Amman- Khadijat Umm Mohammed sits in her small house on the outskirts of Khan Sheikhoun, its foundation intermittently rattled by the force of nearby explosions. She is waiting for an opportunity to go to the dialysis center so she can complete her weekly sessions.

Um Mohammed, 70 years-old, usually goes to her local hospital, Maart National Hospital, for dialysis. However, she is scared that the increase in bombings this weekend would make the local hospital a prime target for regime planes, as she has seen happen with the other hospitals in the area.

Regime warplanes struck three clinics on Sunday, according to the Municipal Health Service of Idlib and Hama. In Southern Idlib, the Kafr Nabl surgical center and “Pulse of Life Clinic” were bombed. The Kafr Zeita clinic in Northern Hama was also hit, forcing their staff to stop all medical services Sunday.

The Municipal Health Service, which is part of the opposition-run Syrian Interim Government, released a statement on Monday announcing the resumption of bare-bones service in Idlib hospitals and clinics.

“The focus during this time will be on emergency cases,” the statement said. “Non-emergency cases will have to wait for later periods.”

In the aftermath of the medical center bombings and the continuing military campaign against Idlib, options for medical treatment are slim for those in Northwest Syria.

Um Mohammed now must make the journey northwards to the Syrian-Turkey border if she wants to get treatment.

“If the bombings continue, we are going to have to take her to another dialysis center far from here,” Abd al-Rahman, the son of Um Mohammed, told Syria Direct over Whatsapp.

The sounds of explosions could be heard clearly in the audio messages Abd al-Rahman sent Syria Direct.

“Deliberate Targeting”

The Union of Medical Care and Relief Organizations (UOSSM) issued a statement Sunday, saying the aerial campaign in Idlib has ramped up immensely in the last 72 hours.

“At least 77 civilians were killed in the last week, and most of the cities in Northern Hama have been completely emptied out,” the statement said. “There are huge numbers of IDP’s whose needs far outstrip the weak humanitarian response to the crisis.”

“A large portion of these IDP’s are without any forms of housing or shelter,” the statement added.

“43 thousand families have fled the bombings in Idlib in the last week alone,” Muhamad Halaj, chief of Response Coordinators, a local observatory and aid organization, told Syria Direct.  

Emad Zahran, the spokesman for the Municipal Health Service of Idlib, accused government forces of purposefully attacking medical centers and clinics.

“The most difficult thing for us is the deliberate targeting of our medical services,” Zahran told Syria Direct. “Three medical centers were completely destroyed on Sunday in direct strikes. The intention is clear.”

The targeting of medical centers in Northwest Syria presents a major challenge to the area’s ability to provide medical services and has contributed to the growing number of IDP’s headed towards the calmer areas along the Northern Turkey-Syria border.

According to Ibrahim al-Shamaly, a press officer for the Hama Health Directorate, air strikes have caused a huge wave of displacement from the surrounding areas and have taken medical centers out of service.

“A number of people have left their homes in the northern Hama countryside because the area now lacks any health or triage centers to provide medical treatment,”al-Shamaly told Syria Direct.

Despite the ferocious bombing which led his neighbors to flee, Hassan al-Hamawi decided to remain in his home in Kafr Zayta, northern Homs. Hamawi, 40 years-old, made his decision to stay in part because of the difficult conditions that face IDP’s.

However, the nearest hospital to al-Hamawi is Ma’ara National Hospital, nearly 50 kilometers away.

Military escalation endangers diplomatic negotiations

The dramatic military escalation in Northwest Syria, now in its second week, comes in the wake of the 12th round of the Astana negotiations.

The talks in Astana wrapped up at the end of April without reaching any agreement on the creation of a constitutional committee, an essential part of a broader effort to end fighting in the country. The current on-the-ground events in Northwest Syria deeply strain the Russian-Turkish detente concerning Idlib.

Further military escalation threatens to upend it completely.

Ömer Özkizilcik, a political analyst for an Ankara-based think tank, SETA, believes that there is hope yet for the Astana Peace Track. He sees the current escalation in Idlib as a Russian attempt to pressure Turkey.

“As long as the Turkish observation points are present in these areas, there will not be wider [military] operations in Idlib,” Özkizilcik told Syria direct on Monday.

“The costs of the regime attack on Idlib are very high for Turkey. Turkey is unlikely to succumb to pressure,” he explained.

Still, Turkey has not escaped the aerial assault unscathed.

On Saturday, two Turkish soldiers were wounded when a position near a Turkish observation point in the Idlib de-escalation zone was bombed. The Turkish Ministry of Defense claimed  the shelling was launched from Regime-controlled territory.

The most recent bombing campaign in Idlib is widely considered to be the most violent since Ankara and Moscow came to the Sochi de-escalation agreement in September 2018.

“For four months we have been subject to bombing and rockets and war planes, but this is the worse yet. Where is there left to go?” asked al-Hamawi.