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New report calls for Russian attacks on Ukraine healthcare to be investigated as war crimes

*** This article was updated on 23 February to include comments from the World Health Organization ***

Russia’s sustained attacks on healthcare facilities and health workers in Ukraine should be investigated as war crimes, according to a new report.

The report, ‘Destruction and Devastation: One Year of Russia’s Assault on Ukraine’s Health Care System’, documents attacks on healthcare facilities, ambulances, destruction of critical health infrastructure and theft of supplies.

It also documents and includes first-person accounts of assaults, torture, and ill-treatment of health workers, including doctors, nurses, and paramedics.

Produced by eyeWitness to Atrocities, Insecurity Insight, the Media Initiative for Human Rights, Physicians for Human Right, and the Ukrainian Healthcare Center, it was released just ahead of the first-year anniversary on 24 February of Russia’s invasion of Ukraine.

The report claims to provide “the most comprehensive documentation to date of attacks on Ukraine’s healthcare system as well as their devastating impact on the right to health”.

It draws on a dataset of attacks – collectively developed from open-source and confidential information over the course of 2022 – as well as detailed case studies based on visits to hospitals in four different regions of Ukraine to inspect attack sites, assess damage, take photographs, and conduct semi-structured interviews with hospital staff present at the time of the attacks.

During just the first weeks of the Russian invasion, it says there were constant, daily attacks on healthcare.

“For 35 days, Ukraine’s healthcare system was damaged every single day. Assaults were particularly intense in February and March; during the first two weeks of the invasion, an average of four to five hospitals and clinics were attacked daily.”

Between February 24 and December 31, 2022, the research team documented a total of 707 attacks on Ukraine’s healthcare system. These included:

  • 292 attacks that damaged or destroyed 218 hospitals and clinics. Many health facilities were attacked more than once
  • 65 attacks on ambulances
  • 181 attacks on other health infrastructure (such as pharmacies, blood centres, dental clinics, research centres)
  • 86 attacks on healthcare workers, with 62 health workers killed and 52 injured. Many others were threatened, imprisoned, taken hostage, and forced to work under Russian occupation.

However, these are likely to be under-counts, and the authors say that the true scale and impact on access to healthcare – and on the right to health of Ukraine’s people – will not be known for years to come.

They say the report shows how Russia appears to be violating international humanitarian law by “deliberately and indiscriminately” targeting Ukraine’s healthcare system as part of a broader attack on its civilian population and infrastructure.

The authors urge investigators and prosecutors – in Ukraine, at the International Criminal Court, and in third states that may also have jurisdiction – to prioritise investigations into these attacks.

“Based on the evidence presented here, there is a reasonable basis to believe that attacks on Ukraine’s healthcare system constitute war crimes and comprise a course of conduct that could potentially constitute crimes against humanity as well. At a minimum, this evidence warrants immediate investigation by prosecutorial authorities.”

The report does not cover other issues affecting Ukraine’s health system, including that infrastructure damage has led to direct losses of raw materials for medicines, along with losses in manufacturing, storage, and distribution capacities, and delays in manufacturing and distribution.

Nor does it cover the large number of attacks on Ukraine’s energy infrastructure that have affected the ability of health facilities – ranging from hospitals to retail pharmacies – to remain operational.

Meanwhile, the health impacts of the war clearly extend far beyond the destruction and damage of healthcare services in Ukraine.

A detailed report in Health Policy Watch says Russia’s war in Ukraine has sparked a global health crisis – from the death, suffering and displacement of people in Ukraine, to global food and fuel insecurity, and diminished donor funds to support other health issues.

About 17.6 million Ukrainians, or about 43 percent of Ukraine’s population of 41 million, are expected to need humanitarian assistance this year, with nearly eight million people displaced into neighbouring countries, and 5.3 million people internally displaced, says the report.

WHO comments

On 22 February, the Director-General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, told a media briefing that since the beginning of the conflict, WHO had verified 802 attacks on healthcare, which had resulted in 101 deaths of health workers and patients.

“The war is exacerbating health needs, including for mental health and psychosocial support; rehabilitation; treatment for chronic diseases and others such as cancer, HIV and tuberculosis; and vaccinations for measles, polio and pneumonia and COVID-19,” he said.

WHO had delivered nearly 3000 metric tonnes of life saving medical supplies to Ukraine over the past year, including ambulances, generators, medicines for chronic diseases and trauma and surgery emergency supplies.

WHO has appealed for US$240 million to provide 11.4 million people with health assistance in Ukraine and countries receiving refugees.

“The conflict is affecting health not just in Ukraine but around the world, with millions of people impacted by spiking food prices, especially in low-income countries,” he said. “As always, we need health for peace, and peace for health.”

Further reading

The Conversation: A year on, Russia’s war on Ukraine threatens to redraw the map of world politics – and 2023 will be crucial

The Conversation: Ukraine: 12 months at war – Biden visit to Kyiv sets the seal on a year of growing western unity and Russian isolation

The Conversation: Ukraine war: a year on, here’s what life has been like for refugees in the UK

Reuters: Ukrainian army medics fight to save lives near frontline.


See Croakey’s previous articles on the war in Ukraine

 

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