At least 33 people, including patients, have been killed, and about 70 wounded after an air strike by the country’s military government hit a major hospital in western Myanmar, according to a rebel group, aid workers and a witness.

Myanmar has been gripped by attritional fighting in a raging civil war.

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The hospital in western Rakhine state’s Mrauk U township was struck late on Wednesday by bombs dropped by a military aircraft, said Khine Thu Kha, a spokesman for the Arakan Army, which is battling the ruling government along parts of the coastal state.

“The Mrauk U General Hospital was completely destroyed,” Khine Thu Kha told the Reuters news agency.

“The high number of casualties occurred because the hospital took a direct hit.”

United Nations rights chief Volker Turk condemned the attacks “in [the] strongest possible terms” and demanded an investigation.

“Such attacks may amount to a war crime. I call for investigations and those responsible to be held to account. The fighting must stop now,” he wrote on X.

A spokesperson for Turk’s office said national authorities carried responsibility for conducting inquiries, but warned that “given the prevailing impunity” in Myanmar, international courts or universal jurisdiction mechanisms could be used to pursue accountability.

World Health Organization chief Tedros Adhanom Ghebreyesus said he was “appalled”, describing the hospital as the main facility providing emergency care, obstetrics and surgical services in the area.

“At least 33 people have been killed … including health workers, patients and family members. Hospital infrastructure was severely damaged, with operating rooms and the main inpatient ward completely destroyed,” he wrote on X.

Tedros added that this marked the 67th verified attack on health facilities or personnel in Myanmar this year, saying “every attack on health care is an attack on humanity”.

Myanmar has been gripped by conflict since the military suppressed protests against a 2021 coup that unseated the elected government led by Nobel laureate Aung San Suu Kyi.

The 300-bed hospital was overflowing with patients at the time of the strike, said aid worker Wai Hun Aung, as most healthcare services across swaths of Rakhine state have been suspended amid the ongoing fighting.

‘The situation is very terrible’

On Thursday morning, the facility lay in complete ruins, with a collapsed roof, shattered columns and beams, and the bodies of victims laid out on the ground, according to images shared by Wai Hun Aung that he also posted on social media – which could not be independently verified.

“The situation is very terrible,” he told the AFP news agency. “As for now, we can confirm there are 31 deaths and we think there will be more deaths. Also, there are 68 wounded and will be more and more.”

Soon after he heard the sound of explosions on Wednesday night, a 23-year-old resident of Mrauk U said he rushed to the site.

“When I arrived, the hospital was on fire,” he said, asking not to be named because of security concerns. “I saw many bodies lying around and many injured people.”

Al Jazeera’s Tony Cheng, reporting from central Myanmar, said that such attacks are almost daily occurrences in Myanmar.

“We heard overnight a loud explosion a couple of villages over. What we understand is that a military jet dropped a 1,000-pound [454kg] bomb,” he said, referring to the area he is in in central Myanmar.

“That attack led to one fatality and several injuries,” he said.

Cheng added that almost every household has a bomb shelter these days – used by people as soon as they see aircraft or hear them.

Government ramps up air attacks

The military government, which has the only air force in Myanmar, has been increasingly using air attacks to hit targets inside rebel-held areas.

From January to late November this year, the government conducted 2,165 air strikes, compared with 1,716 such incidents during the whole of 2024, according to the Armed Conflict Location & Event Data Project.

Resistance groups formed in the wake of the coup have combined with major ethnic armies like the Arakan Army to take on the military, which is fighting the rebellion on multiple front lines.

Since the breakdown of a ceasefire in 2023, the Arakan Army has pushed the military out of 14 of Rakhine’s 17 townships, gaining control of an area larger than Belgium, according to an analysis published by the ISEAS-Yusof Ishak Institute in Singapore.

Mrauk U township, located in the north of Rakhine state, has been under the control of the Arakan Army since last year, and there has been no recent fighting in the area, Khine Thu Kha said.