A large wall riddled with shrapnel stands where a renowned otolaryngology department once operated at full capacity, offering specialist operations for serious conditions affecting the head and neck.
On February 27, just three days after Russia’s brutal invasion of Ukraine, the Volnovakha Central District Hospital was bombed for the first time by Russian armed forces.
The attack destroyed the entire section of the hospital, says Dr. Andriy Khadzhynov.
The 48-year-old trauma surgeon sits on a sofa in front of his computer screen as we ask about his experience on that fateful day. Instead of a doctor’s coat, he wears a black shirt that accentuates his muscular upper body.
The hospital was full of people, he said, including “doctors, patients and many civilians who had sought refuge there”.
The small town of Volnovakha in the Donetsk region of eastern Ukraine has a population of just over 20,000. The hospital is the only emergency medical facility for a population of approximately 100,000 within a 50 kilometer (30 mile) radius.
Khadzhynov tries to calm his emotions throughout the interview, but the trauma of the experience repeatedly breaks his composure.
“The hospital is on a hill,” he says, describing it as the only three-story building in the area. “It can be easily seen from all sides.” Renovations to the hospital’s facade, carried out two years ago, have made the building striking when juxtaposed against the abandoned factories that dotted the former industrial heartland that surrounded it.
“It stood out,” he says, suggesting there was little chance the first attack was an accident.
Two days later, the shelling continued as his wife and children sought refuge there along with hundreds of other civilians. The ensuing attacks would leave the hospital in ruins.
More than 500 civilians sought shelter in the basement of the Volnovakha Central District Hospital, according to the facility’s trauma surgeon Andriy Khadzhynov
Prosecute war crimes
Attacks on medical facilities have long been considered war crimes. International humanitarian law explicitly prohibits attacks on hospitals, whether targeted or indiscriminate.
In Ukraine, such attacks have not only disrupted the continuity of health care, which provides essential services to the civilian population: they have also killed dozens of medical personnel and patients, according to anonymized data published by the World Organization health (WHO).
DW’s investigative unit investigated 21 attacks on medical facilities in detail, including several under-reported cases, such as the attack on the central district hospital in Volnovakha at the start of the conflict. This figure represents only a fraction of the 91 attacks on health care infrastructure confirmed so far by the WHO, which represents an average of two attacks on hospitals, ambulances or medical supply depots per day.
The Ukrainian Healthcare Center (UHC), an independent think tank, provided DW with access to undisclosed material, including a log of over 100 attacks on medical facilities (at the time of publication). According to the UHC, the figures are slightly higher than those of the WHO because the center has a national network of sources on the ground who can report attacks as they occur.
“We document attacks on medical facilities to the high standards of legal proceedings in international tribunals because we want these attacks to be prosecuted and those responsible held accountable,” said Pavlo Kovtoniuk, former deputy health minister. and co-founder. organisation.
Although attacks on medical facilities are prohibited by the Geneva Conventions, there is one condition under which hospitals can lose their protected status as civilian objects: if the facility is used for military purposes.
‘A fair trial’
Mariupol had already been under siege for nearly two weeks when Russian warplanes dropped munitions on the city’s children’s hospital and maternity ward on March 9. Viewers around the world were shocked by the images of women and children being carried out of the rubble in their hospital blankets. . Some of them are dead.
Before and after the attack, however, Russian officials had claimed the hospital was a legitimate target, alleging that a Ukrainian battalion was operating there.
DW investigated the allegations by reviewing videos, pictures and satellite images of the attack, and found no indication that a military unit had taken up position in the Mariupol hospital. DW also spoke to eyewitnesses and reviewed visual material in 20 other attacks on medical facilities and, again, found no indication that military targets or legitimate combatants were present or in the immediate vicinity of the facilities attacked. .
The Russian armed forces have repeatedly claimed that the hospitals they destroyed across Ukraine were being used for military purposes.
German judge Wolfgang Schomburg, who has served on international criminal tribunals for atrocities committed during the breakup of Yugoslavia and the Rwandan genocide, told DW that prosecuting such cases is often a lengthy process.
A fair trial would include the defendant’s story and any allegations that might support it, Schomburg says – “for example, that the hospital had been emptied beforehand and that Russia had tried to establish that he was not there was no one left in the building”. witnesses would be called in this scenario.”
“Ultimately, satisfied beyond a reasonable doubt, the court must establish the facts of the case.”
Not a single pursuit
DW could not find a single international attempt to prosecute attacks on wartime hospitals in the nearly three decades since the establishment of the International Criminal Tribunal for the former Yugoslavia (ICTY) by the United Nations in 1993.
During this period, thousands of medical facilities have been attacked in conflicts – from the Balkan wars in the 1990s to the conflicts in Afghanistan and Syria of the 21st century.
Charges have been brought against former Serbian leader Slobodan Milosevic, linked to the massacre of patients and medical staff taken hostage in the Croatian town of Vukovar. But, as the victims were executed offsite, the specific charges did not relate to a direct attack on a hospital – although the facility was also bombed several times over the course of a year. Milosevic died in custody before his trial was completed.
Given the burden of proof, legal experts overwhelmingly agree that, despite public outcry, attacks on hospitals are rarely prosecuted as war crimes because of the legal protections given to the alleged perpetrators.
Yet others argue that significant progress has been made under international law and that there may be grounds for prosecution in other criminal categories, such as crimes against humanity or the crime of terror. .
“International law has evolved over the past few decades. It is no longer possible to misuse the inconsistency between laws for combatants and civilians to argue that a functioning hospital could one day become a legitimate target,” said Mark Somos, a lawyer and university professor. Max Planck Institute for International Law.
“This is categorically a violation of international law and warrants prosecution under the strongest enforcement mechanisms of the international community.”
Attacks on hospitals have disastrous consequences for the civilian population – this pregnant woman and her unborn child died following a bombardment in Mariupol
Part of the strategy
In a video produced by Russian media and posted on YouTube, a journalist in a helmet and body armor with the word “Press” speaks to the camera about the events that left the Volnovakha Central District Hospital in ruins.
In this account, the Ukrainian National Guard is at fault for allegedly establishing a firing position from inside the medical facility. The Russian journalist claims that doctors were being held hostage in the basement and that “ungrateful Ukrainian soldiers” had ordered the bombardment.
Dr. Khadzhynov, who lived through the destruction of his hospital, is aware of this fabricated narrative.
“It’s bull****,” he says.
There were no armed people on the hospital grounds, Khadzhynov added. On March 1, when Russian armed forces launched a new wave of attacks on the hospital, medical personnel turned away injured soldiers as the facility was well over capacity.
DW’s investigative unit has repeatedly requested comments from the Russian Defense Ministry on the attacks on the Volnovakha Central District Hospital and dozens of other Ukrainian medical facilities. The requests went unanswered at the time of publication.
“The world must understand,” said former Deputy Minister of Health Pavlo Kovtoniuk, “that the old rules of neutrality, of apoliticism in the humanitarian field, are no longer relevant here in this war, because the aggressor uses humanitarian issues as part of its hybrid warfare strategy.”
DW’s Emily Sherwin and Birgitta Schülke contributed reporting.
Edited by: Sandra Petersmann and Milan Gagnon