Russia is waging war on Ukrainian healthcare

The author is a practicing physician and associate professor at the Icahn School of Medicine in Mount Sinai, New York.

5,493,437. This is the number of Ukrainians who have fled the country since February 24, according to the United Nations. Eight million others fled their homes but remained in Ukraine. Russia’s indiscriminate bombing has been widely noted, but a particularly insidious aspect of Vladimir Putin’s strategy is the deliberate attack on healthcare facilities.

Attacks on health care flout the most fundamental prohibitions of international humanitarian law (IHL). Russia is deploying people’s addiction to health care against them. By simultaneously attacking civilians and targeting hospitals, Russian forces are simultaneously creating an urgent medical need while denying people access to that care.

These attacks amplify the damage caused by the mass casualties caused by the airstrikes and increase the suffering of chronic diseases. They are particularly harmful to girls and women, preventing them from accessing emergency management of rape, treatment for sexually transmitted diseases, antenatal care or life-saving caesarean sections for complicated pregnancies.

Because everyone needs health care, the deliberate targeting of hospitals is a major driver of displacement. Indeed, the systematic targeting of health care emphasizes that displacement is a primary objective rather than an unfortunate outcome. The Kremlin has used this strategy in Chechnya, Syria and now Ukraine.

There is no doubt that attacks on health care are at the heart of how the Russian military wages war. On February 24, the first day of the invasion, Russian forces struck three hospitals. Since then, the attacks have injured more than six hundred other people, according to Ukraine’s Health Ministry.

There is a cruel logic to the forced displacement of Ukrainians by Russia. Depopulated regions are easier to control for an invading army. Five million refugees from Ukraine means 5 million fewer people to maintain the cohesion of the country. Eight million internally displaced people fighting for their survival have no time to fight for democracy. Forced dispersal facilitates political domination.

This sinister doctrine resurfaces in other armed conflicts, such as in Ethiopia’s northernmost region, Tigray, and in Myanmar. The growing global popularity of these tactics strikes at the heart of IHL and at the heart of the Geneva Conventions.

The protection of health care forms the basis of IHL, established in the first Geneva Convention in 1864. At that time, medical care made little or no difference in the outcome of a war. There was no infection control or antibiotics. Surgery was a treatment of last resort. During World War I, advances in clinical medicine allowed wounded soldiers to return to the battlefield, providing unlawful incitement to attack those who provided it. Yet after World War II, bombings were not only banned, but eventually redefined as war crimes.

Today, modern health care has become essential to a full life for civilians. This increased need increases the cruelty of deliberately depriving civilians of medical aid.

Once we understand that attacks on health care are a high-yield war crime, our goal must be to change the Kremlin’s cost-benefit analysis. Governments should target this criminal strategy for whistleblowing. Urgent efforts must be made to make the Russian people understand, in Russian, the human costs of targeting hospitals.

The World Health Organization must identify attacks on health care in Ukraine as war crimes and describe the consequences for public health. Beyond preventable deaths, the combination of mass displacement and unsanitary conditions affects global health, providing ideal conditions for incubating variants of Covid-19 or even the next pathogen with pandemic potential.

Prosecutors should prioritize these war crimes and pay special attention to those who orchestrate such attacks. Under Putin, this strategy has become entrenched military doctrine, exemplified by its proven record in Syria, where the attacks have been proven beyond doubt. Ukraine presents the opportunity to prosecute Putin for these crimes, not just the infantry.

We must ensure that Putin pays every possible reputational, diplomatic and political price for these atrocities. Otherwise, this criminal doctrine will normalize. The desperate exodus of Ukrainian civilians is likely to continue and replicate itself elsewhere. And the global implications for biosecurity affect everyone.

About John Tuttle

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