates more than 100 medical centers offering specialized and general health care treatment in Syria. In early December, the organization announced its staff had been driven out of Aleppo after all its facilities in the city were seized by the Syrian government.

Sana Sana/Reuters The charred remains of a hospital in Aleppo, Syria, are pictured after an attack in December.

“With the targeting and destruction of ambulances, it’s made it incredibly difficult for first responders to even get to people and bring them to medical facilities,” Cone said. Some Syrian hospitals, he said, are operating underground and in caves as a means of shelter and protection from aerial bombardment. “There’s really no line that hasn’t been crossed in this war.”

Experts anticipate health care problems resulting from the war will far outlast the conflict itself. “There are growing longterm issues that we will see for decades to come,” said Baker, who stressed the urgency of civilians’ various medical needs that have long been neglected. “Kids aren’t getting vaccinations, people have gotten amputations without appropriate rehabilitative care ... Syria’s entire health care system will need to be rebuilt.”

Children growing up in a war zone are also at a greater risk of developing psychological disorders, added Tarakji. “In besieged areas of Syria in particular, we have seen increased incidences of violence and depression ― signs of illnesses that won’t be easily treated, and will last for many generations to come,” he said. “Some of these children witnessed their parents and siblings dying, being raped or burned right in front of them.”

Syria’s entire health care system will need to be rebuilt.

Some of the hospitals that have been damaged by regime airstrikes are government-operated facilities, Baker points out. “Of course the government knows where they are, because it established them,” she said. The activist asserts many attacks on hospitals have “absolutely” been deliberate, initially as a means to “demoralize members of the opposition” and “bomb them into submission.”

But Assad continues to deny Syrian and Russian accountability. After the U.S. government accused the regimes of deadly airstrikes against a Red Crescent aid convoy delivering medical assistance in rural Aleppo, Assad called the White House’s claims “just lies.”

“I would say whatever the American officials said about the conflicts in Syria in general has no credibility,” he said in an interview with The Associated Press days after the assault, calling it a ground attack by rebels.

Eyewitnesses, including relatives, described helicopters, barrel bombs and at least 20 missiles, AP’s Ian Phillips pushed back, noting only the Syrians and the Russians have helicopters.

“You cannot talk about eyewitnesses for such judgment or accusation. What are the credibility of those eyewitnesses, who are they? We don’t know,” Assad responded.

Ahmad Hasan/Anadolu Agency via Getty Images Wreckage of Syrian Red Crescent aid trucks are seen following a Sept. 19 attack killing 12 people in Aleppo.

“In Syria, the government and its allies relentlessly — deliberately — attack hospitals, doctors, first responders and patients,” said MSF president Dr. Joanne Liu during an impassioned speech before the U.N. Security Council in September. “People are being taken off life support so that the multitude of wounded can be treated. With the bombs continuing to fall, the doctors tell us they await their own deaths.”

Beyond the constant exposure to death, pain and relentless misery, doctors in Syria face yet another unimaginably excruciating hardship. With extremely limited resources available, they often have to make the heart-wrenching decision to only treat patients with the best chances of survival, while the others are left to die, explained Tarakji.

“People think this is a political war, and that’s it. But this isn’t true,” he said. “What’s going on inside Syria is a constant violation of humanity.”

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