Intended for healthcare professionals


Ukraine: Over 700 recorded attacks on health facilities and workers in year since Russia invasion

BMJ 2023; 380 doi: (Published 23 February 2023) Cite this as: BMJ 2023;380:p451
  1. Elisabeth Mahase
  1. The BMJ

More than 700 attacks on hospitals, health workers, and other medical infrastructure in Ukraine have been reported in the year since the Russian invasion began, according to an investigation by human rights groups.1

A report—Destruction and Devastation: One Year of Russia’s Assault on Ukraine’s Health Care System—found there were an average of two attacks every day between 24 February and 31 December 2022. These included hospitals being bombed, medics being tortured, and ambulances being shot at.

Over that period, there were 292 attacks that damaged or destroyed 218 hospitals and clinics, 181 attacks on other health infrastructure (such as pharmacies, blood centres, and dental clinics), and 65 attacks on ambulances. There were also 86 attacks on healthcare workers, with 62 killed and 52 injured.

“Healthcare workers, who became witnesses, talk about the horrific crimes committed by Russia in Ukraine,” said Lyubov Smachylo, analyst for the Media Initiative for Human Rights. “Some were held hostage by the Russian military, others were under fire, and some were forced to work under occupation. Witnesses described these events with horror and tears in their eyes.”

“Unpunished evil always grows”

The research was conducted jointly by several human rights groups, including eyeWitness to Atrocities, Insecurity Insight, Media Initiative for Human Rights, Physicians for Human Rights, and the Ukrainian Healthcare Center.

Based on the evidence they collected, the report said there was 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.”

It highlighted that across 10 regions, 48 hospitals were hit multiple times, suggesting they were being deliberately targeted. In one case, Bashtanka Multiprofile Hospital director Alla Barsehian described how the hospital was attacked despite a red cross being painted on a canvas on the roof to indicate it was a medical institution. “We hoped this would somehow save us. But it turns out nothing is sacred in this war,” Barsehian said.

Pavlo Kovtoniuk, report co-author and co-founder of the Ukrainian Healthcare Center, said, “For them, destroying hospitals, schools, and the power grid is a way to achieve military aims. Russia used this murderous tactic before, in Chechnya and Syria, but faced no accountability. If impunity doesn’t end now, we will see many more hospitals destroyed as a means of war in the future. Unpunished evil always grows.”

In more than a decade of war in Syria, there have been more than 600 attacks on 350 separate medical facilities, with over 900 medical personnel killed. These attacks have largely been carried out by the Syrian and Russian governments, and neither have faced any repercussions. “The perpetrators pay no price, they suffer no consequences,” Len Rubenstein, chair of the Safeguarding Health in Conflict Coalition, told The BMJ.2

Working under occupation—accounts from doctors

“They waited for him to die slowly without insulin”

One doctor, who wished to remain anonymous, spoke to the researchers about what he saw prior to fleeing—disguised as a student—on 7 July 2022. He described how his hospital came under control of occupation authorities, who demanded access to the electronic database of patient records, which contained everything from medical information to passport details.

“I was worried, because the week before, I had received a patient from the occupied city of Mykolaiv Oblast. He was a former member of the anti-terrorist operation and he had diabetes. The Russians found out about his illness, arrested him, and waited for him to die slowly without insulin,” he said. “The man somehow managed to escape. I gave him the contacts of acquaintances who sheltered him.”

Prior to this, the doctor said that occupation authorities had banned the import of medicines into the region, leading to an “underground” trade through which Russian “entrepreneurs” appropriated Ukrainian pharmacies and started selling poorer quality Russian medicines.

“The hospital became a human shield”

Another doctor, anaesthesiologist Oksana Kyrsanova, described what it was like to work while under bombardment. Kyrsanova worked at the Regional Intensive Care Hospital in Mariupol, which was occupied by Russian forces from 12 March 2022.

“Russian military occupied the hospital. Their target was the hospital itself, because they could shoot from it and knew that the Ukrainian military would not fire back. The hospital became a human shield,” she said.

“On the day of capture, the Russian military went around all the floors, making doctors and medical personnel face the wall. The men were stripped to the waist while Russians searched them for military symbols, gunpowder stains on their fingers, and imprints from the use of weapons on their shoulders.”

“They made our hospital their headquarters,” Kyrsanova continued. “They occupied the entire building, completely surrounded and controlled the hospital, all entrances, exits, and stairs. They were on the roof of our hospital. We had a very big building, and they had a view of everything.”