Everywhere Insiders 43: Ukraine Maternity Hospital Attacks, War Crimes Intent, Iran, Myanmar, and Cuba

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2026/04/23

Irina Tsukerman is a human rights and national security attorney based in New York and Connecticut. She earned her Bachelor of Arts in National and Intercultural Studies and Middle East Studies from Fordham University in 2006, followed by a Juris Doctor from Fordham University School of Law in 2009. She operates a boutique national security law practice. She serves as President of Scarab Rising, Inc., a media and security strategic advisory firm. Additionally, she is the Editor-in-Chief of The Washington Outsider, which focuses on foreign policy, geopolitics, security, and human rights. She is actively involved in several professional organizations, including the American Bar Association’s Energy, Environment, and Science and Technology Sections, where she serves as Program Vice Chair in the Oil and Gas Committee. She is also a member of the New York City Bar Association. She serves on the Middle East and North Africa Affairs Committee and affiliates with the Foreign and Comparative Law Committee.

Scott Douglas Jacobsen and Irina Tsukerman examine Russian attacks on maternity facilities in Ukraine, the legal difficulty of proving intent in war crimes, and the broader demographic damage of war on Ukrainian society. They compare Ukraine’s collapsing birth rate with Russia’s internal social decline, then turn to the U.S.-Iran strategy, arguing tactical gains do not equal strategic victory. The interview closes with an analysis of Myanmar’s junta rule and renewed geopolitical pressures around Cuba and Venezuela today. 

Scott Douglas Jacobsen: So, we can do some domestic for me currently and foreign for you, although domestic for your heritage. So UNFPA recently announced that, several times in March, particularly around the end, at least three, and by 28 March, the sixth total in 2026, a UNFPA-supported medical facility in Ukraine had been attacked. In the 28 March case, it was Odesa Maternity Hospital No. 5, and UNFPA also said that on 24 March, maternity facilities it supports at Ivano-Frankivsk Hospital were damaged.

It is, as per the very high legal standards on genocide claims, that the most difficult thing to prove is intent. So this is a message to all activists in the United States. And so the cards in this case of bombing these maternity hospitals are more serious.

I sat down with two representatives in their main office in downtown Kyiv. Basically, there are very disturbing patterns. Because we are talking about pregnant women, newborns, and new mothers. And in the Odesa case on 28 March, everyone was evacuated in time, and no injuries were reported.

The two who were killed were in Ivano-Frankivsk, for some reason. For those who do not know, that is not a big city. It is far from the frontline. Yet somehow two people were killed there. However, everyone at the perinatal centre remained alive and unharmed, even though the maternity hospital buildings were damaged.

So we cannot say it was deliberate or accidental. We can only stick with the evidence-based option; we do not know, or remain uncertain about, the specific question of intent. That was disturbing news. There has also been, in Ukraine, the signing of deals with Gulf states and related cooperation. 

So, Ukraine has been signing defence cooperation agreements with Gulf states, including Saudi Arabia, the UAE, and Qatar, covering countermeasures against missiles and drones, the exchange of expertise, and technological collaboration.

And even if they did not necessarily have the best technology, Ukraine does have hard-earned operational experience in countering Shahed-type attacks. Gulf states, including Saudi Arabia and the UAE, are now exploring a Ukrainian-designed interceptor drone as a cheaper way to counter Iranian drone attacks.

But this is a very adaptive field, where systems can be studied, modified, and reproduced quickly. And on the Russian side, the Geran line is indeed tied to Iranian Shahed designs: the Geran-II is widely identified as the Shahed-136 in Russian service.

So that is some of the big news from today. All very interesting.

So what are your thoughts? You certainly have more legal expertise than I do. Maybe you can give some commentary on the difficulty of proving intent at that scale. And then also your thoughts on the bombing, whether accidental or deliberate, of maternity care facilities. That is, for most people, a soft spot, like bombing a children’s hospital.

And also your thoughts on these technology deals involving Ukraine. Those are three key points.

Tsukerman: Okay, so proving intent may be difficult at the moment; it may be easier later on, when more information is available. The reason it is difficult to prove at the moment is that you do not have the full picture of what is going on. You do not have access to the communications of the officials planning the military operation. You do not have the full sequence of events, and you do not have the means to analyze the trajectory of the missiles and other weapons.

For instance, if something was blown off course, it is more likely an accident if it was heading for one site but, due to weather conditions, air defences, or some other incidental third-party intervention, it deviated and struck a civilian site. That could be classified as an accident or an unintentional act.

On the other hand, if the trajectory was consistent and clearly directed toward that general location, that is less likely to be accidental, or at least not outside the foreseeable consequences of firing in that direction.

There is also the question of AI, whether the decision-making process was guided by AI technologies, where the human element was introduced, and so on.

So many factors can go into determining intent. But much of the information that would be helpful for analysis is currently impossible to gather, especially shortly after an incident, when responses to ongoing attacks are still underway, and the situation is in the midst of kinetic escalation.

That is why gathering information and analyzing war crimes come later. That is why it takes so long. It can take years. That is also why government cooperation is incremental. You may not always be able to obtain all the evidence needed to prove intent, because the other side may not be cooperating and may be impossible to reach. Decision-makers, as well as soldiers on the ground, may be dead, unavailable, in their home country and inaccessible, may have fled under different identities, or may have taken steps to conceal communications and evidence of criminal intent.

Intent can sometimes be easy enough to establish, but very often, especially when the situation is unclear and there is the so-called fog of war, it may take time.

One more point: it may be useful to analyze patterns. If you examine multiple incidents of a particular type of civilian site being targeted, are the circumstances identical, or is there wide divergence in how they were attacked? If there is a consistent pattern of similar steps leading up to that type of attack, it is less likely to be accidental because it suggests that certain ballistic and operational considerations were taken into account.

If, on the other hand, the incidents differ significantly, and there are simultaneous strikes on both military and non-military sites, then it may appear more random or incidental.

Jacobsen: Outside of intent, maternity care facilities, in a broader conceptual sense, what difficulties do these raise regarding humanitarian law? Not just general social sentiment around newborns being killed or the vulnerability of women about to give birth, but the concept of maternity care facilities being bombed.

Tsukerman: It creates a threat to the very continuity of Ukrainian society. That threat is not only due to any genocidal intent on the part of the Russians; it is also the fact that, due to the increased threat to women and their children, there is a falling birth rate.

There has been a correlation observed that birth rates in Ukraine are declining, and one of the contributing factors is the number of attacks on women’s care facilities and childcare-related infrastructure, precisely because of that increased threat. And, of course, giving birth at home is also fraught with risk, both medically and in the context of ongoing hostilities.

So in general, the impact of these types of attacks is producing the opposite of a baby boom at the moment. People are less likely to want to have children right now because there is a significant risk involved.

So, whether or not the attacks on specific sites are intentional, the overall impact is to disrupt normal life. And even if those individual sites were not specifically targeted in every instance, the broader trajectory has been to create conditions in which continuity, whether reproductive, familial, or social, is much more difficult.

Jacobsen: That is absolutely true. From speaking with some of these professionals, I learned that they spend a lot of time studying this: the current best estimates place Ukraine’s total fertility rate at approximately 0.9. For Russia, it is not much higher.

So we get commentary from prominent figures who may be skilled in technology but offer poor social analysis. They take those numbers at face value and insert generalized narratives that do not account for different underlying factors.

So, taking Ukraine and Russia as a dual case example: in Ukraine, people are under sustained national pressure, especially in frontline areas, but also more broadly under daily threat. We had multiple air raid alarms today alone. Strikes have damaged maternity care facilities and hospitals. There is ongoing pressure for information and propaganda. Women are serving on the front lines. Women know that their friends’ children have been mobilized and, in some cases, killed, which contributes to demoralization around having children.

There is also the absence of fathers in many cases, in a society that remains relatively traditional. In a predominantly Christian cultural framework, there are still expectations about men as providers and women as primary caregivers. I am not making a value judgment; I am describing a prevailing social framework. All of these factors have disrupted the social, economic, and relational fabric of society.

So women are less inclined to have children under these conditions, though some might be willing to if conditions improved.

On the Russian side, there are different dynamics. There appears to be a reluctance to have children in an increasingly authoritarian environment, with pressures on civil liberties and media freedom. Based on international indices, such as those from Reporters Without Borders, Russia’s press freedom ranking declined significantly in recent years, reflecting broader structural constraints.

Across multiple indicators, including governance, economic conditions, and rights environments, these factors shape family planning decisions. In contexts where there is economic hardship and limited protections, women are often less inclined to have children.

So I do not think these are unfair assessments, and I do not mean them as judgments. What I am trying to emphasize is that we have two different systemic conditions, Ukraine under external military pressure and Russia under internal structural pressures, leading to similarly low birth rates. Simply noting a low birth rate without context does not explain much.

What are your thoughts?

Tsukerman: The fact is that there are many factors logistically preventing childbirth from being a possibility. There are serious infrastructure issues in large parts of the country. We mostly hear about Moscow, St. Petersburg, and a couple of other large cities. But in rural areas and peripheral parts of the country, it is extremely difficult to raise a family. That does not mean it does not happen.

There are also other factors, such as high rates of alcoholism, drug abuse, and suicide, issues that interfere with normal family planning, as well as medical challenges and higher mortality rates at birth for both women and children.

All of these factors need to be taken into account. It is not just the issue of wanting to have children; it is also whether that is realistically possible given the social conditions.

The other issue is that, despite all the propaganda about patriotic reasons for having children, there are probably not just women but also men who do not want to have additional children. Many are away at war or have died. Some are depressed about their own lives and feel incapable of raising children or having more. Others do not share the mindset that having children is a duty simply because the government promotes it.

So I think the concerns of men about having larger families in Russia have not been properly explored. It is common to assume that women are the primary drivers of declining birth rates, but I think men are not particularly inclined either.

And yes, there have been changes in domestic violence laws, but if men strongly wanted to have children, permissive conditions alone would not necessarily translate into higher birth rates. It seems that men also do not wish to raise children in such an environment, for various reasons.

And again, people claim that Russia is a tolerable economic environment, and that may be true in some areas. The major cities are relatively privileged, but most of the country is not. So economic factors are also a concern. Even with government incentives for additional births, that may not be enough.

Jacobsen: Mr. Trump has proclaimed that U.S. military objectives in Iran are nearing completion. I assume that Iranian officials are declaring the opposite. But as we have discussed in prior sessions, this conflict is unusual in that, on the American side, administrative leadership messaging can be inconsistent, making absolutist claims, then revising them, sometimes in the opposite direction, creating an oscillatory pattern in public statements.

The Iranian side appears more reactive to this messaging, but also adopts a posture of strength while confronting what is widely considered the most powerful military in the region, and arguably globally.

If there are claims, if verified, of large-scale targeting involving thousands of targets by U.S. and Israeli forces, then those targeted land, air, and sea assets would likely be degraded to some extent, at least in the areas affected.

So what are your thoughts on this most recent declaration, and how does it fit into the broader pattern we are seeing from both sides?

Tsukerman: Look, if the U.S. and Israel, especially the U.S., because Israel largely did, had formulated their objectives from the beginning as degrading Iran’s military, targeting a defined number of sites, destroying a defined set of capabilities, and then adhering to that, I think the outcome would have been broadly acceptable. It would have been achievable, measurable, and ultimately achieved. Even if disappointing to some, it would not have been unreasonable to conclude that Iran, not a major military superpower to begin with, had been forced into a more inward-looking posture and would need years to rebuild, limiting its ability to act as an international threat in the near term.

That is not what happened, and it is still not what is happening. The problem is that the U.S. keeps changing its definition of even these narrow tactical aims. On the one hand, there have been relatively specific and limited military statements from officials, but broader, more expansive statements have emerged, redefining the scope. As a result, it is unclear where things stand.

To add to the complication, it is not clear whether the U.S. is providing fully accurate numbers regarding targets. For instance, claims that Iran has only half of its missile launchers remaining are difficult to verify. It is hard to determine whether such figures are precise or approximate. Even if broadly accurate, Iran could still retain enough capability to remain a threat.

Moreover, whatever the stated tactical aims, it is evident that Iran continues to pose a significant threat through asymmetric means. This includes actions directed at Israel and Gulf states, potential risks to U.S. bases, the use of maritime coercion tactics, and the continued operation of proxy networks that engage in conflict at various levels.

So even if it is accurate to say that U.S. military objectives are nearing completion, the idea of “victory” is not straightforward. Victory would imply that Iran is no longer capable of significantly disrupting international trade or energy flows, and that is not clearly the case.

If the objectives were narrowly defined, they should have been broader from the outset, or they need to be redefined now. While the U.S. may be succeeding tactically, it is unclear whether it is achieving a durable strategic outcome. If Iran can recover within a few years, then the result may be temporary mitigation rather than resolution.

There is also a financial dimension. Iran continues to benefit from multiple revenue streams, including oil-related income despite sanctions pressures, economic and military relationships with countries such as China and Russia, and various illicit networks that have not been fully disrupted. These factors contribute to its ability to sustain itself.

In addition, maritime activity in the Strait of Hormuz continues to generate leverage and revenue through coercive practices. So the question remains: can military objectives be considered achieved if the adversary retains the capacity to regenerate capabilities and sustain its operations?

There have also been statements suggesting that operations could conclude within weeks, with the possibility of returning if necessary. But it is not easy to re-engage once disengagement occurs. Once forces withdraw, the other side begins rebuilding, as seen in prior periods.

Finally, the nuclear issue remains unresolved. There have been discussions about removing enriched uranium from Iran, but there is no clear indication that this will occur. It is also unclear whether nuclear-related objectives are still part of ongoing operations or deferred to a later stage. Based on what is publicly known, that aspect has not yet been resolved. 

Jacobsen: Myanmar’s parliament has elected the ruling general as president, effectively keeping the military in charge. So, from Bangkok, Min Aung Hlaing, the general, is now president. This follows the 2021 removal of Aung San Suu Kyi’s civilian government. This was an election, but one organized by the military.

Opponents have said it was neither free nor fair, particularly as the civil war continues. China and Russia have supported the military administration, while many Western governments have imposed sanctions.

So this is straightforward but also serious. China and Russia supporting a military government is not surprising. Western sanctions are also not surprising. But with a civil war ongoing, and the military organizing an election that results in the general becoming president, it is also not surprising. But in terms of stability, is it good, even temporarily, to have the general in charge as president?

Tsukerman: Stability has been invoked in nearly every military dictatorship. What makes countries unstable is not the absence of a military ruler, but the use of authoritarian methods by those in power.

Yes, you can suppress crime and opposition, but that does not make a country more stable. It often makes it less stable because authoritarian leaders who lack exposure to criticism are more likely to overreach and apply coercive tactics internally and externally, thereby increasing instability.

In suppressing opposition, they often drive parts of society underground. That, in itself, creates instability. So I do not think military rule or generals in charge necessarily produce stability. In the long run, an authoritarian regime that is isolated from international engagement and internal criticism tends to become less stable.

Myanmar has been anything but stable in recent years. There are opposition groups and separatist movements. There is external involvement, including Chinese support to different actors, sometimes on multiple sides. There are border tensions between India and neighbouring countries.

So I do not think the military junta has stabilized the situation, especially under the current leadership. Perhaps in some contexts, military regimes might act more effectively, but in this case, it reflects poor governance, corruption, and a disconnect from both international norms and internal societal needs.

There is no broad coalition of actors contributing to governance, only a narrow set of external backers aligned with the regime’s methods. That does not create durable stability.

Jacobsen: So Russia is planning to send a second oil tanker to Cuba. An FBI team is arriving in Cuba to investigate the fatal shooting involving a U.S.-flagged speedboat. And Cuba is releasing 2,010 prisoners, which has been a longstanding issue under U.S. pressure. Busy Easter coming up.

What do you think about this kind of proxy contestation? 

Tsukerman: I find it striking that, without resolving issues in Iran or achieving major change in Venezuela, the U.S. is becoming involved with yet another country.

In Venezuela, there have been reports that criminality is down, but that may reflect more effective repression rather than genuine improvement. It could include the suppression of both criminals and legitimate critics.

So I am not convinced that claims of stabilization in Venezuela are fully warranted. It requires more scrutiny. Another factor is that the Venezuelan government has been partially normalized diplomatically, despite maintaining core elements of its previous political approach. There has not been a substantial structural change beyond increased access to oil and certain political claims that may be overstated.

China has not withdrawn from the region. It is likely to remain involved. There are also reports of increasing tensions involving maritime and regional security issues.

Overall, I do not see a clear positive trajectory. The same may apply to Cuba. I do not think external actors are primarily motivated by democratic outcomes there.

For someone like Rubio, coming from a Cuban-American background, this raises additional questions. But in his current role, those questions are not being publicly emphasized.

This situation will not be resolved better than Venezuela, and it may create additional complications involving organized crime, foreign influence, and domestic governance challenges.

Jacobsen: Thank you very much for the opportunity and your time, Irina. 

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