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Over the past week, eastern Ghouta – home to more than 400,000 people – has been the target of an unprecedented offensive by the Syrian regime and its allies. In less than two days, about 200 civilians were killed in continuous airstrikes, shelling and bombing that has destroyed civilian infrastructure, making the residents even more vulnerable.

Five health facilities were attacked during this offensive, and there is precedent to believe the strikes on healthcare infrastructure are deliberate and strategic, rather than collateral damage. Health facilities in opposition-controlled areas in Syria have been under fire since the beginning of the conflict, suffering more than 492 attacks. Some undergo frequent attacks. The central hospital in northern Hama has been targeted at least 11 times.

The targeting patterns are much more pronounced for health facilities than for other civilian infrastructure. Many residents of opposition-controlled areas consider hospitals to be the most dangerous places they can go to. Perhaps more telling, in the early stage of the conflict, doctors would avoid establishing health facilities close to military targets, in the interest of safety; now the situation is reversed, with some armed groups avoiding having a base close to a health facility, as a way of reducing the risk of airstrikes.

It is plausible that the purpose of targeting health facilities is to weaken the community’s resilience, so that people start to push desperately for any military or political solution. Healthcare is perceived, by Syrian communities, as a vital service without which people will be prone to leave their homes. People in eastern Ghouta have been able to bear the siege for several years so far, but losing access to healthcare, especially in the presence of daily shelling and bombing, is likely to be too much to bear. A paper by the Lancet last year reached a similar conclusion, that the regime was using healthcare as a weapon against the population, by depriving them of it.

The Assad regime could be using this strategy in eastern Ghouta to force the opposition groups there to accept a surrender agreement in which residents will be forced to evacuate the area. This scenario has happened several times in various locations in Syria over the past six years. As early as February 2012, people were forced to leave their homes in the Baba Amr neighbourhood in Homs city after the Assad regime destroyed most civilian infrastructure and all field hospitals there. In December 2016, preceding the agreement to evacuate 250,000 people from eastern Aleppo, all hospitals were destroyed and dozens of medical staff were killed. By then, opposition groups had no other option but to surrender.

These forced displacement agreements could cause long-lasting demographic changes in the country. Most people who have been forced to evacuate their homes in the last six years have not been able to return. Instead, the regime repopulates some strategic areas with people from different ethnic groups, sectors or political affiliations to tighten its control over these areas.

Such demographic changes are a serious threat not only to the resolution of the conflict but also to the prospect of reuniting Syria. What peaceful coexistence existed in Syria is fading out. Even after the conflict is over, it remains to be seen whether Syrians will be able to return to their homes and come back together again.

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