The woman in labour stared out from the stretcher, as medics rushed her over a wasteland left by a Russian attack on a maternity hospital. In a different hospital and feeling her baby slipping away, she begged doctors: “Kill me now.” Hours later, both she and her child were dead.
The horror of the attack on a maternity hospital in the besieged Ukrainian port city of Mariupol stunned the world. But it was not the first time Russian bombs had fallen on women as they gave birth.
As Russian strikes reduce Ukrainian cities to ruin – killing, injuring and terrorising thousands of civilians – comparisons have been made with the second world war, but there was a much more recent precedent. The tactics, and even some of Russia’s soldiers, have come direct from the civil war in Syria – which Moscow joined in 2015 to support Bashar al-Assad.
Since then it has carried out a brutal but ultimately successful campaign – helping Assad seize back nearly all of the country from rebel hands. In the process entire cities have been devastated and up to 24,743 civilians allegedly killed by Russian strikes, according to the civilian harm monitor Airwars.
From the Damascus suburb of Ghouta, to the great cultural and economic powerhouse of Aleppo, Russian bombs hit hospitals, schools, markets, queues of people waiting for bread. Its planes helped enforce Syrian sieges on the ground, reducing people to desperate skeletons. And when Russia and the Syrian army promised exit routes, they sometimes bombed and shot the civilians trying to flee.
Some observers predicted Putin would not import the tactics of Syria to Ukraine because of close ties of family and friendship that straddle the border. While Syrians were distant, anonymous victims to most in Russia, the people of Mariupol include relatives, classmates and former colleagues.
But over the past month, the targets have been the same: hospitals, schools, markets, bread queues, a theatre. Russian troops have promised escapes and then attacked civilians on the roads.
Below is an examination of five key elements of the “Syria playbook”, looking at how the tactics from one war have been imported to devastating effect into another.
Cutting off rebellious areas
Syrian and Russian forces besieged multiple cities in Syria to starve them into submission, effectively holding civilians hostage as forces moved in on rebel fighters.
Perhaps the most notorious was the siege of Aleppo in 2016. Syrian rebels were first cut off from their supply lines and then squeezed, street by street, over more than six months, while indiscriminate bombing took place.
By 2017, 4.9 million Syrians in need of humanitarian assistance were living in besieged or hard-to-reach areas.
Now the same is happening in Mariupol, where Russian forces are closing in on Ukrainian forces trapped between their front lines and the sea. As the fighting rages civilians are barred from leaving, civilian infrastructure is being targeted, and life has become a daily gamble.
Russian forces appeared to be attempting a similar blockade of the capital, Kyiv, and the key eastern city of Kharkiv, but so far Ukrainian forces have been able to keep supply lines open.
In both Syria and Ukraine Russia and its allies have made military targets out of the civilian heart of communities – places ordinary people go for medical care, education and food and other necessities.
Deliberately targeting civilians is illegal under international law, but it can also be effective. It spreads terror, saps the will of fighters and destroys the community they rely on for practical and moral support.
During the eight-month Battle of Aleppo, civilians were reportedly harmed in at least 16 attacks on hospitals, accounting for up to 143 alleged deaths, according to Airwars. Across the rest of Syria, dozens of other strikes on healthcare facilities have been documented, including multiple attacks that have been tied directly to Russian forces.
“We documented numerous attacks on hospitals by precision Russian weapons demonstrating a clear desire to target hospitals – which are protected under international humanitarian law,” Marc Garlasco, a war crimes investigator who analysed Russian activity in Syria for the United Nations, said. “It was shocking.”
The World Health Organization has documented at least 43 attacks on healthcare in Ukraine since the war began, with at least 12 people killed. Countless other patients have had their healthcare disrupted by siege, including children on a cancer ward who are trapped in Chernihiv and running out of painkillers.
Simply feeding your family becomes unsafe under Russian assault. Since 2015, civilians have been killed or injured in 204 reported attacks on marketplaces by Russian or Syrian government forces, according to Airwars data. This was five times the number of such allegations about the US-led coalition against Islamic State during the same period.
Schools too have been attacked; in Syria children were killed while studying. In Ukraine because education has been halted, no students were at their desks when bombs hit, but there have been casualties. In Mariupol a missile hit an art school sheltering at least 400 people.
And even when there are no deaths, damaging or destroying schools rips out the heart of a community and its future; in eastern Kharkiv alone the mayor said 48 schools had been destroyed. Nationwide hundreds have been hit.
Water, gas and power supplies were hit in Syria. In Ukraine, an attack on a power station in the east came even before Russia launched its full invasion, and utility supplies have been disrupted around the country. This is particularly devastating in the bitter Ukrainian winter.
Widespread use of indiscriminate weapons
In Ukraine, Russian forces have deployed indiscriminate weapons when targeting residential areas of towns and villages, reducing entire settlements to rubble.
The largest-scale devastation has taken place in districts of Mariupol, where fires extended the work of bombing. But other towns have been attacked in this way, including eastern Volnovakha and Schastia which were targeted early in the war. Locals say 90 percent of Volnavakha has been razed or damaged.
The civilian toll of this kind of attack is high. Many people are killed, bodies cannot be buried and surviving residents have spent days sheltering in freezing basements without water, their food supplies dwindling, and hopes of an evacuation repeatedly dashed.
Again the echoes of Syria are clear – with videos of the ruins reminiscent of footage from Aleppo. In Syria Russian forces allegedly used so-called vacuum missiles – a particularly deadly explosive that can suck the oxygen from the air – hundreds of times in heavily populated neighbourhoods.
Russia has also used other inherently indiscriminate weapons in both countries including cluster bombs, which scatter from a delivery case, and grad rockets – indiscriminate and unguided weapons designed for open battlefields.
Civilian harm allegations have resulted from cluster munitions reported 567 times in Syria, with at least 2,000 civilians killed. They have also been widely used in Ukraine, from Kharkiv in the north-east to Mykolaiv in the south. There one man told the Guardian a neighbour had been killed and another badly injured by cluster bombs that landed in his village.
“What Russian did in Syria was almost indescribable – intensive attacks destroying whole areas,” said Fadel Abdul Ghany, chair of the Syrian Network for Human Rights. He pointed to the 2018 siege of the rebel-held suburb of eastern Ghouta. “They had at least 12 airplanes shelling a civilian area and when they finished another 12 would return in their place.”
Russia also used its wars to develop tactics and test new weaponry. The country’s defence minister boasted of testing more than 300 new weapon types in Syria, and in Ukraine they claim to have used new hypersonic missiles for the first time.
A fourth part of the “playbook” is the announcing of so-called humanitarian corridors. In both Syria and Ukraine, Russia has appeared to offer escape routes from areas under siege or intense shelling and then at the last minute snatched away the chance of safe passage for civilians to areas beyond the conflict.
The sight of buses lined up for a rescue mission, then forced to wait as bombardment continued became familiar in Syria and has been repeated in Ukraine.
Perhaps the most notorious in Ukraine is Mariupol. After weeks of attack and false hopes, tens of thousands fled ad-hoc convoys of private cars, once word got out in the city that Russian checkpoints were letting civilians through. Those without cars had a brutal choice of walking for several kilometres, or staying in the ruined city.
In Syria, Russia sometimes announced the corridors unilaterally without coordinating with international organisations such as the United Nations – meaning they were unable to monitor them, Emma Beals, a non-resident scholar at the Middle East Institute, said. The corridors were sometimes open for too short of a time to be useful, were unworkable or even took civilians to areas under the control of militaries they were hiding from.
“The important lesson from Syria is when military and political victory is their explicit ambition there is pretty much nothing that will cause them to stop except achieving that. And the humanitarian corridors were used as part of those goals,” Beals said.
On at least seven occasions in Syria, Russia and its allies were accused of killing or injuring civilians while targeting humanitarian convoys including those carrying food, resulting in the deaths of at least 44 people, according to Airwars data.
The opening of corridors, even if they are not functional, can also presage an intensified attack. “Russia then usually argues that having given this chance for departure, anyone left is a “terrorist” and as such a legitimate military target. This was the pattern most infamously in Aleppo,” said Kyle Orton, a Syria analyst.
Another trademark of the “Syria playbook” is consistent denial and disinformation of civilian casualties and war crimes. To date Russia has not accepted killing a single civilian in Syria and has no known mechanism to measure the civilian impact of its actions.
Since invading Ukraine its domestic propaganda machine has gone into overdrive, baring even the simple truth of calling the invasion a war. Instead it is a special operation. Putin claims that his soldiers are fighting to “denazify” a country whose president is Jewish.
Internationally, Russia has attempted to deny some of its worst atrocities in Ukraine. Even the pregnant woman killed in Mariupol was not left to die in dignity – the Russian embassy in London claimed images of her final agonising moments were “fake”.
That echoed attacks on the White Helmet civilian rescue group, Syrian victims of Russia’s most aggressive and successful disinformation campaigns. They gained worldwide fame for filming their rescues following bombings, but were regularly accused of faking the carnage they captured.
The chief spokesperson for the Russian defence Ministry Maj Gen Igor Konashenkov even alleged, without evidence, that Ukrainian forces were planning to make “staged videos” of fake civilian deaths, in campaigns “based on patterns used by the White Helmets”.
Sara Kayyali, Syria researcher at Human Rights Watch, said over several years the campaign in Syria succeeded in casting doubt among many over any allegation of civilian harm.
“What we came up against was the sophisticated disinformation campaign that the Russian media, in particular, launched against people like the White Helmets. Unfortunately, in many circles, this was quite successful.”
Fears over the next step?
One potential further step that Russia could take to echo the war in Syria would be using chemical weapons. Russia did not use chemical weapons in Syria, but Putin’s ally Assad illegally deployed them against civilians multiple times. Syria has either denied these attacks or claimed they were “false flag” operations by rebels but the UN-aligned body that oversees chemical weapons has confirmed the Syrian regime deployed chemical agents including the nerve gas sarin.
Western leaders have warned that Russia may be planning a similar attack in Ukraine. The Russian state has already used a nerve agent and a radioactive poison in attacks on British soil.
Moscow’s false accusation that Ukraine has biological and chemical weapons is a “clear sign” that a desperate Vladimir Putin is considering using them himself, the US president, Joe Biden, has said. Putin has also made a veiled nuclear threat by ordering nuclear deterrence forces onto high alert.
That threat, if carried out, would take Putin beyond even his own brutal Syrian playbook. The western world, which has stepped back from intervention in either war even as civilians were trapped, starved and bombed, has not yet decided how it would respond.
Joe Dyke heads the investigation team at the civilian harm monitoring organisation Airwars. Additional reporting by Adam Gnych and Sanjana Varghese.