Beirut: Last month's chemical weapons attack on a rebel-held Syrian town may have caught the world's - and US President Donald Trump's - attention, but it was not the only recent suspected use of a nerve agent by Syrian government forces.
On three other occasions in the months leading up to the attack on the town of Khan Sheikhoun, witnesses, doctors and human rights investigators say, government attacks left scores of people sickened with similar symptoms, like foaming at the mouth, shaking and paralysis - including two attacks in December, little noticed at the time, that killed at least 64 people.
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New US sanctions against Syria announced
The United States has issued 271 sanctions, the largest amount in US history, in response to Syrian President Bashar Assad's alleged use of chemical weapons.
New information about the additional attacks appears in a Human Rights Watch report released on Monday, placing Khan Sheikhoun in the context of wider evidence that the Syrian government continues to use chemical weapons despite its 2013 agreement to give them up.
Despite the missile strike Trump ordered on the Syrian military airfield he said was the source of the Khan Sheikhoun attack, Syrian forces are doubling down on tactics that constitute war crimes, including bombing hospitals and rescue and medical workers and using chemical weapons, according to the report and other witness accounts.
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The Syrian government and its main ally, Russia, deny that it uses such tactics.
At a news conference held at United Nations headquarters in New York to release the report's findings, the executive director of Human Rights Watch, Kenneth Roth, ridiculed what he described as "preposterous" assertions by the Syrian and Russian governments denying responsibility.
Roth said it was time for them "to stop these transparently false diversionary claims and come clean".
He also said the pattern of attacks as described in the Human Rights Watch report amounted to "a level of culpability and horror that cries out for prosecution".
On Saturday, an attack on a headquarters of the White Helmets civil defence rescue group in the town of Kafr Zita killed eight of its members, the group and other witnesses say. And medical organisations working in Syria have tallied 10 government attacks in April alone on hospitals and clinics in rebel-held areas, part of a pattern of hundreds of attacks on medical workers and facilities that UN investigators have described as war crimes.