More than 70 separate attacks on hospitals, ambulances and doctors have been carried out in Ukraine since the Russian invasion began more than a month ago – and that number is increasing “daily”, according to the World Health Organization (WHO).
According to the organization, targeting medical facilities has become part of the strategy and tactics of modern warfare.
The newly renovated central hospital in Izyum, south of Kharkiv, was recently targeted on 8 March.
The site was hit by what Ukrainian authorities said were Russian shells. Videos and photos posted online by the city’s deputy mayor showed extensive damage to the hospital’s main building. A new reception area built last year was completely destroyed.
The footage has been verified by the BBC and other media, although the exact circumstances of the attack are impossible to establish at this time.
“After the first bombing, the windows of the hospital exploded,” deputy mayor Volodymir Matsokin told the BBC. A second attack destroyed the hospital’s operating rooms, he added.
That day, hospital staff were treating children, pregnant women and three newborns, as well as soldiers and civilians injured in fierce fighting in the region, according to Ukrainian authorities.
They were sheltered in the basement at the time of the attack and no one was killed.
“The government has invested millions to provide good facilities with modern equipment,” Matsokin said. “Patients had to climb out of the rubble on their own to escape.”
The BBC contacted the Russian embassy in London about the attack but received no response, although in the past Moscow has deliberately denied targeting civilians.
Since February 24, the WHO has reviewed and verified 72 separate attacks on medical facilities in Ukraine, causing at least 71 deaths and 37 injuries.
Most damaged hospitals, medical transport and supply stores, but the WHO also recorded the “likely” kidnapping or detention of health workers and patients.
“We are concerned that this number is increasing daily,” WHO representative in Ukraine, Jarno Habicht, told the BBC.
“Health care facilities must be safe places for doctors and nurses, but also for patients to have someone to turn to for treatment. That must not happen.”
As the war in Ukraine is an international armed conflict between two States, the Geneva Conventions apply.
Expanded after World War II, the conventions set out basic rights for civilians and military personnel and protection for the wounded and sick. These principles were ratified by the then Soviet Union in 1954.​
According to article 18 of the Conventions, civilian hospitals “cannot be attacked under any circumstances, but must always be respected and protected”.
A violation of this rule can be investigated by the International Criminal Court in The Hague and, if found to be a war crime, the perpetrators can be prosecuted and punished individually.
However, there are exceptions to the Conventions.
Protection against attacks is ineffective if the medical facility is close to a legitimate military target or if there is a suspicion that an act “detrimental to the enemy” is being committed.
According to the International Committee of the Red Cross (ICRC), this could include using a hospital as a shield or installing a medical unit in a position that prevents an enemy attack.
Neve Gordon, professor of international law and human rights at Queen Mary University of London, said: “What we have today is actually a situation where hospitals and medical facilities have become fair game.”
“If there are soldiers outside the hospital or just next to a train station, he could be attacked. Or it could be that a wounded soldier has a cell phone and is calling other troops and saying that someone is nearby.”
“All these loopholes make it possible to say that the attack was legitimate.”
The ICRC says that, in theory, before attacking a hospital that might violate these rules, the offending side should always give a warning, with a time limit, and the other side must have ignored that warning.
There is no evidence that this happened in the conflict in Ukraine.
Gordon advocates for a much stronger blanket ban in international law against any attack on medical facilities, similar to the United Nations’ adopted ban on torture that went into effect in 1987.
From Vietnam to Syria
Exceptions to the Geneva Conventions have been used to justify attacks on hospitals and medical facilities in post-World War II conflicts, from Korea to Vietnam.
The trend, however, appears to be accelerating rapidly, driven in part by the use of ballistic missiles, drones and other long-range munitions.
The US advocacy group Physicians for Human Rights says Russian or local forces are linked to at least 244 separate attacks on health facilities in Syria since 2011.
At one point, Doctors Without Borders even made the decision to stop sharing the GPS coordinates of some health clinics it operated with the Syrian government or its Russian allies, amid concerns that they would likely become direct targets. as a result.
Russian officials have denied deliberately attacking hospitals in Syria and have suggested that jihadists in the country were routinely taking shelter in protected civilian buildings.
The WHO said it feared that attacks on medical facilities were quickly becoming part of the broader “strategy and tactics” of modern warfare, regardless of the rules of the Geneva Conventions.
Destroying health facilities, the organization warned, “is the destruction of hope” and the denial of basic human rights.
“We have never seen this rate of attacks on health globally,” WHO emergency director Michael Ryan told a news conference this week.
“This crisis is reaching a point where the healthcare system in Ukraine is on the edge of a cliff.
“It needs to be supported…but how can we do that if the very infrastructure these people are going to rely on is under direct attack?”
