Britain and the US have warned Syria that they will “respond appropriately” if allegations of a fresh chemical attack on rebels are confirmed.
Four fighters from the hardline Hayat Tahrir al-Sham (HTS) group were admitted to hospital on Sunday morning after an air assault on the village of Kabana in Latakia, which borders Idlib province – the last-remaining opposition stronghold.
According to a report by the Idlib Health Directorate, seen by the Telegraph, the patients were suffering from “respiratory failure, vomiting, wheezing and damage to their pharynx.”
Medical staff said they smelled a substance “that was very similar to that of chlorine” during treatment.
A video from the scene appears to show the fighters struggling for breath, with reddened eyes.
The medical team confirmed that it had taken blood and urine samples from the victims and had sent them off for testing.
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The Sunday morning attack took place on the frontline between Islamist HTS fighters and government forces – a mountainous area which has seen fierce fighting in recent weeks.
There has been no independent confirmation of the use of chemicals. White Helmets civil defence workers, which do not operate in the immediate area, said they had no information on the attack.
It is the first reported use of chemicals since the government began attacking Idlib in earnest last month, in a worrying indicator of what could be to come.
President Donald Trump has twice acted in response to a “red line” over chemical weapons once set by his predecessor, Barack Obama. The Trump administration, along with the UK and France, hit several sites linked to Syria’s chemical weapons production in response to attacks in Idlib in 2017 and the Damascus suburb of Douma in 2018.
A State Department spokesperson warned that Washington and its allies would respond "quickly and appropriately" if the reports were proven.
"Unfortunately, we continue to see signs that the Assad regime may be renewing its use of chemical weapons, including an alleged chlorine attack in northwest Syria on the morning of May 19," Morgan Ortagus said in a statement.
"We are still gathering information on this incident, but we repeat our warning that if the Assad regime uses chemical weapons, the United States and our allies will respond quickly and appropriately," she said.
It is not clear if the statement marks a change in policy. Previously, the US has stated that only attacks using nerve agents, not chlorine – a less deadly chemical which has domestic uses – would elicit a military response.
Prime Minister Theresa May told UK Parliament that she was in close contact with the US and would “respond appropriately” if a chemical attack was confirmed.
“Our position is clear,” she said. “We consider Assad incapable of delivering a lasting peace and his regime has lost its legitimacy due to its atrocities against its own Syrian people.”
The Syrian government has been accused of using chemicals against its own people hundreds of times since the war began in 2011.
“Assad has shown time and time again that he uses chemical weapons in strategic areas in order to give his forces advantage,” said Hamish de Bretton-Gordon, the former director of the UK’s Biological, Chemical Radiation and Nuclear department who is now advising NGOs in Syria.
Kabana is a fortified and strategically positioned stronghold that has been frustrating regime advances in Idlib.
The alleged chemical attack came after several failed attempts to capture the area, which overlooks regime-held Latakia – Assad’s birthplace and heartland.
The jihadists have used the hills as a launchpad for rocket and drone attacks on the Hmeimim air base of the government’s main ally Russia.
“Government fighters on the frontline there are Tiger Forces, an elite group which is known to have been behind previous chemical weapons attacks,” Mr de Bretton-Gordon told the Telegraph.
“This time it was on rebel fighters, but there is nothing to say they won’t use chemicals again – next time on civilians – if the UK and US doesn’t act.”
The Syrian Observatory for Human Rights, a UK-based war monitor, says more than 180 civilians have been killed in the flare-up in Idlib since April 30, while tens of thousands have fled their homes.
On Wednesday, air strikes on a market in the town of Maarat al-Numan, which was busy with Ramadan observers breaking their fast around 9pm, left at least 12 civilians dead.
More than 18 medical facilities have also been targeted in recent weeks, leaving thousands without access to care.
More than three million people live in Idlib and surrounding areas, including many who fled government advances in other parts of Syria.
Since last year, the region has been partly shielded in a ceasefire brokered by Russia and Turkey, but Assad has warned he aims to retake “every inch of Syria”, including Idlib.
The possibility of full-blown offensive there threatens yet another humanitarian catastrophe, with the UN warning that up to 2.5 million people could flee toward the Turkish border in such a scenario.
"Despite our repeated warnings, our worst fears are coming true," said David Swanson, a spokesman for the UN humanitarian office.