Documenting Attacks on Healthcare in Ukraine: Accountability, Impunity, and International Humanitarian Law

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2026/03/10

Uliana Poltavets, M.S., is the International Advocacy and Ukraine Program Coordinator at Physicians for Human Rights (PHR), where she focuses on documenting attacks on health care in Ukraine since the start of Russia’s full-scale invasion. Before joining PHR, she spent more than a decade supporting Ukrainian civil society and leadership development, working across human rights advocacy, civic and political education, and public ethics and institutions with organizations including the Council of Europe and Democracy Reporting International. Poltavets holds a Master of Science in Public Administration from Leiden University (Netherlands) and speaks English, Ukrainian, Russian, French, and Dutch.

In conversation, Scott Douglas Jacobsen and Poltavets examine documented attacks on healthcare in Ukraine and their broader implications under international humanitarian law. Poltavets outlines patterns showing sustained strikes on hospitals, pediatric facilities, and energy infrastructure critical to medical services. She argues these attacks are not incidental but strategically undermine civilian life and force displacement. Despite UN Security Council Resolution 2286, accountability remains rare, emboldening perpetrators. She emphasizes prevention through military integration of humanitarian law, operational legal review, and enforcement mechanisms, including sanctions and investigations. Without credible accountability and global pressure, attacks on healthcare risk further normalization across contemporary conflicts.

Scott Douglas Jacobsen: Over these four years, the peak of attacks in your dataset appears at the beginning. The trend resembles an elongated U-shape, with a middle period showing a modest reduction. It is unclear whether that reflects limitations in verification capacity or an actual decrease in attacks. More recently, the numbers have risen again. What can we infer from that broader pattern?

Uliana Poltavets: In the first months of the full-scale invasion, attacks on healthcare were extremely frequent. Across 2022 and through mid-April 2024, documentation by Physicians for Human Rights and partners recorded nearly 1,500 attacks on healthcare facilities, averaging roughly two attacks per day over that period.

The pattern has shifted over time. In 2024, 445 incidents were documented, and in 2025, that number rose to 663—an increase of nearly 50 percent. The rise reflects intensified strikes on densely populated civilian areas.

In frontline regions, many facilities have already been damaged or destroyed. There, we often see ambulances targeted or hospitals evacuated due to proximity to active combat.

When attacks occur in cities farther from the frontline—such as Kyiv or Lviv—they are not explained by immediate battlefield conditions. This supports the conclusion that attacks on healthcare are not merely collateral damage but form part of a broader strategy to undermine civilian life and contribute to displacement.

Hospitals are essential to community stability. When healthcare systems are disrupted or destroyed, normal life becomes unsustainable, and people leave.

These attacks include not only strikes on hospitals and clinics but also on systems vital to healthcare operations. Attacks on energy infrastructure directly affect healthcare delivery. In that sense, attacks on energy function as attacks on health.

Jacobsen: Ukraine has stated that more than 19,500 children have been taken to Russia or Russian-occupied areas without parental consent. That figure is widely cited as Ukraine’s official claim rather than as an independently verified consolidated total.

In addition, there was the July 8, 2024, strike on Kyiv’s Okhmatdyt Children’s Hospital, a major pediatric facility that provides specialized treatment, including oncology care. What did your reporting find about that case? More broadly, what patterns have you identified regarding children’s hospitals and pediatric healthcare?

Poltavets: Since the beginning of the full-scale invasion, we have recorded 127 attacks on children’s healthcare facilities. This includes pediatric hospitals and specialized children’s departments.

One of the most prominent attacks was on Okhmatdyt Children’s Hospital in Kyiv. The name is an abbreviation derived from “Protection of Mother and Child.” It is the largest children’s hospital in Ukraine and serves not only Kyiv but patients from across the country. Many children receive specialized treatment there, including oncology care, treatment for autoimmune diseases, and other rare conditions.

When the hospital was struck, the impact extended far beyond Kyiv. At the time of the attack, more than 600 patients were present. The strike occurred during a busy daytime period.

We analyzed with our partners, including the investigative organization Truth Hounds. Their findings, along with independent assessments, indicated that the strike was likely deliberate. The attack resulted in civilian deaths, including a doctor and patients, and caused severe damage to hospital buildings, including critical departments.

The hospital lost power for several days. This was particularly dangerous given the number of patients dependent on life-sustaining equipment, including dialysis and cardiac care. Emergency generators and additional resources had to be mobilized, and many patients were evacuated under urgent conditions.

We spoke with an ophthalmologic oncologist who described a colleague performing delicate eye surgery at the moment of the strike. The procedure was seconds from a critical stage when the explosion occurred. Incidents like this underscore that these were children receiving complex medical care.

Many people also remember one of the earliest images of the war: a pregnant woman carried on a stretcher after the bombing of a maternity hospital in Mariupol. That image became symbolic. We spoke with one of the anesthesiologists who treated that patient. She described conditions in Mariupol at the time: the city was nearly encircled, medical supplies were scarce, the hospital had already been struck multiple times, and there was no reliable power or heat. Under such circumstances, providing adequate care was extremely difficult. The patient later died.

These patterns are not unique to Ukraine. Similar tactics were documented in Syria, particularly after Russia’s direct military involvement. There, attacks on healthcare facilities and medical personnel increased significantly. The lack of accountability in Syria demonstrated how impunity can normalize such practices.

Jacobsen: Under international humanitarian law, how does impunity contribute to recurrence, particularly in light of what you have just described?

Poltavets: That is a complex question. Attacks on healthcare have historically been marked by severe impunity. If you examine court cases over the past several decades across different conflicts, very few perpetrators have been prosecuted specifically for attacks on healthcare facilities.

There are multiple reasons for this. First, these cases are difficult to prove. It must be established that a hospital was not being used for military purposes. It must also be shown that the strike was not incidental to a legitimate military objective. Even then, prosecutors must assess proportionality and intent. These evidentiary thresholds make such cases legally challenging.

As a result, prosecutors have often been reluctant to pursue them, even when attacks on facilities such as maternity hospitals appear egregious. The lack of accountability for this category of crimes has been significant.

Because similar attacks were rarely punished in recent conflicts, including Syria and Chechnya, perpetrators have been emboldened. The tactic undermines civilian life, disrupts essential services, and contributes to displacement. It weakens morale and destabilizes communities.

Our documentation in Ukraine contributes to the global database of attacks on healthcare. Globally, such attacks have increased in recent years, despite strong protections under international humanitarian law, international human rights law, and international criminal law.

In 2016, the United Nations Security Council adopted Resolution 2286, which reaffirmed the protection of medical facilities in armed conflict. This year marks ten years since its adoption. However, during this period, attacks on healthcare have not declined; in many contexts, they have increased.

Since the start of the full-scale invasion in 2022, Ukraine has accounted for a significant proportion of documented global attacks on healthcare. In 2022, Ukraine represented over 30 percent of reported incidents worldwide. With the escalation of hostilities in Gaza, global numbers rose further. Current data indicate that Ukraine remains one of the primary contributors to global attack figures.

Our central call to action is that investigative bodies and accountability mechanisms must prioritize attacks on healthcare. Without credible accountability, deterrence will remain weak.

Jacobsen: In situations where states conduct attacks on humanitarian targets, what measures have historically reduced or halted such attacks in active war zones, outside the specific context of Russia’s aggression in Ukraine?

Poltavets: There is no simple answer. Legal scholars, humanitarian actors, civil society organizations, and states are actively examining what measures can reduce attacks on healthcare.

This year marks the tenth anniversary of UN Security Council Resolution 2286 on the protection of medical facilities in armed conflict. The International Committee of the Red Cross in Geneva is currently engaged in efforts to strengthen the implementation of international humanitarian law, particularly regarding healthcare protection, and to identify practical measures that improve compliance.

The response must be multifaceted.

First, prevention. International humanitarian law must be embedded within military doctrine, operational planning, and training. This cannot be a one-time course; it must be continuous and integrated into command structures.

Operational decision-making is critical. Legal advisers and, where appropriate, public health or medical experts should be involved in targeting decisions. They can assess legality, proportionality, civilian impact, and foreseeable reverberating effects.

Reverberating effects are especially important. The destruction of a hospital has immediate consequences and long-term impacts on access to care, public health, and civilian survival. These effects must be considered during planning.

Second, accountability. When unlawful attacks occur, enforcement mechanisms must function. The legal framework is already extensive; the problem is not a lack of norms but weak enforcement and inconsistent interpretation.

Enforcement measures can include targeted sanctions, restrictions on arms transfers, independent investigations, and public attribution. Naming violations and documenting responsibility can increase reputational and political costs.

Finally, normalization must be resisted. The frequency of attacks does not make them lawful or acceptable. Public awareness and sustained advocacy are necessary to prevent erosion of established protections.

Reducing attacks on healthcare requires simultaneous action across prevention, accountability, and global advocacy. These measures must operate together to create meaningful deterrence.

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

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