On November 18 last year, as fighter jets roared overhead, explosions ripped through the Omar bin Abdul Aziz Hospital in Aleppo Syria.
The airstrikes destroyed the last operating hospital in the eastern part of the city. This wasn't a rare event. Three other hospitals in Aleppo were bombed on that day, too.
These bombings occurred despite the fact that attacking a medical clinic is a war crime under international law.
Leonard Rubenstein. a lawyer who directs a program on human rights, health and conflict at the Bloomberg School of Public Health at Johns Hopkins. says there were a staggering number of assaults on health care facilities in 2016.
"The international community says it wants to stop this and then does nothing to implement its own recommendations," he says. "These attacks go on."
Rubenstein is the editor of a new report called "Impunity Must End" about aggression against health facilities and health workers globally last year. Syria is definitely the most dangerous place to practice medicine "in terms of the intensity and impact of the attacks," according to the report. The authors say at least 108 Syrian hospitals were hit in 2016, "most by Syrian government and Russian forces."
But Rubenstein found that health care facilities were under assault last year in many other parts of the world. The report was not able to compile data on the total number of attacks in each country.
"It's quite remarkable how varied the forms of attack are," Rubenstein says. "For example we found in 10 countries hospitals were bombed or shelled, in 11 countries health workers were killed, in about 20 countries there were various forms of intimidation — abductions, kidnapping of health workers."
Heath care facilities and workers were attacked in 23 countries in 2016. Note: CAR is the Central African Republic; DRC is the Democratic Republic of Congo; OPT is the Occupied Palestinian Territories.
In August a suicide bomber killed 74 people and wounded 112 others at a hospital in Quetta, Pakistan.
In Yemen, Saudi airstrikes directly struck clearly marked medical facilities. In South Sudan mortar shells landed in the maternity wing of an International Medical Corps hospital in the capital, Juba.
In Libya clinics were hit by car bombs and improvised explosive devices. In Iraq ISIS seized control of several health care facilities in order to prioritize treatment of their own wounded fighters.
In Ukraine, soldiers blocked ambulances, resulting in at least 3 deaths, according to the report. Polio vaccinators were kidnapped in Afghanistan, Pakistan and Nigeria. Some were even killed.
On May 3, 2016 the U.N. Security Council adopted a strongly worded resolution — Resolution 2286 — denouncing attacks on medical personnel and facilities worldwide.
But this new report says combatants continue to shell, bomb and shoot up hospitals with impunity.
"It must be emphasized that in the months since the passing of resolution 2286, attacks on hospitals dramatically escalated in Syria and continued without respite in other parts of the world," the report states.
Rubenstein points out that one Syrian hospital in Aleppo known as the M10 was bombed four times over the course of two weeks.
"The result is people who were suffering traumatic injuries from the bombings had no place to go. And many, many died because they couldn't get medical care," he says. "Unless we really commit to something and hold the perpetrators accountable, they'll continue."