During the week of the 14 December, the Maram foundation trucked tents in two vehicles from the Turkish border towards Latakia province in Syria to provide shelter for the increasing number of people displaced by air raids. When they saw Russian bombers approaching the road, the aid workers stopped the trucks and ran way. After an hour, when the jets had disappeared, the staff dared to return to their vehicles and continued their journey. While neither the aid workers nor their cargo was hit in this case, the incident illustrates the fear among aid workers and the resulting delays in the delivery of aid when explosive weapons are insight near major supply routes during intensified air campaigns that cause civilian casualties, damage civil infrastructure and trigger displacement.
The Maram Foundation, like all aid agencies, is concerned about the safety of their aid workers and introduced added security measures for the supply trips into Syria. They no longer travel in convoy but leaving a few kilometers between trucks. They no longer take the vehicle directly to the warehouse. This has slowed down distribution. The cumulative effect of security measures introduced across the board by aid agencies in response to the intensified bombing resulted into a sharp decline in the quantity of aid delivery. According to Mercy Corps, one of the largest aid agencies working in Syria distributing aid with the help of local partners, the organisation’s ability to transport and distribute food fell by 80% since the number and severity of air strikes increased over northwest Syria following the downing of the Russian plane by Turkey on 24 November 2015. Commercial suppliers, who use the same routes, experience identical threats and have taken similar measures. The result are food and other shortages in Syria. Armed fighter jets overflying major supply routes, even if they never directly bomb the highway, have a devastating effect on aid agencies’ abilities to mitigate the effects of the use of explosive weapons on the civilian population.

During the month of October 2015, two MSF hospitals in Afghanistan and Yemen and at least five health facilities in Syria were hit by air strikes.
http://www.insecurityinsight.org/aidindanger/wp-content/uploads/2015/11/The_Aid_Security_Monthly_News_Brief_October_2015.pdf
These events killed at least 55 people, among them patients, their relatives and 14 medical staff. The incidents also reduced the access to critical healthcare services for the period that the health facilities remained closed. In addition, the events risk further knock-on effects beyond the directly affected countries and the immediate present. The available information suggests that the health facilities were hit by targeted air strikes rather than collateral damaged from a nearby impact. This context affects the international community’s risk assessment for health care services during period of air delivered explosive weapons in present and future conflicts.
Humanitarian actors are particular concerned because it does not appear that insufficient communication between the healthcare providers and the conflict parities was at the origin of the decision to strike the health facilities. MSF stated that it informed all warring parties of the locations of its two hospital complexes. In Yemen, the roof of the hospital building in rebel-held Haydan District, Saada Province, Northern Yemen was clearly marked with its painted name and logo when it was hit on 26 October by Saudi-led military coalition air strikes. In Kunduz Afghanistan, the attack on 3 October continued for 30 minutes after they had contacted US officials informing them that they were under attack.
Humanitarian health care services are in jeopardy when users of air delivered explosives cannot be trusted to respect IHL and fail to take the necessary precautions not to target neutral and impartial healthcare providers. Once communication mechanisms have been exhausted, humanitarian agency’s natural response will be to reduce their presence. It is likely that the reverberating effects of explosive weapons use against hospitals will be felt in future conflicts. Their impact will extend beyond the boundaries of the countries where the bombs were dropped this month. It is likely that many people will be deprived of access to critical healthcare in areas under aerial bombardment because healthcare service providers will refrain from offering services.

30 March 2015: On the fifth day of air strikes, 40 people were killed in the Al-Mazraq IDP camp in northwestern province of Hajjah. MSF representatives working in the Haradh hospital where the injured were treated, said the camp was hit by Saudi airstrikes. UNHCR confirmed the incident but did not say who struck the camp. Yemen’s foreign minister believes that the camp was hit by Houthi artillery fire. An Al Jazeera correspondent said that the displaced were ethnic Houthis driven from their homes by the 2004 offensive. Witness say that there are Houthi among the civilian population. More information Al Jazeera.

On 7 April 2015, Safouh Al-Mosleh from Caritas Syria was killed when a shell fell on his house in Aleppo in Syria. His neighbourhood experienced heavy shelling in the days before his death and he evacuated his family. On the morning of 7 April, he looked after his elder parents and then returned to his neighbourhood to check his apartment. At that moment, a mortar struck, causing a huge fire from which he was unable to escape from.
The tragic death of Safouh Al-Mosleh illustrates the specific danger local humanitarian staff face during the use of explosive weapons in populated areas. They don’t just continue with their work, in the case of Safouh Al Mosleh shelter for vulnerable elderly people in Aleppo. They also deal with extreme difficulties of protecting their own families and housing when mortar shells hit the city every day. The sad death of Safouh Al Mosleh is a terrible loss to his family but also a difficult loss to Caritas who is one of the few agencies left in Syria trying against the odds the alleviate suffering. Caritas Press Statement

On 4 February, a shell landed some 10 meters from an outpatient clinic in Donetsk, in the fought over territory in eastern Ukraine. It was midday. Dozens of people were queuing to see a doctor. A second shell followed seconds later. “There was a sudden explosion,” witness Dr Anna Kravtsova said. “A mortar round flew through the window.” Two people died on the spot, others were injured. Some died of their injuries later. The impact left a crater and shattered the windows in the multi-story building and destroyed an array of dentistry equipment in the dentistry unit.

The incident occurred as fighting between Separatists and Ukrainian forces intensified in the run-up to the Minsk talks. As typical for incidents that cause civilian incidents and destroy protected civilian medical infrastructure, both warring parties denied responsibility and blame the other side. Separatists accused the Ukrainian army of bombarding a densely populated civilian area with heavy artillery. Observers reported that government troops made tentative progress in retaking some Separatist controlled areas around Donetsk. Avoiding urban street battles, they attempted to push back their opponents with artillery fire. The Ukrainian government denies the use of artillery against residential areas and point to the surging violence of recent weeks as the pro-Russian rebels attempt to encircle the key town of Debaltseve, north-east of Donetsk. According to the Ukrainian government, separatist forces launched around 80 artillery or rocket attacks on Ukrainian positions and villages in the 24 hours preceding the incident that killed people outside the health facility.

Life has been hard for the civilian population in Donetsk. The controversial Ukrainian degree to severe ties with the breakaway parts of the country, ended pension and other social payments in the separatist controlled areas, leaving those depended on transfers very vulnerable. The use of difficult to control explosive force makes it harder for people to access aid and health services.

On 30 January, a mortar hit a crowd of people waiting in line to receive humanitarian aid distributed for children and the elderly by the Rinat Akhmetov Charity. Seven people were killed and at least three were wounded. The statement of one of the woman who had come to collect food for her 82-year old mother ‘I will never come again, not after this,’ highlights how the fear of explosive weapons goes beyond the deaths and injuries and makes the needy more vulnerable as they have difficulties access aid the need.

ISIS captive killed

Kyla Mueller, the “unknown female captive” of the Islamic State was killed on 6 February 2015. The young American woman moved to the Syrian border in December 2012 to work for aid agencies. Eight months later she accompanied a Syrian friend on a trip to Aleppo, where she interviewed patients at a Médécins Sans Frontières medical facility. Kyla was abducted by Islamic State (IS) militants when she was leaving the MSF hospital. 18 months into her captivity, her captors announced her death.
How did Kyla Mueller die? Her captors blamed her death on Jordanian airstrikes, circulating a photo of the building she was supposedly held in after it had been hit by shelling outside the town of Raqqa, a stronghold of Islamist militants. The Jordanian Air Force denied that the attack caused her death.

We will likely never know the truth. Her tragic death illustrates the indiscriminate nature of explosive weapons in populated areas, and the uncertainty that often follows an attack. This particular Jordanian Air Force strike hit roughly 20 buildings, which were described as a ‘weapon storage area.’ The US military indicated that the photo circulated by the Islamic State was among the facilities affected, but a White House spokesman claimed there was “no evidence of civilians in the target area prior to the coalition strike taking place.”

While anonymous experts examined photos of Kyla’s body, they could not determine the cause of death, or whether her injuries were consistent with being killed in the flattened building, as claimed by IS. It is impossible to confirm or deny that the air strike killed Kyla.

The use of explosive weapons may have inadvertently caused the death of a kidnapped civilian. Equally, IS may have used the airstrike as propaganda, exploiting the imprecise nature of explosive weapons and the fact that it is impossible to account for their impact with certainty. Her death is a tragic example of the difficulty in accurately determining the number and nature of casualties from explosive weapons and to predict and report their full impact.

On 20 January 2015 a hospital run by Doctors Without Borders /Médecins Sans Frontières (MSF) in Sudan was bombed by the Sudanese Air Force (SAF). One MSF staff member and one patient were injured.While little physical damage was done to the hospital, the aid agency suspended operations to avoid putting staff and patients at risk. Approximately 150 patients and staff were in the hospital when 13 bombs were dropped by a SAF fighter jet . MSF believes that it was “a deliberate and targeted bombing on a civilian hospital structure and part of a strategy to terrorize the community.”

For the last four years, the SAF has been bombing civilians in the Nuba Mountains as part of the military campaign against rebels. Humanitarian agencies are restricted from accessing most of these areas, and health facilities were in short supply even before the 20 January attack. With the closure of the MSF hospital, civilians now have even less access to services to help with both violence and non-violence related healthcare.

The bombing additionally illustrates how fear of explosive weapon use often leads to the reduced presence of outsiders, meaning that the plight of civilians in South Kordofan will not be communicated to the wider world. The impact of explosive weapons can be devastating. Not only do they kill and main, but they result in reduced access to healthcare, humanitarian aid, and make the lives of those already in a perilous situation even worse.

During the week of the 14 December, the Maram foundation trucked tents in two vehicles from the Turkish border towards Latakia province in Syria to provide shelter for the increasing number of people displaced by air raids. When they saw Russian bombers approaching the road, the aid workers stopped the trucks and ran way. After an hour, when the jets had disappeared, the staff dared to return to their vehicles and continued their journey. While neither the aid workers nor their cargo was hit in this case, the incident illustrates the fear among aid workers and the resulting delays in the delivery of aid when explosive weapons are insight near major supply routes during intensified air campaigns that cause civilian casualties, damage civil infrastructure and trigger displacement.
The Maram Foundation, like all aid agencies, is concerned about the safety of their aid workers and introduced added security measures for the supply trips into Syria. They no longer travel in convoy but leaving a few kilometres between trucks. They no longer take the vehicle directly to the warehouse. This has slowed down distribution. The cumulative effect of security measures introduced across the board by aid agencies in response to the intensified bombing resulted into a sharp decline in the quantity of aid delivery. According to Mercy Corps, one of the largest aid agencies working in Syria distributing aid with the help of local partners, the organisation’s ability to transport and distribute food fell by 80% since the number and severity of air strikes increased over Northwest Syria following the downing of the Russian plane by Turkey on 24 November 2015. Commercial suppliers, who use the same routes, experience identical threats and have taken similar measures. The result are food and other shortages in Syria. Armed fighter jets overflying major supply routes, even if they never directly bomb the highway, have a devastating effect on aid agencies’ abilities to mitigate the effects of the use of explosive weapons on the civilian population.

On the 11 September, at 10.30 local time, an improvised explosive device (IED) detonated in a tent in Nigeria’s largest IDP camp, Maikohi, near Yola in the State of Adamawa. The previous evening, 315 new people fleeing from Boko Haram terror had arrived at the camp. According to the State Emergency Management Agency (ADSEMA), the blast killed five and injured 20 people. Among the injured were camp workers and student volunteers who were hit by flying debris. While the death toll was a small addition to the thousands recorded as killed by Boko Haram, the bomb affected the perception of aid agencies and volunteers. This has wider consequences for the displaced seeking safety from attacks.
The fact that suspected Boko Haram militants were able to plant a bomb despite the high security at the camp, where armed soldiers manned the gates and carried out checks on vehicles and passengers, is highly concerning to those with responsibilities for the safety of aid workers and volunteers. Most are reluctant to expose those under their care to unpredictable security risks. In response to the bomb, the ICRC decided to suspend all its activities in government run IDP camps. Organizers of student volunteers will reconsider sending those under their care into the camp. This illustrates how the detonation of explosives in what should be a safety zone has consequences for civilians fleeing violence that go far beyond immediate death and destruction.

Since the conflict in Yemen erupted in March 2015, humanitarians and their life-saving infrastructure have been directly caught up in the widespread use of explosive weapons in populated areas in Yemen.

On 20 April, the offices of International Medical Corps (IMC) and an Oxfam warehouse were damaged in a set of air strikes.

On 21 May at least five refugees were killed when shelling hit an international humanitarian aid office near Yemen’s border with Saudi Arabia.

On 28 June, the UN Development Programme (UNDP) offices were severely damaged by airstrikes in the city of Aden. UN Secretary-General Ban Ki-moon condemned the attack as deplorable, and called for a full investigation by the Saudi-led coalition.

On 1 July, two offices of the International Organisation for Migration (IOM) were damaged by mortar fire and airstrikes in Basateen, Aden and in the villages of Haradh Aden Governorate.

These incidents highlight the due diligence concerns that humanitarian agencies face over how to protect their staff and assets when warring parties cannot guarantee their safety because of the wide-area effects of the explosive weapons in use. Although 80% of Yemen’s population is in need of support, agencies say that only a fraction of the country’s 21 million-plus people in need can currently receive aid.

On 10 June, a barrel bomb exploded just outside the Medicines Sans Frontieres (MSF) supported medical centre in Aleppo damaging medical equipment and the pharmacy. The hospital’s post-operative room was knocked out of service.

On the evening of 15 June the Busra hospital in Dara’a governorate was destroyed after it was hit by ten barrel bombs. It was the only health facility providing neonatal care and dialysis services in Dara’a.

MSF knows of nine health structures attacked since May 2015 and states that 40% of hospitals currently operating in East Aleppo have been affected. Patients seek alternative medical facilities but there are few options and some specialized services remain inaccessible. MSF.

Damage and destruction of health infrastructure drives up indirect conflict mortality because people needing medical care cannot access the help they require. The number of people who die in a conflict zones above the expected mortality rate is influenced by how badly the functioning of the health infrastructure is affected by violence.

The use of explosive weapons often leads agencies to suspend programmes in order to ensure the protection of staff. This often has devastating consequences for the civilian populations living in the area affected by explosive weapons.
The examples below illustrate some of the reported cases.
The pattern that emergences from this cases is that agencies tend to suspend when they feel that the risks are difficult to calculate. FOr most agencies, the risk of explosive weapons use in conflict is a too high and unpredictable risk to expose their staff to. As a consequence, most agencies suspend programmes in affected areas that are centred around a specific building, for which the coordinates can be communicated to the conflict parties. Agencies working in or running hospitals often stay and seek to communicate the coordinates. that

Non-state actors feature much less frequently in the reported cases of agencies taking preventive decisions. Presumably, this is because non-state actors use of explosives is either in unpredictable terrorist attacks that could strike anywhere anytime and therefore are not responded to with a specific withdrawl or agencies feel less under threat because they negoatited their accepted presence with non-state actors. Decisions to withdraw or suspend programmes in response to non-state actor explosive use tends to occur when agencies have been directly targeted or when the security risks appears so high but specific.