The Syrian Government of President Bashar Al-Assad revived memories of the gas attacks in Damascus, which led to its being forced to divest itself of chemical weapons, with the series of bombings of hospitals in Aleppo, which is one of the strongholds of the anti-Assad forces. These bombings violate the Geneva Conventions, which protect medical facilities from being targeted, and there is a case for the government pilots of being guilty of war crimes.

However, the findings of another country’s army’s inquiry into a similar incident provides an indication of a possible line of defence for the Syrian Air Force pilots responsible for the bombings, which started on Tuesday, April 26, and in which 250 have died so far. Apart from the first hospital bombed, the Al-Quds hospital run by the Médecins Sans Frontières, the French INGO Doctors Without Borders, there have been a total of four hospitals hit.

The US Army enquiry said that the hospital in Afghanistan, also a Médecins Sans Frontières facility, was bombed by error, on receiving proper targeting information. Administrative action would be taken against the pilots responsible, though it was not a war crime. Still, the administrative action does mean that the pilots responsible were guilty of something, even if it was merely not following Standard Operating Procedure.

Is Médecins Sans Frontières a thorn in the side of warring countries? After all, its hospitals have been hit by differing air forces in differing theatres. This would first show the difficulty of carrying out bombing raids in crowded inner cities. The onus should be on the countries to explain why they were using air power on inner cities rather than on Médecins Sans Frontières to explain why they located their hospitals in such areas. Among the factors involved in locating a hospital are the cost, and the proximity to patients. As Médecins Sans Frontières operates in war zones, its hospitals have to be close to where people are getting injured. Another reason for it setting up its own facilities is that government soldiers have military hospitals of their own. This is another reason why combatant governments tend to look askance Médecins Sans Frontières, or anyone who wishes to provide their opponents, who are insurgents, with any facility, particularly medical. One of the advantages government troops are supposed to enjoy is a higher survival rate, as well as a faster turnaround time, from battlefield injuries. Though they are not supposed to deny opponents medical treatment if available, they make them prisoners, and send them to a camp rather than back to the battlefield, when they recover.

Because of this, Médecins Sans Frontières is usually not liked by the government of the country it operates in. It is primarily a funding organisation, for while its budget of $750 million is raised by donations, it is staffed mainly by locals. It collects the money from private donors, and is not a means of funneling aid money. It employs all sorts of doctors, not just those who can treat war wounds. One would expect a high preponderance of orthopaedic surgeons as well as burns specialists, which along with emergency medicine practitioners would cover the vast mass of battlefield wounded, but it should not come as a surprise that one of the medical staff killed in the Aleppo bombings was a paediatrician. Médecins Sans Frontières works in war zones, not necessarily with combatants, and thus would almost naturally treat children on a scale extensive enough to provide a specialist full-time employment. National armies employ paediatricians to treat the children of soldiers, but this is not the purpose of Médecins Sans Frontières.

There is an irony in a regime headed by a medical man bombing hospitals. Bashar is a UK-trained ophthalmologist, and thus trained in one of the specialties that are more useful than others for battlefield injuries. Ophthalmology may not be a high priority in Aleppo, but it does hark back to the origin of the Médecins Sans Frontières in Biafra, that part of Iboland which tried to secede from Nigeria in a three-year war from 1967 to 1970. A common ailment in Biafra (as in the whole of sub-Saharan Africa) was trachoma.

Bombing hospitals does not just deny the fighters the possibility of treatment. Not only is it an important incentive to combatants to know that their injuries will be attended to, but commanders know that experienced combatants can be treated if wounded, and returned to battle, thus saving both time and money which would be expended in providing training to a new recruit.

However, hospitals like the ones bombed in Aleppo are tempting targets. They almost never have any anti-aircraft armament, relying on their ‘inviolate’ status. They contain a concentration of combatants whose return to the battlefield will be delayed if they sustain fresh injuries, or averted altogether if they are killed. In an irregular war, this might overcome the strong protection granted to the injured, even if they have been combatants, and will be again.

The comparison with the gas attacks in Ghouta, a suburb of Damascus, in August 2013, is perhaps inevitable because children were killed also. The estimates of the number of dead vary from 281 to 1729. Fewer have been killed in Aleppo, but in both, the deaths of children are being used as fuel to fan the flames abroad. The Ghouta attacks were used to make Syria give up its chemical weapons, the current attacks are being used to prolong the ceasefire that does not seem to have achieved its aim. The West might not be behind the attack, but that would not stop it trying to use it to achieve its ends.

That would be the replacement of Bashar. However, neither the West, nor Russia, nor the Arab states involved (notably Saudi Arabia and Qatar), have an acceptable substitute, even though it is only Russia which wants Bashar to stay. The alternative, for which the Syrian people have laid down as many as 370,000 lives, is not centred around a person, but around Islam. This the West finds unacceptable. This failure to find an alternative means that Bashar feels free to pound the Syrian people into submission, even in hospitals.

It is perhaps inevitable that, because it is Syria’s second largest city, the deaths in Aleppo governorate should be second only to those in Damascus governorate. However, the suffering of Aleppo seems set to continue as long as the fighting continues. Aleppo is no stranger to grandiose violence. There had been suicide bomber attacks on a military barracks and military intelligence offices on 10 February 2012, killing 11 and 17 people respectively.

The lack of an alternative had made the USA incline towards keeping Bashar, as Russia wishes. However, by attacking hospitals, Bashar has only made this task that much harder. It seems that he is pushing the USA to send in the primarily Arab coalition, which includes Pakistan, but again, that might only be possible if a replacement is on the horizon. None is, but more bombings of hospitals are, as Bashar finds that he can get away with this.

There is an irony in a regime headed by a medical man bombing hospitals.