Destruction of Ukraine's Healthcare Facilities Violates International Humanitarian Law

On March 6, 2022, Izyum Central City Hospital (Kharkiv oblast) was attacked as a part of what appears to have been a large-scale carpet-bombing campaign. Reportedly, the hospital team had also marked the hospital with a big red cross that could be seen from the air. Credit: UHC
On March 6, 2022, Izyum Central City Hospital (Kharkiv oblast) was attacked as a part of what appears to have been a large-scale carpet-bombing campaign. Reportedly, the hospital team had also marked the hospital with a big red cross that could be seen from the air. Credit: UHC
  • by Ed Holt (bratislava)
  • Inter Press Service

According to a report released by the Ukrainian Healthcare Centre (UHC), 80% of healthcare infrastructure in one of Ukraine’s largest cities, Mariupol, was destroyed as Russian forces occupied the city.

It was left with practically no primary care, general hospitals, children’s hospitals, maternity hospitals, or psychiatric facilities, and large areas of the city were thought to have no medical care available at all.

Reports have been circulating for some time that a humanitarian catastrophe has already unfolded in the occupied city, and with the almost complete lack of healthcare provision, the threat of disease and sickness looms large among those still living there.

UHC says the destruction of Mariupol can only be compared with what happened to Grozny in Chechnya or Aleppo in Syria where Russia did its utmost to destroy each of these cities. And it claims that with its massive, indiscriminate shelling of civilian infrastructure, Russia “did not only violate certain regulations of international humanitarian law — waged the war as if this law did not exist”.

“This destruction of healthcare facilities is a very, very serious war crime. Russia did the same in Syria, but in Ukraine, what it has also done is that it has not distinguished between military and civilian infrastructure – the goal has been to just destroy everything, and in Mariupol, we saw this philosophy at its most concentrated,” Pavlo Kovtoniuk, UHC co-founder and former Deputy Minister of Health of Ukraine, told IPS.

The Russian siege and eventual occupation of Mariupol was one of the earliest and clearest examples of the destruction and brutality which have come to define the war in Ukraine.

Pictures and drone footage of the city at the time showed the consequences of massive, indiscriminate bombardment by Russian forces, and in the months since Mariupol fell, Ukrainian officials have reported on what they claim are the appalling conditions facing those still living - its population has dropped from 425,000 pre-invasion to an estimated around 100,000 today as people have fled or been killed – in the city.

It is difficult to verify any such reports as access to the city and information about life there is strictly controlled by occupying authorities.

But there were confirmed reports as early as last summer of mass protests in the city over a lack of water, electricity and heat, and sources with some access to locals in Mariupol have told IPS that the reports of severe hardship are largely accurate and that war crimes and human rights abuses are regularly being committed against the population.

Kovtoniuk said even without any direct access to Mariupol, it was certain that the situation there was “dire” for many and would almost certainly be the same in other occupied areas.

“It is difficult to know too much about exactly what is happening in occupied areas, but we can see from the experience in areas which were once occupied and then retaken by Ukraine,” he explained.

Indeed, reports from liberated cities and testimony from people who managed to escape from occupied areas paint a picture not just of widespread war crimes and atrocities such as mass executions, rapes, torture, abductions, forced disappearances, imprisonment, and unlawful confiscation of property, but also of humanitarian catastrophes. People are without money, and jobs, unable to access any services, and are completely reliant on humanitarian aid.

Kovtoniuk highlighted that in Mariupol alone, the destruction has been so great – since the start of the invasion, four out of five general hospitals have been destroyed, but also five out of six maternity facilities, and there is no mental health care available – that there is no way comprehensive medical care can be continuing in the city.

“There may be some facilities still going, but there is no system, which is just as bad if not worse. What we also don’t know is the situation with drugs and their supply. What about people with chronic conditions who need them? Are there drugs for them, and if so, where are they coming from? Are some people simply not taking them anymore? This is course can be fatal for some people with certain conditions,” he said.

“Russian strategies have been to completely destroy healthcare, healthcare staff have been deported, civilians are being denied access to healthcare as facilities are being used solely to treat Russian soldiers, healthcare facilities are looted for equipment,” Kovtoniuk added.

Ukrainian Minister of Health Viktor Liashko said earlier this month that about one thousand Ukrainian medical facilities had been damaged or destroyed, while as of January 23, the World Health Organisation (WHO) has documented 747 attacks on healthcare facilities in Ukraine since the start of the invasion. Its officials have said these attacks are a breach of international humanitarian law and the rules of war.

Other groups, like UHC, are documenting and collecting evidence of alleged car crimes during the invasion and have said the attacks on healthcare are part of a wider, even more, destructive Russian military strategy in Ukraine.

“Attacks on medical facilities are considered particularly condemnable under international law. They have serious negative consequences for the safety and health of Ukrainians. Since Russia is using war crimes as a method of warfare, we can talk deliberate actions to create a humanitarian catastrophe in Ukraine and a desire to make it uninhabitable,” Svyatoslav Ruban of the Centre for Civil Liberties human rights organisation in Kyiv told IPS.

Other rights groups have also condemned the targeting of healthcare facilities and workers. In its latest global report, Human Rights Watch (HRW) castigated Russian forces for a “litany of violations of international humanitarian law” in Ukraine, and Rachel Denber, Deputy Director of the Europe and Central Asia Division at HRW, told IPS: “Attacks on critical infrastructure which are carried out with the seeming intent to instil terror in the population and deliberately deprive people of essential services could be potential war crimes and illegal. These attacks in Ukraine are unlawful.”

“It is obvious that the authors of these attacks are fully aware of the harm they will cause, and the aim is to make living cumulatively untenable. These attacks on infrastructure impact millions of people, having an effect on hospital operation, water supplies, heating etc,” she added.

She also warned that the apparent Russian strategy of deliberately targeting Ukrainian civilian infrastructure was chillingly reminiscent of what its forces had done in Idlib in Syria in 2019-2020 - hospitals, schools and markets were repeatedly targeted during an 11-month Syrian-Russian offensive which ultimately left 1,600 people dead and another 1.4 million displaced.

HRW’s own report on the Idlib offensive documented scores of unlawful attacks in violation of international humanitarian law, or the laws of war. Meanwhile, UN investigators claimed Russian forces had been responsible for multiple war crimes.

“It would not surprise me if it turned out that the Russians are doing the same in Ukraine as they did in Idlib,” said Denber.

While Russian attacks on civilian infrastructure, including medical facilities, continue, the situation will not improve, said Kovtoniuk.

He pointed to Russian forces’ ongoing deliberate destruction of power, heating, and water plants, and potential subsequent health risks – damage to water and sewage systems led to a serious risk of a cholera epidemic in Mariupol last summer – as well as the effects of such attacks on the ability of medical facilities to continue functioning.

He said people outside Ukraine, including leaders in countries already supporting Ukraine, must not allow the current situation to be accepted as a new normal, nor let the conflict drag on.

“We have learnt to survive and adapt, but it is important that this situation is not normalised – that is the Russian aim, to normalise it like what happened in Syria. People have to understand that the pattern of Russian strategy is to not make a distinction between waging war on civilians and on the military. It is also critical to end this war as soon as possible. Its protraction is bad for Ukraine and bad for Europe,” he said.

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