A/HRC/37/72 71. The protracted siege of eastern Ghutah (see annex II for details), is now entering its fifth year. Like that of eastern Aleppo city, the siege of eastern Ghutah by pro-Government forces has been characterized by the lack of access to sufficient food, limited deliveries of humanitarian aid and the denial of medical evacuations. The Commission has documented the use of prohibited chemical weapons and cluster munitions in densely populated areas and attacks against civilian and protected objects, including schools and hospitals. Although they are protected objects, hospitals in besieged areas struggle to operate in damaged facilities that have been the object of repeated attacks,23 and often without the most basic equipment and medication for which delivery has been denied. Fearing bombardments against hospitals, expectant mothers have often opted to give birth at home without medical assistance. The Security Council, through its resolutions 2165 (2014), 2191 (2014) and 2258 (2015), authorized the unconditional delivery of humanitarian assistance, including medical assistance, to besieged and hard-to-reach communities countrywide. Nonetheless, the brutal siege of eastern Ghutah and surrounding areas in Damascus endures. IX. Erosion of civilian infrastructure 72. Since the inception of the Syrian conflict, attacks against civilian and protected objects by all parties have been a grotesque feature, in violation of international humanitarian law. Hospitals, places of worship, civil defence centres, densely-populated residential areas, homes, bakeries, markets and, to a lesser extent, schools have been razed by indiscriminate attacks or, more commonly, have deliberately been targeted for attack. Children throughout Syria remain disproportionally vulnerable to violence and abuse, and continue to be denied the protection to which they are entitled under the Convention on the Rights of the Child, to which Syria is a party. A. Hospitals 73. Nowhere have attacks against civilian and protected objects been more apparent than against hospitals and medical facilities in opposition-held areas, including those besieged by pro-Government forces. Those attacks markedly increased in frequency as of October 2015. Over the past two years, numerous hospitals and medical facilities have been operating from reinforced basements or caves dug into the mountains, with the aim of reinforcing them from exposure to attack. Out of fear of attack, health-care administrators have ceased using a distinctive emblem as is generally required by international humanitarian law. 74. Hospitals, medical units and medical personnel are afforded special protection under international humanitarian law because of their specific humanitarian function. Parties to a conflict must take additional, specific measures prior to targeting such objectives. In no instances recorded, however, have pro-Government forces or armed groups ever given warning prior to attacking hospitals, medical units or civil defence centres. The lack of warnings and the absence of military objectives within and near hospitals demonstrate that pro-Government forces deliberately target medical infrastructure as part of their war strategy, which constitutes the war crime of intentionally targeting protected objects. Furthermore, deliberate attacks against medical staff and ambulances constitute the war crimes of intentionally attacking medical personnel and medical transport. 75. During the period under review, the Commission documented the ongoing pattern of deliberate attacks by pro-Government forces on hospitals in Idlib (see annex IV, paras. 2– 6), Hamah (see annex III, para. 21) and eastern Ghutah (see annex II, paras. 25–28). 23 16 See A/HRC/34/64, paras. 30–40.

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