A/HRC/42/51 Approximately 20 minutes later, in anticipation of further attacks, patients at Al-Hayat hospital were transferred to an underground shelter, in which they remained for 30 minutes before being evacuated. During the evacuation, between 7.00 and 8.00 p.m., a third missile struck the main entrance of Al-Hayat hospital, damaging a generator and vital medical equipment. Some 15 to 30 minutes later, a fourth missile struck an ambulance response unit located less than 1 kilometre from Al-Hayat hospital, damaging its walls and windows and injuring a male staff member (see annex II for a detailed description of a series of other attacks). 46. A second escalation of violence by pro-government forces began in northern Hama and Idlib Governorates on 29 April. Approximately one week later, on 5 May, progovernment forces carried out air strikes against at least three hospitals in Idlib: a “deconflicted” cave hospital in Haas, the “deconflicted” Orient hospital, and Al-Sham hospital in Kafr Nubl. 47. On 14 May, at around 7.00 p.m., pro-government forces airdropped between two and four missiles on a fish market and primary school for girls in Jisr al-Shughur. Eyewitnesses described how at least three missiles had been airdropped on the market, largely destroying commercial shops and market stands, while bodies were scattered throughout the affected area. The attack killed at least eight civilians, including seven men and a 3-year-old girl, while injuring eight other persons. 48. Witnesses interviewed by the Commission recalled that, a few minutes after the first strike, a second missile hit nearby Abdul Rahman al-Naser primary school for girls, destroying its walls, the administration office, as well as the school bookshop and playground. One witness described how, earlier in the morning on that day, teachers had interrupted the distribution of diplomas due to the increased number of reconnaissance aircraft circling over the town. Moreover, during the period under review, the Commission received credible information that some 70 schools in the demilitarized zone of Idlib had been destroyed or damaged by hostilities, depriving over 200,000 pupils from receiving formal education. 49. Alongside dozens of attacks against civilian infrastructure, including specially protected objects, the Commission notes with grave concern that tens of thousands of hectares of vital crops and farmland in the demilitarized zone were set on fire during the period under review. Satellite imagery reviewed by the Commission showed fields, orchards and olive groves burning throughout the region, including those used to harvest crops, such as barley, wheat and vegetables. Investigations are ongoing. 50. In late May and into early June, pro-government forces carried out attacks using incendiary weapons in southern Idlib. For example, pro-government forces launched attacks in Khan Shaykhun on 25 and 26 May, which began at approximately 11.30 p.m. and continued after midnight. The closest front lines to Khan Shaykhun at the time were in Suran and Kafr Nabudah, both located some 12 kilometres away. Due to attacks against civilian infrastructure and those on agricultural land, tens of thousands of civilians had fled Khan Shaykhun by July. 51. Hundreds of civilians have been killed in the north-west of the Syrian Arab Republic since the beginning of 2019. In addition to the deaths and injuries, at least 330,000 women, men, and children had been displaced by the end of June to different communities in Idlib, western Aleppo and Hama Governorates. Civilians fled to overcrowded areas in which resources were already scarce, further stretching the limited relief capacities of the humanitarian organizations. Others, unable to secure a place in camps such as Atma camp near the border with Turkey, were left without shelter and subsequently forced to seek refuge under olive trees nearby. Approximately 50,000 civilians from the demilitarized zone are currently stranded, the majority of whom are women and children who subsist without adequate access to food, medicine or sanitary services. 52. The above pattern of attack strongly suggests that pro-government forces systematically targeted medical facilities. Such attacks may amount to the war crime of 10