The World Health Organization has yet to announce a case of Covid-19 in Yemen, but a new report sheds light on how years of attacks, many targeting hospitals and clinics, have helped push the country’s health system past the breaking point. The report, produced jointly by Physicians for Human Rights and the Yemen-based human rights organization Mwatana for Human Rights, documents four years of attacks against health care facilities in the country, part of a global trend that has led to a record rise in attacks on health care workers and facilities in war zones. Based on nearly 200 interviews, cross-checked with witness statements, photographs, and media and NGO reports, the report documents 120 attacks against medical facilities across 20 of Yemen’s 22 governorates between March 2015, when Saudi Arabia and the United Arab Emirates started a war there with U.S. backing, and the end of 2018. The report is the most comprehensive attempt to document attacks on medical facilities in the conflict to date, and sheds important light on an already overwhelmed health system that is struggling to cope with the fallout from years of malnutrition, preventable diseases, and escalating violence.

“When you look at it, it’s really a death by a thousand cuts situation,” said Kristine Beckerle, the legal director for accountability and redress at Mwatana for Human Rights. “Yemen’s health sector hasn’t been stretched to its limits; it’s far beyond its limits.” Of the attacks documented in the report, 35 were aerial assaults by the Saudi and Emirati coalition, and involved bombing raids on 32 separate medical facilitates. “Most airstrikes caused significant damage to the facilities in question, destroying vital medical units and causing widespread disruptions in access and service provision,” the report says. Forty-six of the attacks were from ground-launched mortars or rockets, mainly operated by the Houthi rebel group or their allies, and nine were attempts by Houthi forces to occupy or commandeer medical facilities. Rayan Koteiche, one of the authors of the report and a Middle East and North Africa researcher for Physicians for Human Rights, told The Intercept that all warring parties were guilty of attacks against medical facilities, from the Saudi and Emirati air forces to the Yemeni government they support and the Houthis, who occupy the capital of Sana’a in the North. “They’ve all been perpetrating violations of international humanitarian law by attacking — repeatedly — the health infrastructure and medical personnel in Yemen,” Koteiche said.