°®Âþµº

With the fourth anniversary of the Syrian civil war only days away, a report published on Wednesday reveals the extent to which the country's medical infrastructure and health professionals have been devastated by "deliberate and indiscriminate attacks" since the conflict began.

, published by Physicians for Human Rights (PHR), documents the extrajudicial killing of at least 610 medical workers and 233 attacks on 183 medical centres throughout Syria. 

An , updated every month, shows these violations.

"In Syria, a doctor can be detained and tortured just for being caught at a checkpoint with a roll of gauze," said Donna McKay, executive director of PHR. "World leaders must not allow this onslaught against medical personnel to become 'the new normal' in conflict."

The vast majority of these attacks have been carried out by the Syrian government, in violation of human rights and humanitarian law, the report says. Health care services have been "systematically targeted" over the past four years, most recently with barrel bombs.

While non-state groups are responsible for some attacks, government forces are estimated to have committed 88 percent of attacks on hospitals and 97 percent of killings of medical workers.  

The report emphasises that medical workers have been targeted specifically for their life-saving work, and that attacks on medical professionals, facilities and the transport of medical supplies during war are a violation of the Geneva Conventions.

PHR describes these attacks as so "widespread and systematic" that they constitute crimes against humanity.

The report takes the reader through the violations year by year. In 2011, doctors began to be murdered. Government troops entered Daraa National Hospital and positioned snipers on its roof who shot at any injured people trying to enter, ensuring that only regime supporters would be treated.

In the first year, most attacks took place in southern and central Syria - in the Deraa, Homs and Hama regions - with medical workers killed in shootings, bombs or tortured to death.

In 2012, such attacks increased, with Aleppo's Dar al-Shifa Hospital particularly targeted. Situated in the crowded Al-Shaar neighbourhood, medical personnel refused to leave the hospital - even after the death of a 23-year-old medical student working there as a paramedic - until it was destroyed by a missile attack.

Some 90 medical facilities were attacked that year, 89 of them by government forces.

The third year of the war saw attacks increase in number and brutality. The rise of armed groups, including the Islamic State group (IS, foremrly known as Isis), led to some assaults on medical centres by non-state actors.

However, all but two of the 171 medical workers who died  that year were killed by government forces. Dr Osama Baroudi, an eminent gastroenterologist and founder of the Free Union of Syrian Doctors was arrested and tortured to death in July 2013.

Most recently, the government's use of barrel bombs has been particularly destructive. They were dropped on Wisam Hospital in Kafr Zita, killing two babies and a nurse, and injuring several medical workers.

The PHR report concludes that the Syrian government has been using attacks on medical personnel and facilities as a "weapon of war" to prevent its opponents from being treated, and killing thousands of civilians in the process.

It also calls on the international community to exert concerted efforts to reverse such violations, and to "reclaim the norm" that establishes the protected status of medical personnel and facilities in conflict.

While the UN Security Council may not support a referral of the crimes described in the report to the International Criminal Court, there are pragmatic steps that the international community could make. 

"The UN General Assembly could support a resolution calling for justice that could start a process of getting a commitment to create an ad hoc tribunal to address these crimes," Widney Brown, PHR director of programmes, told al-Araby al-Jadeed.

"Such a resolution would send a strong message that impunity for war crimes and crimes against humanity will not be tolerated."

She added that Syrians should be involved in designing such a tribunal and that it should meet international standards to ensure that due process and fair trial standards are met.