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Two years on: Russia continues to weaponise and attack healthcare in Ukraine

Article by Elly Nott

February 21, 2024

Two years on: Russia continues to weaponise and attack healthcare in Ukraine

At the start of Russia’s full-scale invasion of Ukraine in 2022 I wrote in the British Medical Journal that, based on my experience of the Syrian conflict, I feared for Ukraine’s healthcare workers.[1] Tragically, my predictions have been proved correct.


In Syria, where the charity I co-founded has worked since 2012, attacks on healthcare in non-government areas have been a consistent feature of the conflict. Far from being ‘collateral damage’, there is evidence – including cockpit recordings from Russian air force pilots – that healthcare institutions and workers were intentionally targeted.[2]


Two years in to the full-scale invasion and the statistics are shocking. The World Health Organisation has  verified over 1,000 attacks on health care in Ukraine since February 2022;[3] more than 60% of all attacks against health care worldwide in that period.


Citizen researchers at the Centre for Information Resilience have documented attacks on Ukrainian facilities including maternity units and cardiology treatment centres in Kherson, calling them “strikingly reminiscent” of Russian tactics in northwest Syria.[4] Absent a clear link to any military ground operation, the parallel objectives are to create insecurity among the Ukrainian population and demonstrate ongoing determination to secure victory to the Russian public.


Attacking civilian infrastructure frays the ties that bind, both between citizens, and citizens and their government. A strong state relies on an active, vibrant civil society and Ukrainians have valiantly resisted attempts to denigrate their national esprit de corps despite the damage wrought to their infrastructure.


The weaponisation of healthcare and disruption of essential services harms public health and morale in a way that can test that resilience to breaking point.


If the state can no longer provide services, it can prompt the forced displacement of large numbers of people as they seek safety abroad, putting further stress on host nations and in some cases exacerbating social tensions. These actions constitute hybrid warfare tactics, which Ukraine and its allies need to be alert to.


To date, there has not been a prosecution or indictment brought for attacking a healthcare institution. A first step toward accountability is gathering evidence which grassroots entities like the Ukrainian Healthcare Centre are doing.[5] In areas close to the frontline, healthcare facilities may also need to consider moving infrastructure underground or changing their location as protection measures.


There is every indication that attacks on health will continue to be part of the ongoing conflict, necessitating a full spectrum of practical and legal measures to protect healthcare institutions and workers.


Elly Nott is a leader in the humanitarian sector and PhD Candidate, King’s College London.


[1] Elly Nott, Ukraine invasion: Why I fear for Ukraine’s healthcare workers, BMJ, March 2022,

[2] The New York Times, Russia Tapes: Healthcare and Civilians Under Attack in Syria,

[3] United Nations Ukraine, Attacks on healthcare in Ukraine are a grave violation of international humanitarian law, August 2023,,on%20health%20care%20in%20Ukraine.

[4] Centre for Information Resilience, Kherson after occupation: Mapping Russian attacks on medical infrastructure, September 2023,

[5] UHC, Annual Report of the Ukrainian Healthcare Center (UHC) in 2023, February 2024,


Disclaimer: The views expressed in this piece are those of the author and do not reflect the views of The Foreign Policy Centre.

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