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Impact on healthcare from bombing and shelling in Ukraine

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PAX has been monitoring the impact on civilians and their environment from the start of the Russian invasion of Ukraine. We monitor media and social media reports through Telegram, Twitter, Facebook and Instagram, use and contribute to monitoring efforts by other collectives such as Bellingcat, and geolocate for verification. In this publication we highlight one aspect of civilian harm from the bombing and shelling of Ukranian towns, which is the impact on healthcare. This publication only lists a limited number of locations. Undoubtedly more information will surface that will add to this non-exhaustive list. We welcome any input, feedback and collaboration on this topic.


In 2017 PAX and Harvard Law School’s International Human Rights Clinic co-published a study on the impact from explosive weapon use on healthcare in government-controlled areas in eastern Ukraine.
We visited hospitals, clinics, ambulance stations and other medical posts, and interviewed 55 people, including local residents, health care workers, UN representatives and local NGO staff. We documented the devastating impact, both direct as indirect, on healthcare from the use of explosive weapons in towns and cities. The health care system in eastern Ukraine, which already fell below the standards of other parts of Europe, has suffered as a result of the conflict already since 2014. Damage to hospital buildings and equipment, personnel fleeing or unable to visit their patients because of the violence, but also damage to infrastructure like water facilities, electricity and communication networks all had a deep impact on the healthcare system and the conditions under which medical personnel had to operate.

The current widespread damage to healthcare throughout Ukraine is deeply worrying and should inform both political action and humanitarian responses. PAX firmly condemns the invasion and calls for an immediate return of all Russian troops to outside Ukraine’s sovereign territory.

A pattern of harm

Both the UN Office for the Coordination of Humanitarian Affairs (OCHA) and the Office of the United Nations High Commissioner for Human Rights (OHCHR) attribute most of the civilian harm caused during the Russian invasion of explosive weapons with wide area effects. These weapons are generally considered to include weapons that are inaccurate (such as unguided artillery), weapons that launch multiple munitions (such as multi-barrel rocket launchers, also referred to as multiple launch rocket systems (MLRS)) or weapons that have a big blast and fragmentation radius (such as heavy aircraft bombs).
We see all of these explosive weapons being used now in towns and cities in Ukraine, and the harm it causes is devastating.

Research indicates that worldwide 9 out of 10 casualties from the use of explosive weapons in populated areas are civilians. The ICRC warns that the use of heavy explosive weapons in populated areas should be avoided, because of the high likelihood of indiscriminate effects. Internationally states are working towards a political declaration to prevent further civilian harm from the use of these weapons in populated areas.

As of 24 March, one month after the start of the invasion, the World Health Organization (WHO) had verified 64 attacks on health care. The WHO notes that this is more than 2-3 attacks per day, stressing that “Attacks on health care are a violation of international humanitarian law, but a disturbingly common tactic of war – they destroy critical infrastructure, but worse, they destroy hope,” according to Dr Jarno Habicht, WHO representative in Ukraine. On 26 March, in an interview with the BBC, Habicht expressed concerns that the number of attacks on healthcare is increasing daily”.

OCHA has reported many civilians to be left without access to water and electricity because of damage to water and electricity facilities. This also has a profound impact on the provision of healthcare: medical equipment needs electricity, medicines may need to be kept in a fridge, patients can not be washed, medical instruments can not be sanitized, light that is needed in operating rooms doesn’t work, and so on. It also impacts heating systems, leaving patients in the cold.

One month after the invasion, the WHO reports that close to 7 million people are internally displaced, and the number of people that have fled to neighboring countries is fast approaching 4 million. This brings the total of displaced to 11 million – nearly a quarter of the population of Ukraine. Among these people, there will undoubtedly also be medical personnel that have been forced to flee.

Parties to conflict have an obligation to uphold international law and to protect the civilian population, including from harm caused by damage to and destruction of vital civilian infrastructure and services. PAX therefore calls on all parties to the conflict to avoid the use of explosive weapons in populated areas and protect civilians.