1,000 Attacks On Healthcare During The Russian Invasion Of Ukraine

From the start of the Russian invasion in February 2022 to May 31, the WHO has verified a total of 1,004 attacks against healthcare in Ukraine. In total, they have claimed at least 101 lives, both health workers and patients, and have left at least 139 injuries, according to their data.

“Attacks on healthcare are a violation of international humanitarian law,” says Jarno Habicht, WHO representative in Ukraine, in a statement. “They deprive people of the care they need and have far-reaching, long-term consequences,” he explains.

Along the same lines, Aitor Zabalgogeazkoa, head of the Emergency Unit of Doctors Without Borders (MSF), who has just returned from Ukraine, recalls in statements to elDiario.es that hospitals and other health centers, as well as ambulances, never They must be objective: “They must be respected because international humanitarian law says so and because there is no room for maneuver for civilians to ask for help, which is one of the conditions in this type of conflict.”

As can be seen in the following graph prepared by elDiario.es, if the bulk of the attacks verified by the WHO in Ukraine are broken down, a total of 896 affected health facilities, while 273 affected supplies and 121 affected transportation, including ambulances. 72 attacks affected personnel; 27, to patients and 17 have also been verified that hit warehouses. Taken together, these numbers add up to more than 1,004 because one attack can affect multiple aspects of healthcare.

The data not only includes bombings: they can range from violence with heavy weapons (which are the vast majority, a total of 843) to threats and intimidation, which affect access to health care for those who need it. There are, for example, 78 cases of militarization and 30 of psychological violence. The WHO defines an attack on medical care as “any act of verbal or physical violence, obstruction or threat of violence that interferes with the availability, access and provision of curative and/or preventive health services during emergencies”.

Habicht has also specified that the attacks against other civilian infrastructure, especially in the last six months –as is the case with power plants– are indirectly affecting the capacity of the health system in general.

The WHO does not specify responsibility for the attacks. Asked about it, a spokeswoman for the UN agency has responded to elDiario.es that they do not have “the mandate or the equipment” to investigate them, “including the identification of the perpetrators.” “WHO’s role is to systematically collect and disseminate data on attacks. It does so by verifying that attacks have taken place” and “to highlight their scope and consequences”.

Last week, at the World Health Assembly, the annual forum of the WHO, 88 member countries they voted in favor of a resolution calling on Russia to immediately cease any attacks on hospitals and other medical facilities.

The independent commission of experts sent by the United Nations studied several attacks with explosive weapons in populated areas of nine regions of Ukraine, many of them indiscriminate – they do not specify the objectives, nor if there were hospitals or other centers among them. The commission concluded in its final report that the Russian armed forces fired or probably fired the majority, while it considered it likely that Ukrainian troops committed “a small number.”

As for the Russian attacks, they underline that the fact that the attacks affected civilian buildings, such as operating medical institutions, also shows that precautions were not taken: “Even if the Russian armed forces had military objectives when carrying out the attacks, the special protection status of medical institutions should have led them to exercise extreme caution.”

“Practically no civil infrastructure has been respected”

Doctors Without Borders has denounced the “massive and widespread” destruction of health structures in Ukraine. “The main problem in the Ukrainian war is that practically no civilian infrastructure has been respected. And within these, the health centers and hospitals”, says Zabalgogeazkoa to this medium. “We do know that there have been some installations that have been targeted without having to be, because they are isolated or very recognizable, but in general what there is is a brutal destruction of all the urban areas near the front, and the civil infrastructures They are devastated,” he says.

The NGO does not have permanent access to frontline areas, where it only has a temporary presence, and can only operate in areas under Ukrainian control. The head of MSF explains that in Donetsk, Kherson, Mykolaiv and Kharkiv he has witnessed that all of the health centers that they have attended, “about 50 or 60 of them [en total entre las cuatro áreas], have damages “and some of them are absolutely destroyed.” “We are trying to alleviate it with temporary rehabilitations so that they can be used by local personnel”, he indicates.

Last week, Zabalgogeazkoa was in Kharkiv: “I saw everything: from a completely intact health center that is not used because there is simply no population around to a affected health center, with a few rooms destroyed, half of which is used . The other half we have rehabilitated. Others have broken glass. There is everything”. Last year, MSF medical workers in witnessed “damage compatible with cluster bombs” at hospitals” in Mikolaiv and in Apostolove (Dnipropetrovsk) that forced the suspension of medical activities for several days, and also discovered the presence of mines. anti-personnel inside operating hospitals, in areas formerly under Russian occupation in the Kherson, Donetsk and Izyum regions.

According to a WHO tool called the Health Resource Availability and Service Delivery Monitoring System (HeRAMS), health centers in the areas most affected by fighting in the east and south of the country, including the Kherson regions, Kharkov, Zaporizhia and Donetsk have reported that they are facing difficulties due to lack of security and structural damage.

However, according to the agency, a high percentage of the structures in these regions are operational and accessible, although they continue to function partially. “The fact that Ukraine’s healthcare system continues to function under such circumstances is a testament to the heroic dedication of healthcare workers,” who continue to save lives and provide medical care every day, Habicht says.

Difficulties

What are the effects of attacks of this type? According to the WHO, by depriving an entire population of essential health services, they cause an increase in illnesses and deaths and deteriorate systems in the long term: “The psychological effect on patients, frightened when seeking health care, and in health workers, unable to provide health care in safe and secure environments, it is also important and will affect the health of the population for long periods of time.

The United Nations agency points out that, according to its data, significant difficulties have been reported in providing specialized services such as chemotherapy and mammograms due to a lack of medical personnel and equipment, and in some regions there are difficulties in providing highly qualified delivery services. Primary care is still widely available in war-affected regions, but costs have increased in the last six months: almost a third of the population has difficulty paying for certain health services, according to surveys carried out by the organization.

MSF, for its part, has denounced the serious impediments to medical care under the Russian military occupation. “Accounts from health workers and patients who lived under Russian occupation indicate severe restrictions on access to vital medicines, treatments or medical structures,” the NGO said in a statement in March. His teams frequently had to treat patients with chronic illnesses who went without treatment for several months.

According to MSF patients, people were unable to access medical care “mainly due to movement restrictions, the massive destruction of health facilities or the unpredictable behavior of some Russian units.” “Patients also reported that the surviving medical structures and pharmacies were looted and that the supply of medicines was not systematically secured by the occupying forces,” she says. Doctors who previously lived in areas occupied by Russian forces described intimidation, detention, violence and ill-treatment by soldiers, according to the humanitarian organization.