Russian airstrikes hit nine hospitals in Syria this month, killing at least 12 and wounding dozens of others, according to a medical non-profit operating in the area.

Russian missiles struck a hospital in rebel-controlled Syria twice Tuesday in what the Syrian American Medical Society estimates is the ninth Russian strike on a hospital in recent weeks. Twelve were killed in the strike on the SAMS field hospital, including a hospital guard and a physiotherapist, and at least 28 civilians were injured, including a child less than five years old.

Russia began launching airstrikes in Syria in October to bolster President Bashar Assad’s regime. The strikes have primarily targeted rebel groups fighting Assad, including some CIA-backed forces, although the Kremlin claims Islamic State is a major focus.

SAMS operates dozens of medical facilities in rebel-controlled areas, and alleges Russian airstrikes have targeted a total of nine hospitals so far. Russian strikes on the only two hospitals in southern Aleppo over the weekend forced them to shut down and evacuate patients.

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