BEIRUT: Syria’s Palestinian refugee population has fallen by one-fifth since the start of the Syrian conflict in 2011 and many of those who stay in Syria have been displaced, the U.N.’s Palestinian relief agency said Friday.

UNRWA Director Pierre Krahenbuhl said there are 440,000 refugees in Syria, compared to 560,000 in the country before the war.

Many of those still in Syria have been displaced by Syria’s six-year civil war. For them, it is the second time they or their families have been forced out of their homes, after being displaced from Palestinian lands by Israeli forces last century.

“Displacement is a very difficult experience, to lose another home, to lose another place of residence,” said Krahenbuhl, who was wrapping up a five day tour of UNRWA operations in Syria.

Several Palestinian camps in Damascus and Aleppo, Syria’s largest city, have been destroyed during the conflict that has killed more than 400,000 people, displaced half the country’s population and sent more than 5 million as refugees, mostly to neighboring countries.

Elsewhere in Syria, opposition activists reported clashes between government forces and insurgents groups in different regions including the central province of Hama, the northwestern province of Idlib and the suburbs of Damascus, according to opposition activists and state media. The activists reported airstrikes on rebel-held parts of Idlib and Hama.

Physicians for Human Rights reported Friday that at least two medical facilities in Hama have come under attack over the past week. It said the facilities, a hospital in the village of Latamneh and a medical point in Kafar Naboudeh, together serve tens of thousands of people in the province that witnessed intense violence over the past two weeks after insurgents launched a wide offensive against government-controlled villages.

The group said the attacks on the two medical facilities violate international law, in that they are either intentional attacks on medical facilities or indiscriminate attacks on civilian-populated areas.

“Hospitals have become scenes of total devastation and destruction throughout this conflict,” said PHR’s lead Syria researcher Elise Baker. “What we’re seeing in Hama governorate is an extension of a gruesome pattern of attacks against medical facilities and personnel across the country.”

“As we’ve seen throughout the conflict, as fighting intensifies and the need for medical care grows, hospitals and other medical facilities come under increasing attack,” she said.