A/HRC/37/72 beds, tables, and a solar panel. Medical staff said they believed that the attack was carried out as reprisal against them for having treated a large number of civilians who were injured in pro-Government forces’ bombardments in the days preceding the shelling. 26. Between 14 and 17 November, 84 people were reportedly killed and another 659 injured. On the afternoon of 20 November, when hospitals were overwhelmed with casualties, shells believed to have been launched from pro-Government forces’ artillery positions in Al-Maliha impacted the Kafh hospital and its surroundings in Kafr Batna. One shell hit the roof of the hospital damaging water tanks and electrical installations. A second shell hit the front of the hospital’s main entrance injuring a hospital worker in the head. Another two shells landed near the hospital, killing a woman and her four children, including two girls, aged between 2 and 11-years-old. 27. In both incidents, interviewees denied the presence of fighters or other military objectives in the hospitals. No warnings were issued prior to the attacks. Hospitals, medical units, and medical personnel are afforded “special protection” under international humanitarian law as a result of their specific humanitarian function, and parties to a conflict must take additional, specific measures prior to targeting such objectives. Throughout the entire Syrian conflict, in no instances has the Commission documented that proGovernment forces ever gave warning prior to attacking hospitals or medical units. Such attacks constitute the war crime of intentionally targeting protected objects. IV. Medical evacuations 28. Until the initial closures of tunnels in February, only about 80 patients out of 700 estimated to be in need were able to leave eastern Ghutah to obtain treatment in Damascus city. Those who left fell into two categories: one group were patients, such as those in need of open-heart surgeries, who could only obtain treatment in Damascus as it was the only city with the required specialists. The second group were patients, including those requiring dialysis, who could be treated in eastern Ghutah were it not for the fact that siege conditions prevented the required medication and equipment from reaching those in need. In both groups, specific difficulties were faced by men and women. Men under the age of 42 risked being conscripted by Government forces once they reached Damascus city. Further, if a husband left for treatment, life for his wife and children became increasingly difficult. Women and girls in need of medical care faced additional challenges as armed groups in eastern Ghutah only allowed them to travel if accompanied by mahram (male guardian). In practice, this meant that a seat for evacuation that could have been taken by another patient was instead used for the mahram who did not medically need it. 29. After the complete closure of tunnels in May, all movement of patients was halted, leading to a desperate situation for those sick and wounded. Healthcare practitioners reported that the closure of tunnels led to shortages of medical equipment and medication, which — compounded by malnutrition — exacerbated existing medical conditions for countless civilians. 30. By early October, an estimated 368 patients, including 101 women and 48 children, required urgent medical evacuation. Among them were two girls under the age of three, one requiring heart surgery and the other chemotherapy. Requests for evacuations were submitted to the Syrian Arab Red Crescent (SARC) and followed a heavily bureaucratic process including having to go through the Ministry of Foreign Affairs, the Ministry of Health, and obtaining authorisation by all parties controlling checkpoints along the route patients needed to take. In October, a woman and 14-year-old girl were taken to Damascus for treatment but reportedly only because they were exchanged for a member of Faylaq alRahman. Another four patients were reportedly evacuated in October. 31. By December, the number of patients requiring evacuation had risen to 529. In an attempt to assist the gravest cases, 29 patients with severe injuries and chronic diseases were selected for immediate evacuation. While waiting for evacuation, at least two children died, and nine men refused to leave eastern Ghutah because they feared being arrested by Government forces. Their names were replaced with those of other patients. Requests to pro-Government forces for guarantees that patients would not face reprisals went 25