Nearly 960 people have been killed worldwide in attacks on medical facilities in conflicts over the past two years, the World Health Organization said in a report Thursday that highlighted an alarming disrespect for the protection of health care in war by both governments and armed groups.

The study by the U.N. heath agency detailed 594 attacks on hospitals and clinics in the Middle East, Africa and elsewhere in 2014 and 2015 that killed 959 medics, support staff, patients and visitors and left over 1,500 injured.

Most disturbingly, the report says over 60 percent of the attacks deliberately targeted the medical facilities, while 20 percent were accidental and the rest were undetermined. Over 50 percent of the attacks were perpetrated by governments, one-third by armed groups and the rest were unknown.

War-wracked Syria tallied the largest number of attacks on health care — 228 in the two-year span — accounting for nearly 40 percent of the agency’s global tally.

“This is a huge problem. Attacks on health workers are not isolated, they are not accidental and they are not stopping,” said Dr. Bruce Aylward, the head of emergency response at WHO.

He told reporters in Geneva that often governments or combatants pay lip service to trying to end attacks on health facilities, with no follow-through.

“We hear everywhere, ‘this is unacceptable, attacks on health workers.’ When things are unacceptable, you see a movement on the part of states, on the part of governments, on the part of parties involved to stop these, to hold people accountable. We have not seen that the way we need it if this is to be addressed,” he said.

Dr. Rick Brennan, director of WHO’s emergency risk management, agreed that those attacking medical facilities must be named and held accountable.

“We want to hold all parties to conflict — whether they be governments or non-state armed groups — to account … Why do they continue? It’s a lack of respect, or ignorance, or dismissal of international humanitarian law,” he said.

Brennan says WHO is also trying to better document the after-effects from attacks on access to health care. Following attacks on vaccinators in Pakistan, he said “kids’ can’t get vaccinated, pregnant women can’t deliver at health care facilities, (mothers) can’t take their kids to a health facility for basic antibiotics or rehydration when the kids get sick.”

Targeting hospitals, doctors and patients constitutes a war crime, according to the Geneva Conventions. The U.N. Security Council has denounced the attacks and demanded that all parties in conflicts protect medical facilities, but some of the Council’s most powerful members have been associated with these crimes.

U.S. forces struck a clinic in Afghanistan last year, killing 42 people, in what the Pentagon said was a mistake caused by human error. Medical facilities have also been hit by the U.S.-backed Saudi-led coalition in Yemen. Syrian President Bashar Assad and the Russian forces that back him have been accused of deliberately striking hospitals to make life in opposition-held areas unlivable.

“It’s an absolutely devastating breakdown of this long-held norm — protection and respect of health care,” said Susannah Sirkin, a director at the New York-based Physician for Human Rights.