Geneva (AFP) - More than 60 health facilities in Syria supported by the Doctors Without Borders (MSF) charity were hit in attacks last year, with a dozen completely destroyed, the group said Thursday.
In a new report, MSF warned Syria's health infrastructure "has been decimated", with frequent aerial assaults and shelling of hospitals and clinics, in violation of international law.
The report comes days after an MSF-supported facility in the northwestern province of Idlib was hit in an air strike that killed 25 people.
MSF did not assign definitive blame for the strikes, but the organisation's president, Joanne Liu, told reporters in Geneva that the "attack can only be considered deliberate.
"It was probably carried out by the Syrian-government-led coalition that is predominantly active in the region," she said.
The Syrian Observatory for Human Rights, a Britain-based monitor, said it appeared to have been carried out by Russian warplanes waging an aerial campaign in support of Damascus. Moscow has denied the claim.
Liu was cautious on the question of Russia's possible involvement, stressing that for MSF the priority was for "the facts to be established."
She voiced hope that an independent investigative body could conduct an inquiry but noted that without the consent of state-parties, including the Damascus government, the prospect of a probe were dim.
MSF, Liu said, does not "want to become 'investigators without borders'" and was counting on the international community to find out who was responsible.
- Syria 'a kill box' -
The MSF report said 63 facilities it supports in north, northwestern, and central Syria had been hit in a total of 93 aerial and shelling attacks throughout 2015, with 12 completely destroyed.
A total of 23 health workers at the facilities were killed and another 58 were injured in the attacks, the group said.
The charity further said it recorded 7,009 deaths and 154,647 wounded last year alone in 70 of the Syrian hospitals and clinics it supports.
"The figures for us are really, really appalling and unprecedented in terms of war wounded... 155,000 (injured) is something we have never seen in 44 years of work for MSF," Liu said. "Syria is a kill box."
Between 30 and 40 percent of those casualties were women and children, "indicating that civilian areas were consistently hit by aerial bombardments and other forms of attack," MSF said.
The group noted that its report only covered a fraction of all the health facilities in Syria, and did not account for deaths outside clinics or from war-related issues like malnutrition or lack of appropriate treatment.
All the facilities supported by MSF are located in opposition-held areas of Syria because the group does not have government permission to work in regime-held regions and does not operate in territory held by the Islamic State (IS) group.
- 'Targeted attacks' -
The group said several of the strikes at hospitals it supports were so-called "double-tap" attacks, in which a second strike followed shortly after the first, increasing the chances of casualties among those responding to the initial incident.
"This indicates that in some instances the attacks go beyond indiscriminate violence, using targeted attacks against rescue workers -- including medical responders -- as a method of war," MSF said.
Given the relentless pace at which health facilities have been struck, Liu said MSF was having an internal debate on whether it should share the GPS coordinates of health facilities with the warring parties.
"Right now, it's the hot topic in my organisation," she told reporters.
MSF officials said they did not share the GPS coordinates of the Idlib hospital with Russia.
That decision followed consultations with hospital staff, who said sharing the coordinates could heighten insecurity, Liu said.
Since it began with anti-government protests in March 2011, the war has evolved in a multi-front conflict involving the Syrian regime, rebels, Kurdish forces and jihadists.
A US-led coalition is carrying out air strikes against IS in the country, and since September, Russia has also been waging an aerial campaign in support of the government in Damascus.
More than 260,000 people have been killed in Syria since the war began, including more than 76,000 civilians.