The bombs smashed into a child care center, a refugee camp and a school. They destroyed makeshift clinics and hospitals, disabling essential services for tens of thousands of people.

Over the past year, attacks on buildings in northwestern Syria, which are supposed to be off limits during wartime under international law, grew so frequent that the head of the United Nations launched an inquiry to document the violations.

Secretary General António Guterres's establishment of the investigation is seen by many diplomats as a success at a United Nations largely stymied by division in the powerful Security Council. Russia, a Syrian government ally and a major perpetrator of these attacks, has cast 14 vetoes in the Security Council since the start of the war in Syria, blocking accountability efforts and hindering humanitarian aid deliveries into Syria.

Since April, at least 60 health facilities in northwestern Syria have been damaged in strikes, and at least 29 of them were on the off limits list. But the United Nations, at least so far, is looking at just seven incidents. A United Nations spokesman would not say how the inquiry’s sites were determined.

Human rights and medical groups that support hospitals in Syria have criticized the inquiry as insufficient, saying it fails to match the gravity of the violations. The inquiry, for example, is looking at only one attack likely to have been carried out by Russia, despite previous investigations by The New York Times that found Russia bombed hospitals at least five times in May and November.

Seven incidents on the United Nations list investigated by The Times. Satellite image by Landsat and Copernicus, via Google Earth

Diplomats also told The Times that Russia had pressed Secretary General Guterres to keep the findings of the inquiry secret. A United Nations spokesman, Farhan Haq, said the U.N. was still considering whether the report, or parts of it, would be made public. In addition, Mr. Haq said the inquiry was meant to be a fact-finding mission, not a criminal investigation to determine responsibility.

The Times obtained the list of attacks under examination from four officials briefed on the inquiry, and investigated those incidents in an attempt to determine culpability. Our reporting suggests that the Syrian military was most likely responsible for at least four of the attacks, the Russian Air Force for one and rebel groups for one or two.

To reconstruct individual attacks, The Times relied on witness statements, forensic analysis of photos and videos, weapons identification, satellite imagery and cockpit recordings of Syrian and Russian pilots during bombing missions.

We correlated this information with thousands of flight logs recorded by Syrian ground observers, who listen in on radio transmissions, track the flight paths of warplanes and identify aircraft by sight and sound.

Several of the attacks happened in late April and early May, when the Syrian government and its Russian allies began a major offensive to retake the last insurgent-held parts of Syria, in Hama and Idlib, provinces in the country’s northwest.

Satellite image by Maxar Technologies, via Google Earth 1. Ariha Child Protection Center Suspect Syrian Air Force

The child center was put out of service during a weekend of airstrikes most likely carried out by the Syrian Air Force.

The center provided health and recreation services for the children of Ariha, Idlib’s second-largest city.

“It was a safe space for children to go back to their childhood and move away from weapons and what they see in the streets,” said Baraa al-Smoudi, executive director of Ihsan Relief and Development, an organization that supported the center.

In September 2018, the center’s coordinates were entered onto the United Nations list of facilities meant to be off limits. But less than a year later, airstrikes on consecutive days damaged the center beyond repair, and killed over a dozen civilians, including several children, who were nearby.

Where

The center was nestled between apartments in a busy high-rise residential area in central Ariha. Several apartment buildings were also severely damaged in the airstrikes.

When

Witnesses began reporting airstrikes at 11:22 a.m. on Saturday, July 27.

The strikes hit two apartment blocks just 50 yards from the Child Protection Center’s entrance. The force of the blast blew in the center’s doors and windows, Mr. al-Smoudi said.

Videos verified by The Times show the gruesome aftermath of that July 27 attack.

Airstrikes destroyed apartment buildings just 50 yards from the children’s center on July 27. Ariha Today, Hadi Alabdallah, @shamalmjd1, via Twitter, Maxar Technologies, via TerraServer.

Warplanes returned almost exactly 24 hours later, at 11:18 a.m. on July 28. This time, pilots bombed the street in front of the center and a building adjacent to it.

The center was relocated after airstrikes hit it and buildings adjacent to it on July 28. @belalbayoush654, via Twitter, Maxar Technologies, via TerraServer.

Who

Our timeline of evidence and an analysis of the damage suggest the strikes were likely carried out by the Syrian Air Force.

At 11:14 a.m., minutes before the airstrikes, flight spotters log a MiG-23 fighter jet, which only the Syrians fly, circling Ariha.

location province aircraft type aircraft category heading local time Jabal Akrad Lattakia Mi-8 (Hip) Helicopter Circling 11:12:05 a.m. Jabal Al-Zawye Idlib Other Fixed-Wing Fixed Wing North West 11:12:13 a.m. Mha.m.bal Idlib Other Fixed-Wing Fixed Wing Circling 11:13:04 a.m. Ariha Idlib MiG-23 (Flogger) Fixed Wing Circling 11:14:30 a.m. Ha.m.a Military Airbase Ha.m.a Yak 130 (Mitten) Fixed Wing North 11:15:15 a.m. Jabal Akrad Lattakia Mi-8 (Hip) Helicopter Circling 11:15:58 a.m. Approximate time of the Ariha apartment block strike: 11:22 a.m. Tal Tuqan Idlib Drone Drone Circling 11:25:36 a.m. Jabal Al-Zawye Idlib Drone Drone Circling 11:31:04 a.m. Zmar Aleppo Russian Fixed Wing South East 11:34:05 a.m.

The airstrikes happen close to 11:22 a.m. An eyewitness who describes himself as a citizen journalist posts a video reporting the continuous shelling of Ariha after that.

And at 11:29 a.m., cockpit recordings capture a Syrian pilot, codenamed Baz 4, confirming that he has finished his operation, a phrase we have heard Syrian pilots use countless times to confirm a bombing run is complete.

July 27 audio of Syrian pilots Pilot “Wehad, Baz 4 finished.”

No other airstrikes in Idlib are reported at the time of the Ariha strikes, and Russian pilots are not conducting strikes at this time, according to audio files obtained by The Times. This suggests that the Syrian pilot was most likely responsible for the strike.

On July 28, flight observers again logged a MiG-21 fighter jet, another model that only the Syrian Air Force flies, circling Ariha and four miles away at Jabal Al-Zawye at 11:15 a.m.

location province aircraft type aircraft category heading local time Khan al-Sobol Idlib Other Fixed-Wing Fixed Wing North West 11:13:59 a.m. Jabal Akrad Lattakia Su-24 (Fencer) Fixed Wing Circling 11:14:31 a.m. Kafr Zeita Hama Other Fixed-Wing Fixed Wing Circling 11:14:45 a.m. Ariha Idlib MiG-21 (Fishbed) Fixed Wing Circling 11:15:27 a.m. Jabal Al-Zawye Idlib MiG-21 (Fishbed) Fixed Wing South 11:15:46 a.m. Jabal Akrad Lattakia Su-24 (Fencer) Fixed Wing Circling 11:15:59 a.m. Approximate time of the Ariha street strike: 11:18 a.m. Jisr al-Shughour Idlib Su-24 (Fencer) Fixed Wing Circling 11:18:02 a.m. Hama Military Airbase Hama MiG-23 (Flogger) Fixed Wing North 11:18:16 a.m. Jabal Akrad Lattakia Su-24 (Fencer) Fixed Wing Circling 11:18:49 a.m.

Airstrikes are first reported just a few minutes later at 11:18 a.m. on a local Facebook page, Ariha Today.

The Times has spoken to experts on the Russian and Syrian Air forces, former Soviet and Syrian pilots, and conflict analysts. The pattern of airstrikes on both days — when weapons are dropped and hit several locations at once — is typical of Syrian attacks. An incident report by the conflict monitoring group Airwars also listed the Air Force as suspects.

Children were among at least 11 people killed and 25 people injured on July 27, according to Ariha Today. At least four people were killed in the July 28 strikes.

Satellite image by Maxar Technologies, via Google Earth 2. Kafr Nabl Surgical Hospital Suspect Syrian Air Force

The surgical hospital was disabled by airstrikes highly likely to have been carried out by the Syrian Air Force.

Kafr Nabl Surgical was a well-known hospital that provided services to around 14,000 patients per month, according to Physicians for Human Rights, a nonprofit advocacy group that has investigated attacks on health care.

Repeated attacks on the hospital throughout the Syrian conflict forced administrators to move it underground. After attacks rendered it unusable in early 2019, it was restored in March with support from the World Health Organization and the Japanese government.

Officials say the U.N. is investigating only the July 4 incident, but other attacks on the hospital in 2019, including Russian attacks in May and November, have wrought greater damage, including death and injury to patients and workers.

Where

Kafr Nabl Surgical Hospital is located in opposition-controlled Idlib Province. On the day of the attack, the front lines were over 15 miles south of the town.

Since 2016, the hospital has been run by the U.K.-based charity Hand in Hand for Aid and Development, which suspended services after the July 4 attack.

When

The hospital came under fire at 2:52 p.m. and 3:40 p.m. local time on July 4, according to the British charity.

Local activists said that the town of Kafr Nabl suffered its heaviest bombardment that day since late April, when the Syrian military and its allies launched a campaign to retake northwestern Syria.

Who

Flight logs, cockpit tapes and visual evidence provided to The Times tie the airstrikes to the Syrian Air Force.

Kafr Nabl Surgical was first attacked at around 2:52 p.m. with three barrel bombs that rocked the hospital in quick succession, according to the British charity. Barrel bombs are crude unguided bombs that are dropped out of a helicopter. They have been used extensively by the Air Force.

Around that time, flight spotters recorded an Mi-8 helicopter circling above Kafr Nabl at 2:43 p.m., 2:47 p.m. and 2:57 p.m.

location province aircraft type aircraft category heading local time Ma'ret Hurma Idlib Yak 130 (Mitten) Fixed Wing Circling 2:39:35 p.m. Ma'ret Hurma Idlib Mi-8 (Hip) Helicopter Circling 2:40:14 p.m. Ma'ret Hurma Idlib Mi-8 (Hip) Helicopter North 2:40:25 p.m. Kafranbel Idlib Mi-8 (Hip) Helicopter Circling 2:43:33 p.m. Kafranbel Idlib Mi-8 (Hip) Helicopter Circling 2:43:40 p.m. Khan Sheikhun Idlib Yak 130 (Mitten) Fixed Wing Circling 2:44:09 p.m. Jabal Al-Zawye Idlib Mi-8 (Hip) Helicopter North 2:44:56 p.m. Ma'rrat al-Nu'man Idlib Yak 130 (Mitten) Fixed Wing North West 2:45:39 p.m. Kafranbel Idlib Mi-8 (Hip) Helicopter Circling 2:47:12 p.m. Ma'rrat al-Nu'man Idlib Yak 130 (Mitten) Fixed Wing West 2:48:33 p.m. Kafranbel Idlib Yak 130 (Mitten) Fixed Wing Circling 2:49:07 p.m. Kafranbel Idlib Yak 130 (Mitten) Fixed Wing South 2:50:25 p.m. Ma'rrat al-Nu'man Idlib Yak 130 (Mitten) Fixed Wing North West 2:51:05 p.m. Kafranbel Idlib Mi-8 (Hip) Helicopter Circling 2:51:19 p.m. Approximate time of first airstrike (helicopters): 2:52 p.m. Kafranbel Idlib Mi-8 (Hip) Helicopter South 2:57:46 p.m. Kafranbel Idlib Yak 130 (Mitten) Fixed Wing Circling 2:57:56 p.m. Kafranbel Idlib Yak 130 (Mitten) Fixed Wing Circling 3:03:02 p.m. Kafranbel Idlib Drone Drone Circling 3:10:53 p.m.

Yaser Kaddour, the hospital’s administrator, filmed it being rocked by one of the barrel bombs. He said it was the third explosion.

Hand in Hand for Aid and Development

The audio recordings capture a Syrian pilot confirming an attack at this time. At 2:51 p.m. — seconds before the barrel bomb reportedly exploded — a crew member is heard saying “I executed one.”

Cockpit recording of a Syrian pilot Pilot “I executed one.”

Mr. Kaddour was lucky to survive. He went to the hospital’s entrance to document the attack, and filmed the remains of an apparent barrel bomb. In the video, an airplane is suddenly heard overhead. Then, another airstrike.

Hand in Hand for Aid and Development

The time of this next strike — at 3:40 p.m., according to the British charity — is corroborated by local news media reports just two minutes later of “renewed raids” on Kafr Nabl by MiG-23 warplanes. These planes are flown only by the Syrian Air Force.

“Renewed raids of MiG-23 warplanes with four vacuum rockets at once on the city of #Kafranbel.” kafranbelnews, via Telegram

Flight observations from plane spotters show that a MiG-23 was seen circling over Kafr Nabl at 3:39 p.m. and 3:41 p.m. — one minute before and after the attack.

location province aircraft type aircraft category heading local time Ma'rrat al-Nu'man Idlib MiG-23 (Flogger) Fixed Wing North West 3:37:12 p.m. Ma'rrat al-Nu'man Idlib MiG-23 (Flogger) Fixed Wing North West 3:38:02 p.m. Ma'rrat al-Nu'man Idlib MiG-23 (Flogger) Fixed Wing West 3:38:21 p.m. Kafranbel Idlib MiG-23 (Flogger) Fixed Wing Circling 3:39:27 p.m. Approximate time of second airstrike (air-to-surface): 3:40 p.m. Kafranbel Idlib MiG-23 (Flogger) Fixed Wing South 3:41:15 p.m. Hama Military Airbase Hama Mi-8 (Hip) Helicopter North 3:41:21 p.m. T4 West Airbase Homs Su-22 (Fitter) Fixed Wing North West 3:47:46 p.m. Shayrat Airbase Homs Su-22 (Fitter) Fixed Wing North 3:49:14 p.m.

Following the July 4 bombings, the Hand in Hand charity expressed concern that the United Nations’ system of sharing coordinates of protected facilities with warring parties was not preventing attacks and had become “inept.” Four months later, Kafr Nabl Surgical Hospital was bombed again, this time by a Russian pilot, a Times investigation found.

Satellite image by Maxar Technologies, via Google Earth 3. Martyr Akram Ali Ibrahim Al-Ahmad School Suspect Russian Air Force

The Russian Air Force was bombing the town, and most likely carried out the attack.

The secondary school was located in the town of Qalaat al-Madiq. A maternity and children’s hospital built inside the school compound served around 8,000 people each month, said Ibrahim Shamali, the media officer for the Hama Health Directorate.

Staff members evacuated most of the hospital on April 26, when Russian and Syrian forces began an offensive to wrest control of the town from opposition armed groups.

On April 28, Russian airstrikes on Qalaat al-Madiq forced both the hospital and school to be abandoned. Attacks on the town killed five civilians and wounded seven, according to the Hama Media Office.

Eleven days later, Syrian government forces took the town.

Where

Qalaat al-Madiq sat on a front line in Hama province dividing armed opposition groups from President Bashar al-Assad’s military for more than a year before government forces took the town on May 9. It had been the target of Russan and Syrian government attacks on numerous occasions, and there were multiple reports of shelling and airstrikes throughout April and early May.

Both the hospital and secondary school were located at the northern end of the town, alongside two primary schools. An opposition-run education office was located across the street.

Satellite image by Maxar Technologies, via TerraServer

When

The airstrike on the school and hospital compound occurred sometime between 1:00 a.m. and 1:30 a.m, according to Mr. Shamali and the international charity that supported the hospital. The Syrian Network for Human Rights said that the first projectile landed on or near the education offices and the second in the street between them.

A video filmed by a witness around 7:30 a.m., and verified by The Times, showed heavy damage to both the education offices and the hospital.

This clip from a video filmed inside Hospital 111 shows extensive damage to the facility. It was abandoned after the April 28 attack.

Photos provided by the network also confirmed heavy damage to both.

The local education office, located about 130 feet north of the school and hospital, was also heavily damaged by the April 28 airstrike. Syrian Network for Human Rights

At 12:07 a.m., local news outlets began reporting Russian airstrikes on the town. Over the next 19 minutes, Wisam al-Hamwi, a reporter, would tweet about three strikes, at 12:07 a.m., 12:15 a.m. and 12:26 a.m.

“Russian warplanes launch an air raid in the city of Qalaat al-Madiq in the western Hama countryside.” @wseemalkade, via Twitter

At 1:11 a.m., a local news agency reported a fourth Russian airstrike, and at 1:31 a.m., an Amman-based member of a Syrian activist network tweeted about a fifth airstrike.

“Urgent: Russian occupation warplanes target Qalaat al-Madiq with a fourth raid with high-explosive missiles and are still circling.” Gaftleknews, via Telegram

“Hama countryside

Russian warplanes strike Qalaat al-Madiq

Five air raids on the city until now

God protect them” @yaseenalbakhi, via Twitter

Who

Witnesses reported five airstrikes in the two hours after midnight. Flight logs and audio recordings made clear that a Russian pilot was bombing Qalaat al-Madiq at that time. Experts on the capabilities of the Russian and Syrian air forces have also told The Times that only Russian planes typically carry out night strikes.

Syrian ground observers recorded Russian warplanes above Qalaat al-Madiq at 12:09 a.m., 12:14 a.m. and 12:33 a.m., matching the times that Mr. Al-Hamwi reported the first three strikes.

location province aircraft type aircraft category heading local time Ma'ret Hurma Idlib Drone Drone Circling 11:45:36 p.m. Jabal Shahshabo Idlib Drone Drone Circling 11:54:36 p.m. Jabal Shahshabo Idlib Russian Fixed Wing North East 12:06:23 a.m. Strikes begin on Qalaat al-Madiq: 12:07 a.m. Madiq Castle Hama Russian Fixed Wing Circling 12:09:42 a.m. Madiq Castle Hama Russian Fixed Wing Circling 12:14:51 a.m. Hmemim Airbase Lattakia Russian Fixed Wing South East 12:22:56 a.m. Madiq Castle Hama Russian Fixed Wing Circling 12:33:09 a.m. Jabal Shahshabo Idlib Russian Fixed Wing East 12:36:26 a.m. Tah Idlib Drone Drone Circling 12:36:54 a.m. Zmar Aleppo Ilyushin 76 Fixed Wing South West 12:38:34 a.m.

The fourth and fifth airstrike reports — those most likely to be the attacks on the school and hospital compound — also matched observations of Russian warplanes over Qalaat al-Madiq at 1:11 a.m. and 1:24 a.m.

location province aircraft type aircraft category heading local time Zmar Aleppo Ilyushin 76 Fixed Wing South West 12:38:34 a.m. Tal Tuqan Idlib Russian Fixed Wing Circling 1:08:48 a.m. Zmar Aleppo Russian Fixed Wing North West 1:08:51 a.m. Possible first strike on Hospital 111 and school area: 1:11 a.m. Zmar Aleppo Russian Fixed Wing Circling 1:11:30 a.m. Madiq Castle Hama Russian Fixed Wing Circling 1:11:57 a.m. Zmar Aleppo Russian Fixed Wing Circling 1:15:34 a.m. Tal Tuqan Idlib Russian Fixed Wing North 1:17:52 a.m. Zmar Aleppo Russian Fixed Wing Circling 1:23:13 a.m. Madiq Castle Hama Russian Fixed Wing Circling 1:24:03 a.m. Tal Tuqan Idlib Russian Fixed Wing South West 1:27:15 a.m. Jarjnaz Idlib Russian Fixed Wing South West 1:28:03 a.m. Jabal Shahshabo Idlib Drone Drone Circling 1:28:22 a.m. Jabal Shahshabo Idlib Russian Fixed Wing South West 1:28:38 a.m. Ma'rrat al-Nu'man Idlib Russian Fixed Wing South West 1:28:39 a.m. Possible second strike on Hospital 111 and school area: 1:31 a.m. Kafranbel Idlib Russian Fixed Wing South East 1:33:12 a.m. Ma'rrat al-Nu'man Idlib Russian Fixed Wing North East 1:34:14 a.m. Ma'ret Hurma Idlib Russian Fixed Wing West 1:38:49 a.m.

Cockpit recordings indicate Russian responsibility for the strikes. We know that Russian Pilot 44 was active over Qalaat al-Madiq at that time because he had received latitude and longitude coordinates that point to this location in the town.

Russian Pilot 44 receives coordinates Control “944 one more coordinates adjustment.” Pilot 44 “I am seeing a big difference in minutes.” Control “35 25 18,46 … [36] 23 23,79 Level 211.”

At 11:54 p.m, Pilot 44 tells his dispatcher that “it will start raining” soon. It appears unlikely this was a reference to the weather — which was dry.

Pilot 44 prepares attack Pilot “It will start raining, five minutes.”

Over the next half an hour, Pilot 44 launches three weapons at the same time that Mr. al-Hamwi, the journalist, and other local sources report airstrikes. Russian pilots follow a consistent pattern: they calculate the minute they will strike, and then confirm to ground control that a weapon has been launched.

At 11:56 p.m., Pilot 44 calculates a strike for the “fifth minute,” meaning 12:05 a.m. At that time, he says “sent,” a term Russian pilots use to confirm the release of a weapon.

Pilot 44 confirms the first strike is launched at 12:04 a.m. Pilot “5th minute.” Pilot “Sent.”

At 12:13 a.m., the pilot launches his second airstrike, just before the journalist Mr. al-Hamwi tweets about a second attack.

Pilot 44 confirms second strike at 12:13 a.m. Pilot “14th minute.” Pilot “4 sent.”

And a third strike at 12:20 a.m, just five minutes before Mr. al-Hamwi reports a third attack from the ground.

Pilot 44 confirms third strike at 12:20 a.m. Control “44 repeat.” Pilot “21st minute.” Control “21st minute. Working with one stamp.”

After this time, there are no Russian cockpit recordings that correspond to the times of 1:11 a.m. and 1:31 a.m. — the strikes most likely to have damaged the hospital, school and education offices.

Gaps in the cockpit tapes are not unusual. The Times has translated and decoded months of Russian pilot recordings. We have heard pilots switching to different radio frequencies, and sometimes the audio recordings fail because of technical difficulties.

Because we know Russian Pilot 44 was bombing Qalaat al-Madiq less than an hour before the school strike, however, and flight logs show only Russian warplane activity above the town near the time of the attack, the Russian Air Force is the most likely culprit.

Satellite image by Maxar Technologies, via Google Earth 4. Rakaya Primary Health Care Center Suspect Syrian Air Force

Reports from a charity, local news media activists and flight logs suggest that a Syrian helicopter attack damaged the facility.

The health center provided free pediatric and gynecology services to people from Rakaya Sijneh and nearby villages in Idlib Province. Each month, it served nearly 2,000 people, according to Syria Relief and Development, the United States-based charity that supported it.

No injuries or casualties were reported in the attack, because operations had been suspended a few days earlier “due to the significant increase of aerial bombardment” in the area, the charity told The Times in an email.

Where

The health facility is located in the center of Rakaya Sijneh, a village in the southern countryside of Idlib. On May 3, the town was under the control of armed opposition groups and the nearest front line was around seven miles away.

Rakaya Primary Health Center is located in the center of the village, as seen in this undated photo. Rakaya Village, via Facebook

When

The American charity said that the center was damaged at noon by a barrel bomb that exploded around 50 feet away.

Few other reports corroborate the time. But Orient News, a Dubai-based pro-opposition channel, tweeted at 4:02 p.m. local time that the facility had been bombed.

“#Urgent | The health center in Rakaya village south of Idlib was put out of service due to bombing #Syria #Orient” @OrientNews, via Twitter

Photos published by a British-based monitoring group and verified by The Times confirm that damage was caused inside and outside of the health center. And satellite imagery analysis confirmed that the external damage was caused between late April and May 4, around the time of the attack.

A suspected barrel bomb attack damaged Rakaya Primary Health Center on May 3, 2019. Syrian Network for Human Rights

The Times verified this photo of damage to the health center’s exterior. Syrian Network for Human Rights

Who

The attack on the health center happened in early May, when Rakaya was under near daily bombardment by Russian and Syrian forces.

Syria Relief and Development, the American charity, as well as the Union of Medical Care and Relief Organizations and the Syrian Network for Human Rights all reported that Syrian helicopters had dropped at least one barrel bomb near the health center.

At 11:50 a.m., around 10 minutes before the strike was reported, flight spotters recorded a Syrian Mi-8 helicopter, a type commonly used to drop barrel bombs, above the nearby town of Maarat Hurma. It was headed southeast — in the direction of Rakaya, which is around 3.5 miles southeast of Maarat Hurma.

location province aircraft type aircraft category heading local time Jabal Al-Zawye Idlib Yak 130 (Mitten) Fixed Wing Circling 11:46:57 a.m. Kafranbel Idlib Mi-8 (Hip) Helicopter Circling 11:48:39 a.m. Hbit Idlib Yak 130 (Mitten) Fixed Wing North East 11:50:27 a.m. Ma'ret Hurma Idlib Mi-8 (Hip) Helicopter South East 11:50:48 a.m. Hbit Idlib Yak 130 (Mitten) Fixed Wing Circling 11:51:56 a.m. Bdama Idlib Drone Drone Circling 11:57:51 a.m. Ma'ret Hurma Idlib Drone Drone South 11:58:17 a.m. Approximate time of Rakaya Primary Health Care Center attack: 12:00 p.m. Jabal Shahshabo Idlib Drone Drone North 12:01:53 p.m. Hama Military Airbase Hama Yak 130 (Mitten) Fixed Wing North 12:03:58 p.m. Jabal Al-Zawye Idlib Drone Drone Circling 12:06:10 p.m.

The Russian Air Force was not spotted in the area around the time of the attack, and cockpit recordings of Russian pilots did not indicate any activity at the time the strike was reported.

The absence of Russian activity combined with other evidence — including satellite imagery, flight observations and reporting by three organizations — suggests that a Syrian military helicopter was most likely behind it.

Satellite image by Maxar Technologies, via Google Earth 5. Nayrab Palestine Refugee Camp Suspect Opposition militants or pro-Syrian government forces

The camp was most likely shelled by accident. It’s unclear who was responsible.

Four children were among the 10 people killed when rockets hit the Nayrab Palestine Refugee Camp near Aleppo on May 14, according to the United Nations Relief and Works Agency. Another 30 people were injured.

The attack forced the relief agency to suspend six schools that served 3,000 children.

When

Rockets hit residential buildings around 7:14 p.m., witnesses said, as families were preparing to break their Ramadan fast. The United Nations agency confirmed the time, as did a witness who live streamed the aftermath.

The Times verified these witness photos of the strikes.

A rocket strike on Nayrab Palestine Camp was photographed at dusk on May 14, 2019. . Image via Facebook/alnyrab.

The attack happened on the eve of an annual commemoration of what Palestinians call the “catastrophe,” or “nakba,” marking the displacement of hundreds of thousands of Palestinians from their homes in 1948. The Nayrab camp has existed since that time.

Where

The densely populated camp is home to around 18,000 people in a government-controlled area near a Syrian military airport. Opposition fighters targeted the airport with rockets a week earlier, according to the research firm I.H.S. Markit.

The Times confirmed that rockets hit two locations in the camp, but we were unable to determine what direction they had come from.

A plume of dust and smoke rises over Nayrab Palestine Camp after a rocket strike on May 14, 2019. . Image via Hawar News Agency

Who

Analysts at I.H.S. Markit and the Carter Center, which monitors the Syrian conflict, told The Times the attack had most likely not been deliberate, because belligerents were not known to occupy the camp. Opposition forces trying to attack the Syrian airbase again may have overshot, or errant missiles may have been fired from the military base.

The Times has not yet been able to attribute blame.

The Syrian Network for Human Rights blamed opposition militants linked to Al Qaeda, Hayat Tahrir al-Sham, while Syria’s state news agency, SANA, blamed “unspecified insurgents.” The pro-opposition Shaam News Network reported that the rockets “had been accidentally launched by Iranian Forces at Aleppo's 80th Brigade Army base,” and not by insurgents.

Satellite image by Maxar Technologies, via Google Earth 6. Kafr Nabudah Primary Health Care Center and Surgical Unit Suspect Syrian Air Force or Army

The health facilities were destroyed when the town was pummeled for days. Syrian government forces were probably responsible.

The surgical unit was supported by the Hama Health Directorate, an opposition group that oversees health care in insurgent-held parts of Hama province. According to the World Health Organization, it performed an average of 32 surgeries and 767 outpatient consultations per month before it was attacked.

The health center was supported by the Syrian American Medical Society, a humanitarian group known as SAMS that is based in the United States.

Where

The health center and surgical unit were located on the northwestern end of Kafr Nabudah and served a community of around 16,000 people, according to the World Health Organization. The health center was located about 275 meters to the east of the surgical unit, down the street.

The Kafr Nabudah Primary Health Center and Surgical Unit were located on the northwestern end of the town, which was close to a front line. Satellite image by Maxar Technologies, via Google Earth

Kafr Nabudah was one of several towns located on a front line between Syrian government forces and armed insurgent groups, including Hayat Tahrir al-Sham and the National Liberation Front.

When

In late April and early May, the Syrian government and its Russian allies began a major offensive aimed at retaking territory in the last insurgent-held parts of Hama and Idlib provinces.

On May 1, predawn ground shelling by Syrian government troops damaged the surgical unit, a dispensary, and an office and ambulance dispatch center of the Syrian Civil Defense. All of the facilities were located near one another.

The shelling injured a nurse, damaged the surgical unit and dispensary, and partially destroyed the Civil Defense building, according to a report by the Syrian Network for Human Rights. A second round of shelling that day damaged a Civil Defense car and an ambulance as they tried to respond to the first attack, the network said.

Over the following days, indiscriminate shelling and bombing of Kafr Nabudah intensified as Syrian government forces advanced on the town and battled insurgent groups in surrounding villages.

Videos posted by the Syrian Army unit known as the Tiger Forces show its members participating in the assault on Kafr Nabudah in the first week of May 2019. Syrian Tiger Forces, via Facebook

At least two videos show Syrian government helicopters dropping barrel bombs on different locations within Kafr Nabudah in the days before its capture.

This video, which The Times edited for length, shows a Syrian Air Force helicopter dropping a barrel bomb on Kafr Nabudah. Salah al-Sheikh

And a review of satellite imagery shows widespread damage across Kafr Nabudah from April 29 to May 10, as Syrian government forces assaulted and captured it.

Four satellite images taken on April 29, May 2, May 7 and May 10 show how attacks by the Syrian Army and Air Force caused destruction across large swaths of Kafr Nabudah, including the approximate locations of the health facilities. Planet Labs

Because doctors, journalists, activists and people opposed to the Assad government fled Kafr Nabudah in the days before its capture on May 8, the Hama Health Directorate was not able to document the destruction of the surgical unit, the agency told The Times. Similarly, SAMS and activists were not able to document the health center’s destruction.

Given the multiday assault on Kafr Nabudah and the indiscriminate nature of the shelling, it was not possible to independently confirm the exact date the two health care facilities were hit. But it is highly likely they were destroyed between May 1 and May 8.

Who

Physicians for Human Rights, an advocacy group that has documented attacks on health care facilities in Syria, provided The Times with three images and a video taken after the capture of Kafr Nabudah showing government forces raising the Syrian flag above the dispensary and the surgical unit.

After the town was captured, a Syrian Army soldier spray-painted “Kafr Nabudah Post Office” on the wall of the former Kafr Nabudah Surgical Unit. Physicians for Human Rights

In addition to the videos showing Syrian government barrel bombing of Kafr Nabudah, the government’s 25th Special Mission Forces Division, more commonly known as the Tiger Forces, posted numerous videos documenting their participation in the fight to seize Kafr Nabudah and nearby towns. The videos show the Tiger Forces and their commanders appearing to direct artillery and airstrikes on Kafr Nabudah and using rocket launchers on a nearby town.

In one video, Zein al-Abidin Darwish, a well-known, one-eyed commander in the Tiger Forces, stands in the center of the ruins of Kafr Nabudah after its capture, symbolically stepping on the ground to mark his forces’ victory and referring to the city’s former inhabitants as “sons of whores.”

Syrian Tiger Forces, via Facebook

Finally, Syrian government Mi-8 attack helicopters and Yak-130 fighter-bomber jets were spotted a total of 19 times over Kafr Nabudah on May 7 and May 8, suggesting they were also highly active in the attacks, in addition to ground forces. Ground observers also logged three Russian jets over the city between 8 a.m. and 9 a.m. on May 8, and two Su-24 jets, which could have been flown by Syrian or Russian pilots.

Satellite image by Maxar Technologies, via Google Earth 7. National Hospital in al-Suqaylabiyah Suspect National Liberation Front, an armed opposition group

Opposition militants who bragged about shelling the area were probably responsible for damaging a hospital.

The National Hospital provides services to the people of al-Suqaylabiyah and the surrounding countryside, according to the hospital’s director.

Where

For years, al-Suqaylabiyah has sat on a front line dividing Syrian government forces from opposition militants, who have repeatedly shelled the town, causing extensive damage and injuries.

The hospital was reportedly damaged when dozens of rockets hit the town on May 26, according to several news and official reports.

A pro-government television report showed damage to the hospital compound. The nearby Younes al-Aji School and civilian homes were featured in other reports of the shelling. The Times verified that they are within a mile of the hospital.

There are conflicting reports about whether the attack caused fatalities. Deaths were reported by the Russian Defense Ministry, the state-run Syrian Arab News Agency (SANA), the pro-government Syrian News Channel and the Britain-based Syrian Observatory for Human Rights. But later reports mentioned only two injuries, including to a hospital staff member.

When

The attack happened in the afternoon of May 26, the Syrian News Channel said. That is the only time estimate The Times found.

Hours later, at 11:44 p.m. local time, a pro-government news outlet tweeted that “terrorist attacks by rockets” resulted in the injury of a nurse and the destruction of the hospital’s emergency department, a claim later repeated by others.

“A nurse wounded and destruction in the emergency department, as a result of terrorist attacks by rockets on Al-Suqaylabiyah National Hospital in Hama. #hawa_alsham” @lahawaalsham, via Twitter

Who

A coalition of opposition groups shelled al-Suqaylabiyah and other towns on May 26 during a counteroffensive to retake nearby Kafr Nabudah. The groups included Hayat Tahrir al-Sham, the dominant rebel group in the area, and the Turkish-backed National Liberation Front.

A militia within the National Liberation Front claimed on May 26 that it had killed Syrian and Russian soldiers when it shelled their positions in al-Suqaylabiyah. Some news media repeated that claim, as did opposition supporters on Telegram, a popular messaging app in Syria.

The militants posted videos showing members using what appear to be 122-millimeter artillery shells and a multiple rocket launcher.

National Liberation Front, via YouTube

Weapons remains filmed in al-Suqaylabiyah (below) resemble the 122-millimeter rockets that militants claimed to use.

Alleged weapon remnants were shown on Syrian state-run TV. The remains resemble parts of rockets fired by multiple rocket launch systems. Syrian Arab News Agency, via YouTube

Even if the N.L.F. intended to attack legitimate military targets, multiple rocket systems are not precise. They target a general area, and are indiscriminate when fired at densely populated areas like al-Suqaylabiyah.

The combination of opposition-affiliated news media statements, suspected weapon remnants, witness statements and damage throughout the town suggest that rockets fired by one or more armed opposition groups caused the damage and injuries reported at the National Hospital.

It is possible, given their claims and other evidence, that the N.L.F. is responsible. The N.L.F. did not respond to a request for comment.

Broad Destruction,

Narrow Inquiry

The seven incidents selected by the United Nations comprise a small number of the widespread attacks in 2019 on facilities that are meant to be safeguarded. Medical and human rights groups worry that no one will be held accountable.

The Times’s finding that the United Nations has shared with military forces operating in Syria the precise location of at least 29 sites that have come under attack raises questions about whether the system designed to protect those sites has failed.

Russian pilots bombed four hospitals in a 12-hour period in May. And one of those same hospitals again in November. None of these attacks is among those currently being investigated by the United Nations.

Russia Bombed Four Syrian Hospitals in 12 Hours.

In interviews with The Times, leaders of relief groups that support health facilities criticized the narrow scope of the inquiry.

“We don't think that’s adequate,” said Dr. Mufaddal Hamadeh, president of the Syrian American Medical Society. “Some sites really do not represent the true story.”

One notable attack not yet being investigated, Dr. Hamadeh said, was on a major hospital in Maarat al-Numan. In November, after the inquiry was established, pro-Syrian government forces were also suspected of bombing a camp for displaced people in Qah, in the Aleppo countryside. Its location, too, was shared by the United Nations, but the attack is not currently on the inquiry’s list.

The inquiry is continuing, and investigators may yet broaden its scope.

Khaula Sawah, vice president of the Union of Medical Care and Relief Organizations in the United States, said that if governments and the international community did not “hold the perpetrators accountable for what they do, they will continue their work, they will escalate their actions.”