AMMAN: Civil Defense first responders and local medical personnel are scrambling to salvage what remains of the Maarat a-Numan National Hospital on Monday, one day after three alleged Russian airstrikes “directly hit” the facility, one of the largest medical centers in Syria’s rebel-held northwest.

The airstrikes injured up to 25 people and destroyed ambulances, operating rooms and vital medical equipment, indefinitely shutting down the area’s last remaining hospital. The attack is the latest in a week-long wave of regime and Russian strikes against medical infrastructure in opposition-controlled Hama and Idlib provinces.

One year after a similar attack on the same hospital killed three people, hospital staff are again racing to restore its operations, now with added pressure to accommodate thousands of internally displaced Syrians who have arrived in Idlib province following a series of recent rebel surrenders.

 Aftermath of Sunday’s airstrikes on the Maarat a-Numan National Hospital. Photo courtesy of SAMS.

The airstrikes caused “an unmistakable crisis for residents of the area,” Walid Mohammad, the former president of the Maarat a-Numan Local Council, told Syria Direct on Monday. “Both the sick and the injured must now travel all the way to the Turkish border (approximately 65km due north) in order to receive treatment.”

The first two airstrikes—reportedly vacuum missiles—struck the Maarat a-Numan National Hospital around 7pm local time. Just minutes later, as first responders rushed to the scene, the Idlib Civil Defense said a third missile slammed into the building. That second attack, whereby warplanes circle back minutes after an initial strike, is characteristic of a regime or Russian "double tap" intended to maximize casualties.

Video footage from the hospital, which is supported by the Syrian American Medical Society (SAMS), shows rubble-strewn hallways with downed rafters, damaged operating rooms and a neonatal clinic along with gaping holes in sections of the building.

The hospital’s administration says it will rebuild the facility.

“It’s possible for us to rebuild the hospital, and we recognize the urgency of doing so,” Ibarahim Aboud, the hospital’s spokesman, told Syria Direct on Monday. “But until then, it’s out of service…and we’ll be moving most patients to the Bab al-Hawa hospital [on the Turkish border], and others to nearby medical points.”

 Idlib Civil Defense responds to bombing of Maarat a-Numan National Hospital on Sunday evening. Photo courtesy of Mutia Jalal.

Neither Russian nor Syrian state media has commented on the airstrikes.  

Prior to the attack, the hospital—roughly 30km south of the provincial capital of Idlib city—served the nearly 200,000 residents of Maarat a-Numan, including around 14,000 displaced Syrians newly arrived to the area. However, after a series of recent airstrikes knocked nearby medical facilities out of service, such as the Kafr Zeita hospital, that figure swelled to as high as 600,000 people. Residents must now either travel long distances to receive proper medical care or make due with understaffed and ill-equipped field hospitals.

Abu Omar, the pseudonym of an evacuee from Wadi Barada, received two surgeries on his leg at the Maarat a-Numan National Hospital prior to Sunday’s airstrikes. The hospital, he told Syria Direct from a hospital bed in a different facility, “gave me—and so many displaced people—the medical services we need and won’t soon forget.”

Bombings have intensified in opposition-held northern Hama and southern Idlib provinces in recent days as regime forces and their allies fight back an offensive launched by rebels in the area last month.

Pro-regime warplanes continued to bomb the Idlib countryside on Tuesday with early reporting from pro-opposition media outlets citing at least two casualties in Khan Sheikhoun as well as eight airstrikes in the western city of Jisr a-Shughour.

In at least two previous instances—in October 2013 and November 2012—regime forces bombed the Maarat a-Numan National Hospital, Physicians for Human Rights reported.