“Since 2012, indiscriminate and disproportionate bombardments have been the primary cause of civilian casualties and mass displacement” in Syria according to the United Nations Special Rapporteur on Syria. Such bombing of civilian areas and humanitarian infrastructure has been a theme throughout the Syrian conflict, and eastern Ghouta was no exception. This trend was seen in other rebel-held enclaves such as eastern Aleppo and Darayya, where weapons of all kinds were used against highly populated areas.
The tightening of the siege of eastern Ghouta in 2017 was followed by a military offensive against the enclave from early 2018. Following the start of the ground offensive on February 18, the frequency of air strikes and shelling increased significantly as the Syrian regime and Russians supported their ground offensive with airpower and artillery to wrest control of one neighborhood at a time back from the armed opposition. A wide variety of weapons were used against the population of Ghouta, including more pernicious weaponry like chemical gas, incendiary weapons, and cluster munitions in addition to more traditional weaponry.
The firepower was overwhelming. An average of 345.6 attacks were documented per day, in a period spanning forty-nine days, between the beginning of the ground campaign on February 18 until the fall of Douma, the last opposition-held town in the enclave, on April 8. On February 21, the heaviest day of strikes, 1,658 attacks were recorded.
During the offensive in Ghouta, the number of air and artillery attacks against the area increased significantly when compared with the years preceding the offensive. The graph above charts the total number of recorded attacks per day between February 18 and April 8, the end of the ground offensive on Ghouta. It shows that during this forty-nine-day period, a total of 16,934 attacks were recorded against the enclave, an average of 345.6 attacks each day, or about 14.4 strikes per hour. Bombing was so heavy that local medical services and first responders often failed to reach the injured in time to save them or put out fires that erupted due to incendiary munition deployment. On eight of the days of the offensive, eastern Ghouta witnessed over 800 documented strikes, and on twenty-six of the forty-nine days more than 200 strikes were recorded; seventeen days saw more than 400 attacks.
On February 21, the heaviest day of strikes, 1,658 attacks were recorded, an average of 69 strikes per hour. Locals reported that corpses and body parts were often left rotting under the rubble and even strewn in the streets due to the danger and difficulty in retrieving them. Multiple victims were buried in mass graves with merely numbers attached to their improvised shrouds, as relatives and friends were unable to reach the hospitals and morgues to identify their loved ones. The prolonged government-imposed siege, which prevented the entry of most types of medicine and supplies to Ghouta, coupled with direct attacks on medical facilities, ensured that many of those injured in attacks would later die due to a lack of proper medical care. Dr. Hamid, a doctor in Ghouta, described the state of Ghouta’s medical services shortly before its fall: “We are working with stitches that were used before, disposable gloves that we wore before, chest drainage that was used on other patients. Most wounds get infected and need bandages, but we are using bandages that we used before.”
The majority of these attacks employed traditional weaponry. However, some involved more pernicious weaponry prohibited under international law to be used in civilian populated areas—as they were in Ghouta—due to their indiscriminate nature. The next four chapters of this report will examine these four particularly pervasive and pernicious types of attacks: chemical weapons, cluster munitions, incendiary weapons, and attacks on health facilities whose locations had been shared with the Russian and US governments in an effort to protect them.
In Ghouta, at least six suspected chemical weapons attacks took place during the government’s campaign to recapture eastern Ghouta. The deadliest attack occurred on April 7, precipitating Douma’s surrender one day later and prompting international outcry and retaliatory air strikes on April 14 by the United States, United Kingdom, and France against Syrian military sites implicated in the manufacture, storage, and deployment of chemical weapons.
On five days during the offensive, local activists documented multiple cluster munition attacks. Most of eastern Ghouta’s population centers were hit, injuring and killing individuals who appeared to be mostly civilians. Incendiary weapons appear to have been used in at least twenty-five attacks during the ground operation against eastern Ghouta, with the weapons being deployed primarily against urban areas behind the front lines. Attacks on hospitals have occurred since the beginning of the conflict, with Physicians for Human Rights having recorded 446 attacks by Syrian government and Russian forces on medical facilities over the course of the conflict. Ghouta also suffered from attacks on healthcare centers, including two whose locations had been “deconflicted” by sharing them with the Russian military in an attempt to protect them.
 United Nations, Office of the United Nations High Commissioner for Human Rights, Paulo Sérgio Pinheiro, The Use of Barrel Bombs and Indiscriminate Bombardment in Syria: The Need to Strengthen Compliance with International Humanitarian Law, (12 March 2015), available from https://www.ohchr.org/Documents/HRBodies/HRCouncil/CoISyria/CoISyriaIndiscriminateBombardment12032015.pdf.
 Joel Gunter, “In Syria’s Eastern Ghouta, a Doctor’s Battle: ‘We Will Stay until the End,’” BBC News, March 17, 2018, https://www.bbc.com/news/world-middle-east-43415128.
 “Anatomy of a Crisis: A Map of Attacks on Health Care in Syria,” Physicians for Human Rights, accessed on September 09, 2018, https://s3.amazonaws.com/PHR_syria_map/web/index.html.