A/71/205 Afghanistan in 2015, the highest number of child casualties was recorded since the United Nations began systematically documenting civilian casualties in 2009. In Somalia, the situation continued to be perilous for children: the number of recorded violations showed no signs of abating in 2016, with many hundreds abducted, recruited, used, brutally killed and maimed. In a most troubling example, in South Sudan, children were victims of all six grave violations, in partic ular during brutal military offensives against opposition forces. The deterioration of the situation in July 2016 is of particular concern for the plight of children. In Iraq, intensive armed clashes and attacks targeting civilians by Islamic State in Iraq and the Levant have led to the death of thousands of civilians, including many children. In Yemen, the escalation of conflict has continued, with alarming levels of child recruitment, killing and maiming of children and attacks on schools and hospitals. B. Emerging issues and challenges Attacks on health care and protected personnel 5. The General Assembly has recognized that attacks upon medical and health personnel result in the loss of life and human suffering, weaken the ability of health systems to deliver essential life-saving services and produce setbacks for health development. Numerous attacks on medical facilities, including aerial bombardment, have heightened concerns about the protection of health care in conflict in recent months. However, hospitals, doctors, nurses, ambulances and patients have long suffered from acts that challenge the most basic principles of international humanitarian law. 6. Almost half of all medical facilities in the Syrian Arab Republic are closed or only partially functioning. In Aleppo, there have been a number of air strikes on hospitals in the last six months, and children living there are confronted with the almost impossible task of obtaining basic health care in order to survive. In May, a Syrian doctor wrote in response to one attack that what was most heart-breaking was the need for doctors to choose which patients to save because there were not enough doctors to treat everyone; their hospitals, though they were the targets of bombs, still overflowed with the sick and injured. 1 In Afghanistan, the attack on the Médecins sans frontières hospital in Kunduz in October 2015 caused deaths and injuries of 49 medical staff. The hospital was the only fully functioning trauma care facility for the north-eastern region of Afghanistan and had provided lifesaving procedures to 5,000 people in the period running up to the attack. In Yemen, to give one example, in Taiz, three health facilities were repeatedly hit in 23 separate incidents throughout 2015. 7. Parties to conflict must consider the long-term impact of attacks on health care. When a community is recovering from conflict it can take decades to reinstall skilled doctors, nurses, and the physical infrastructure to provide health care. Even a short period of hostilities can have a lasting impact, in particular because efforts to repair damage from attacks are sorely lacking. 8. Governments bear the primary responsibility for protecting civilians, and all parties to conflict must refrain from attacking civilian objects. Governments should adopt clear legislation and issue orders to their security forces to protect hospitals, __________________ 1 16-12896 Osama Abo El Ezz, “In Aleppo, we are running out of coffins”, The New York Times (4 May 2016). 3/18