Marking six years since the start of the Syrian conflict (15 March), a study in The Lancet provides new estimates for the number of medical personnel killed: 814 from March 2011 to February 2017. With nearly 200 attacks on health facilities in 2016 alone, medicine denied in besieged areas, and indispensable young medics forced to deliver care in extreme conditions, the study describes the extent to which health has been weaponised in the conflict, in what human rights organisations have described as a war-crime strategy.

The weaponisation of health care, a strategy largely used by the Syrian government and its main ally Russia, threatens the foundation of medical neutrality as laid out in international humanitarian law. The authors say the conflict has revealed serious shortcomings of global governance and call for a new role for global health organisations in responding to health needs in conflicts.

Estimates suggest that between 2011 and 2015, at least 15000 doctors, or half of the pre-war numbers, had left the country. In Eastern Aleppo, approximately 1 doctor remained for every 7000 residents, compared with 1 in 800 in 2010.