Russian attacks on Ukrainian hospitals are war crimes

War means suffering, but for civilians the severity of the consequences depends on how a war is fought.

A war crime stands out for its singular capacity to amplify the suffering of civilians, to multiply the effects of mass atrocities and to cause forced displacement: Russia deliberate aggression on health care. Due to its cruelty and devastating effects, this strategy deserves special attention and should be the priority of prosecution.

On March 9, the Russian assault on a maternity hospital in Mariupol, Ukraine sparked international condemnation. Russia’s foreign minister confirmed the attack was intentional but justified it with the specious claim, backed up by fake footage, that the hospital was a military base. For a seriously injured mother-to-be, the attack destroyed the risk of an emergency caesarean section that could have saved her baby’s life. Without the surgery she herself needed, she also died in physical and emotional pain.

War means suffering, but for civilians the severity of the consequences depends on how a war is fought.

A war crime stands out for its singular capacity to amplify the suffering of civilians, to multiply the effects of mass atrocities and to cause forced displacement: Russia deliberate aggression on health care. Due to its cruelty and devastating effects, this strategy deserves special attention and should be the priority of prosecution.

On March 9, the Russian assault on a maternity hospital in Mariupol, Ukraine sparked international condemnation. Russia’s foreign minister confirmed the attack was intentional but justified it with the specious claim, backed up by fake footage, that the hospital was a military base. For a seriously injured mother-to-be, the attack destroyed the risk of an emergency caesarean section that could have saved her baby’s life. Without the surgery she herself needed, she also died in physical and emotional pain.

Attacks on hospitals began on the first day of the invasion, and at the time of writing these attacks targeted 41 hospitals and clinics, four maternity wards, one blood bank, eight children’s hospitals, three cancer centers, four institutions psychiatric and rehabilitation homes, seven ambulances and several first responder teams. At least 10 medical workers were killed.

Russian President Vladimir Putin has a long history of bombing healthcare facilities with surgical precision. In Syria, Russian forces have systematically attacked hospitals and humanitarian convoys. They even bombed a vital vaccine storage facility containing over 150,000 shots during a polio outbreak, depriving children of protection at a time when they needed it critically.

Similarly, in 1996, during the first Chechen war, Russian forces attacked 24 hospitals and occupied a clearly marked and purpose-built International Committee of the Red Cross (ICRC) hospital, where they executed six ICRC staff. During the Second Chechen War, Russian forces decimated hospitals and punished doctors who treated people deemed enemy combatants.

This story leaves little doubt that the attacks in Ukraine are a deliberate strategy to deny civilians access to health care when they need it most. This deprives patients of life-saving treatment and deters them from seeking treatment at other health facilities. It is the militarization of health care.


The purpose of international humanitarian law is to minimize suffering in times of war. After the Second World War, civil immunity was largely established in the Geneva Conventions of 1949 and more particularly in the Additional Protocols of 1977.

Yet access to health care is considered so vital to the relief of suffering that attacks on hospitals have been banned since 1863, after Henry Dunant, a Swiss banker, visited the front lines. of Italy’s War of Independence to seek help from French Emperor Napoleon III with a business problem. Instead, he was faced with the visceral suffering created by the Battle of Solferino in 1859, where tens of thousands of wounded soldiers were left to die in misery.

Dunant’s business trip became a humanitarian mission. Back in Geneva, his first-line report, A memory of Solferino, led to the creation of the ICRC and the first Geneva Convention. The treaty explicitly established legal immunity for medical personnel, ambulances and health facilities. Medical neutrality provides the humanitarian space needed for access to care for the sick and injured.

Yet unscrupulous belligerents sometimes violate this fundamental prohibition and have even used the ICRC as a target. This makes sense in terms of narrow military logic. In 1863, very few wounded soldiers returned to the battlefield. For one thing, most people, not just soldiers, died of infectious diseases, which doctors didn’t understand and didn’t know how to treat. Without anesthesia or infection control, surgery was a treatment of last resort.

As clinical care progressed, so did the military reasons for attacking military hospitals: denying care to enemy combatants. Advances in public health in the early 20th century meant that by World War I more soldiers died in battle than from cholera, and by World War II penicillin had become widely available. In 1977, smallpox was eradicated and the disappearance of infectious diseases seemed certain. Yet the Protocols Additional to the Geneva Conventions of 1977 spelled out special protections for health care workers and institutions because they were so essential to human well-being in times of war.

By simultaneously attacking civilians and targeting hospitals, Russian forces are simultaneously creating an urgent need for care and depriving people of that care when they need it most. These attacks do not reflect ignorance or indifference to international humanitarian law; they consciously weaponize people’s health care needs for the specific purpose of amplifying human suffering.

For the war-wounded, trauma easily turns into infection and amputation. Without birth control or a plan B, gang rapes at gunpoint can lead to unwanted pregnancies, clandestine abortions and even infanticide. The consequences transcend the individuals who need health care and affect public health more broadly. Forced displacement and unsanitary living conditions provide ideal conditions for incubating the next worrying variant of the coronavirus or even the next pathogen with pandemic potential.

A context of fragile health systems, burgeoning COVID-19 variants and one population only 35.7 percent vaccinated against the disease and potentially immunosuppressed by Chernobyl do not bode well. HIV and TB progress faster when medical care is interrupted. People with diabetes forced to ration their insulin go blind more quickly; they become more susceptible to infections and their kidneys fail more quickly.

Interrupting TB treatment breeds drug resistance. Babies born in bomb shelters no longer receive the Bacille Calmette-Guérin, or BCG, (the tuberculosis vaccine), and infants and young children are no longer protected against poliomyelitis, measles, whooping cough or chickenpox . Teens are missing vaccines for HPV and meningitis, and older adults are missing vaccines for pneumonia and shingles. Airborne droplets, like chemicals, are heavier than air and sink into basements, where crowded living makes it easier to spread disease.

In Syria, this kind of deprivation was deliberate. There, the Russian-Syrian military alliance besieged politically hostile areas and withheld humanitarian aid as well as life-saving medical equipment and drugs, including intravenous fluids, blood products, antibiotics, painkillers, Hepatitis B vaccines for healthcare workers, vaccines for children, sterilization equipment. , and chlorine. These have been removed from the handful of authorized humanitarian convoys.

In 2019, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) gave the coordinates of Syrian underground hospitals directly to Russian authorities, ostensibly to protect them. No one except OCHA was surprised when at least four of these hospitals were bombed.

The US government has warned that the Kremlin could use biological weapons in Ukraine, but it is already waging indirect biological warfare by withholding drinking water, medicine and vaccines.


Given the ability of attacks on health care to greatly amplify the already massive suffering of war as well as fuel epidemics, one would think that the World Health Organization (WHO), the United Nations agency responsible of global health and specifically mandated to monitor attacks, would be on it. Instead, he reported nothing until March 5. He reports that hospitals have been attacked but not where, how or by whom, leaving the world with no way of understanding the intent or the consequences.

And although the WHO calls for accountability, it does not call these attacks war crimes, only “violations of international humanitarian law”. This is a problem because war crimes are serious violations of international humanitarian law and systematic attacks on hospitals are war crimes. He also does not name the authors.

The WHO surveillance is a study on shyness. Today, when the world needs it most, WHO’s approach is decontextualized, meaningless and dehumanizing. This is a waiver of WHO’s status as the official United Nations statistical agency for health.

The international community needs a new approach to documenting these war crimes where and when they occur – one that is unafraid to portray its human dimension, identify the assailants, and push vigorously and repeatedly for these crimes to stop while pushing for special attention from prosecutors because of the greater culpability – and cruel intent – ​​they represent.

All war is horrible, but a special place in hell should be reserved for leaders who deliberately increase the human suffering of war by attacking hospitals.

Leave a Comment