A new report out Wednesday from United Nations investigators says that U.S. forces may have committed war crimes in Syria.

Released by the Independent International Commission of Inquiry on the Syrian Arab Republic, the report catalogs how the eight-year conflict "continues to torment civilians who bear the brunt of hostilities," as operations carried out by the U.S.-led international coalition, militants, and Russia-backed pro-government forces have left essential infrastructure obliterated, civilians killed, maimed, and uprooted, and communities in "near complete destruction."

#HRC42 COI on Syria in their latest report: Having entered its ninth year, the conflict in #Syria, characterized by intensifying levels of #violence, continues to torment #civilians who bear the brunt of hostilities. Full report & press release: https://t.co/8Hdlaw0gQM @UNGeneva pic.twitter.com/j25dxhrAIA — HRC SECRETARIAT (@UN_HRC) September 11, 2019

The powers providing support for the warring parties, the report says, "bear a shared responsibility for the crimes committed against millions of Syrian women, men, and children."

The commission's findings are based on investigations conducted from January to July this year, including satellite imagery, interviews, and medical records.

Among the specific actions scrutinized in the report was the Al-Jazeera Storm operation in Hajin carried out by the Syrian Democratic Forces (SDF) and international coalition. One strike in the operation targeted a residential building and killed 16 civilians, the majority of whom were less than 5 years old. The commission said its investigation turned up no evidence of an ISIL presence or military target in the area.

From the report:

The evidence obtained regarding this incident indicated that international coalition forces failed to employ the necessary precautions to discriminate adequately between military objectives and civilians. The commission finds that there are reasonable grounds to believe that international coalition forces may not have directed their attacks at a specific military objective, or failed to do so with the necessary precaution. Launching indiscriminate attacks that result in death or injury to civilians amounts to a war crime in cases in which such attacks are conducted recklessly.

Actions by terrorist groups and pro-government forces were also identified as possible war crimes.

"The commission finds that there are reasonable grounds to believe that members of the armed groups in Afrin continued to commit the war crimes of hostage-taking, cruel treatment, torture, and pillage," the report states.

The document cites evidence of pro-government forces having used cluster bombs on a residential area in southern Idlib.

It also say pro-government forces launched air strikes on at least three hospitals in Idlib. The "pattern of attack strongly suggests that pro-government forces systematically targeted medical facilities," says the report. "Such attacks may amount to the war crime of deliberately attacking protected objects and intentionally attacking medical personnel."

The report also laid out a number of recommendations, including for the Syrian government to ensure unconditional access to medical and humanitarian aid and to ensure protection of health workers.

The U.N. body also urged the U.S.-led coalition to strengthen protections to avoid civilian casualties and to carry out transparent post-operation investigations "following allegations of civilian casualties from aerial and night search operations, with a view to identifying broader patterns of harm, improving operational practice and promoting accountability, and ensuring adequate and prompt reparations."

Advocacy groups including Amnesty International and Human Rights Watch have previously pointed to the ongoing tally of Syrian civilian deaths at the hand of the U.S.-led coalition, and said the true death toll is likely far higher that what the coalition acknowledges.

In their detailed exposé on the 2017 U.S.-led bombing campaign of Raqqa, Amnesty and transparency group Airwars captured the voices of some of the Syrians living through the deadly attacks.

"The shells struck one after the other," said Ahmad, a resident of Raqqa's Darai'ya neighborhood. "It was indescribable, it was like the end of the world—the noise, people screaming. If I live 100 years I won't forget this carnage."