Hospital airstrikes: gathering evidence through images
Interview with Pierre Mendiharat, deputy director of operations (MSF).
Since 2015, nearly 100 MSF or MSF-supported medical facilities have been bombed. The vast majority of these were in Syria, but facilities in Yemen, Afghanistan, Ukraine and Sudan have also been hit. Establishing the facts and identifying those responsible for every one of these airstrikes is vital both for MSF to continue providing medical care, and to demand justice and compensation. But how can the perpetrators be held to account when they deny, refuse or downplay their responsibility, qualifying such attacks as ‘mistakes’?
MSF asked Forensic Architecture, a research agency that investigates state-sponsored violence, to ascertain what happened during the bombing of the Maarat Al Numan hospital in Syria a year ago, killing 25 people including one MSF staff member and injuring 11. The agency collects and analyses images taken on the scene of crimes to help establish the facts and identify those responsible. At the crossroads between cartography, imagery analysis, legal expertise and architecture, Forensic Architecture reconsiders the notions of crime and evidence.
There are a number of issues with using images as evidence. They can be tampered with and used in any number of ways to support a particular vision of reality. Their origins too can raise questions: Was the person that provided a given image entirely impartial? Images are contentious; they can only be truly understood in context. They are, furthermore, often contested. What made MSF decide to work with an organisation like Forensic Architecture?
Pierre Mendiharat (PM): When Dr. Mego Terzian, president of MSF’s French section, publicly accused Russia and Syria of the airstrike on Maarat Al Numan, it caused great controversy within the MSF movement. What proof did MSF’s French section have to be able to accuse Russia and Syria? How reliable were the witness accounts on which the organisation was basing its claims? Many criticised the speed with which the French section reacted. The incident forced us to consider a number of questions. What is MSF’s best course of action when the organisation is targeted by an attack but there is not enough physical evidence to incriminate the perpetrators? What levers are available to the organisation?
MSF internal reviews allow us to gather together the available information, to establish our own version of the facts and to form an opinion — or rather, comfort our initial analysis. A next step, rather than taking the case to the courts of the countries involved, could be to call for an independent and impartial investigation, just as we did after the US airstrike on the Kunduz hospital in Afghanistan. Opening such an investigation requires the activation of the International Humanitarian Fact‑Finding Commission (IHFFC), the only permanent body established to conduct independent investigations into violations of international humanitarian law. The Commission, however, can only act with authorisation from the states in question, and this authorisation was refused for Kunduz. Instead, the US military led an internal investigation into the attack which was only partially published. Given the circumstances, this was a far from satisfactory solution.
Accusing the perpetrators publicly is one course of action available to MSF. With Forensic Architecture, we are exploring a new way to support these accusations, reconstructing events by collecting and analysing images — photographs and videos from social media and satellite imagery — taken at the time.
The war in Syria is characterised by systematic airstrikes on medical facilities by Syrian and Russian forces, and by their denial of this fact. When Maarat Al Numan was attacked, both Syria and Russia denied all the accusations and refused to admit any involvement in the strikes, showing absolutely no willingness to take the issue any further. The flight plans, for that matter, have never been released by the different militaries that conducted air operations in the north of Syria on 15 February 2016.
With restricted access for journalists, particularly in Syria, it is difficult to find concrete evidence or carry out investigations on the ground, which is why we have decided to work with Forensic Architecture.
Through the partnership, MSF hoped to achieve a number of things. Firstly, we wanted to see if we could unearth any evidence that would incriminate one or several governments in the airstrikes on Maarat Al Numan. Secondly, we wanted to document the event as thoroughly as possible to establish a clear picture of what happened. We also want to communicate the findings, putting media pressure on those involved to pursue accountability and stop the memory fading. We are showing that an attack like this will not be forgotten, that it has been documented, and that this documentation may one day be used to complete the picture and bring those responsible to account.
Is MSF looking to use this method systematically, particularly when it has been targeted directly? Are there other projects in the pipeline?
PM: This work should become a systematic response. We must ensure we launch this sort of investigation every time MSF falls victim an attack of this nature. It is one of the tools that can help us achieve our primary objective: to continue providing medical care by lowering the risk of our hospitals and medical facilities being targeted. The only solution we have today is to ensure that attacks against hospitals come at a political cost; that they negatively impact the public image of those committing them. The work of Forensic Architecture contributes to achieving that.
We would like to look back at all past airstrikes on MSF or MSF-supported hospitals. This research will, undoubtedly, reveal trends and repetitions of the same type of event with similar characteristics, like the double tap. Such trends could confirm the intentional nature of an attack, allowing us to understand the military strategies being implemented and denounce them. Forensic Architecture has done some interesting work of this type on US drone strikes.
On 15 February 2016, an airstrike hit the MSF-supported Maarat Al Numan hospital killing 25 people including one MSF staff member and injuring 11. After the airstrike, Dr. Mego Terzian, president of MSF’s French section, publicly accused Russia and Syria. What has the work of Forensic Architecture taught us about the hospital airstrikes and Russia and Syria’s part in them?
PM: The investigation conducted by Forensic Architecture did not uncover any definitive physical evidence to incriminate Russia and Syria. It did, however, highlight new elements that confirmed our initial analysis. For example, it established that the times at which Russian and Syrian planes took off from their respective bases corresponded with the times and locations of the airstrikes. The analysis of the silhouette of a plane caught on film bears a resemblance to the MiG-23, a plane that is used in Syria by the Syrian regime only.
The investigation also clearly pointed to an intentional double — or triple — tap strategy in which airstrikes are repeated in close succession in the same area. Once first responders had arrived on the scene to deal with the first strike, a second one followed. A hospital a short distance away, to which the patients had been transferred, was then targeted in a third strike. This clearly illustrates the intentional nature of the strategy and its brutality towards the civilians and emergency services on the ground. Eyal Weizman, the founder of Forensic Architecture, when interviewed by Russia Today, pointed out how common it is for warring parties to implement this type of military strategy to weaken both opposition forces and the population, severely diminishing their resilience.
While Forensic Architecture’s reconstruction does not provide conclusive evidence, it identifies a number of elements that support our initial conviction: Syrian and Russian forces were responsible for the airstrikes on Maarat Al Numan.
Interview by Agnes Varraine-Leca
 The Maarat Al Numan hospital was bombed on 15 February 2016
 The double tap is a shooting technique where two shots are fired in rapid succession at the same target.