The Ukrainian health care system.
..has become a primary target in the ongoing attack by Russia. Russian forces have systematically targeted medical facilities and professionals, aiming to degrade resistance and enforce control over civilians. Despite the immense resilience shown by the Ukrainian health sector, these continuous assaults pose severe long-term challenges. That’s why we feel the imperative to support NGO’s like our partner – Christian Medical Association (CMA) of Ukraine, which tirelessly works to mitigate this crisis in Ukrainian health care. By contributing through tax-deductible donations, especially regular giving, we can significantly bolster these efforts and provide critical support to the affected populations.
Misuse of medical facilities by the military
Russia’s strategy involves the repurposing of civilian health facilities for military use, which is a blatant violation of international humanitarian law. Hospitals in regions such as Zaporizhia and Kharkiv have been transformed into military bases, severely limiting civilian access to essential health services. The misuse of these facilities not only jeopardises the lives of patients and healthcare workers but also dismantles the very infrastructure needed for civilian health care. The seizure of health supplies, including medical equipment and medicines, further disrupts the provision of health care and occupation of hospitals exposes patients and health care workers to a greater risk of violence.
Dr. Maryna Rudenko, director of the Balakliia Clinical Multiprofile Intensive Care Hospital, recounted the dire situation following Russian occupation:
“Almost everything was stolen. They took away everything that could be taken away. They couldn’t move the CT scanner, so they looted the electronics from it. … We had two surgical stands … We hid them in the basement, but they found them and stole them. All the tools were stolen. The diagnostic department: there is nothing at all, everything was stolen; they lived there. That is, all ultrasound machines, cardiographs, encephalographs; nothing. They took it out … We also had a generator for 100 kilowatts: disappeared. Out of 15 [ambulance] cars, 14 disappeared with them. Telephones, 37 washing machines, microwave ovens [were also removed].”
In 44 reported incidents, health facilities in seven of Ukraine’s oblasts were reportedly repurposed for the use of Russian soldiers. These takeovers of civilian facilities for military medical use were particularly frequent in early 2023, with the number of reported new takeovers increasing between February and April 2023. In all 44 cases, the health facility was fully functioning at the time it was repurposed for the use of soldiers.
For instance, the new Semashko Medical Center in Simferopol, with the capacity to treat 650 patients, was turned over to the Russian military, severely limiting access for civilians.
This not only violates the laws of occupation but also severely disrupts the provision of healthcare to civilians, exacerbating the already dire humanitarian situation.
Olena Yuzvak, head of the Primary Care Center in Hostomel, Kyivska oblast, spoke to PHR about the occupation of the clinic from February through March 2022: “In the building of this primary clinic was the base of the Russian military, and in the basement of this building were children, civilians who were not even allowed to go outside and cook some food, because it was dangerous, no one allowed them to do so. And the people who tried to leave on their own because they were losing it and wanted to leave this hell, […] their cars were shot, they were civilians.” Olena’s husband and son, both civilians, were taken prisoner by Russian forces. Her husband, who was shot when Russian soldiers entered their private house, has since been released in a prisoner exchange, but her son, Dmytro, remains in captivity.
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Forced Nationality Changes for Health Care Access – “passportisation”
A particularly insidious tactic employed by Russian forces is “passportisation,” where civilians must change their nationality to access health care. This practice, implemented in occupied territories like Donetsk and Kherson, effectively restricts Ukrainian citizens from receiving medical services unless they accept Russian citizenship. On April 27, 2023, President Vladimir Putin of Russia signed a decree establishing a procedure to issue Russian passports to residents of the occupied territories of Donetsk, Kherson, Luhansk, and Zaporizhia oblasts of Ukraine. According to the decree, residents have until July 1, 2024, to accept Russian citizenship; otherwise, they will be considered foreigners or stateless and can be detained or deported. As was the case in Crimea after Russia’s occupation in 2014, they may face threats and discrimination, including in accessing medical care and social services.
This coerced change imposes an external identity on Ukrainians and obstructs their access to crucial health care and support. In Kherson oblast, a local resident reportedly died because doctors refused to provide medical care without a Russian passport. In Lazurne, the Russian-appointed head of the town, Oleksandr Dudka, confirmed that medicines purchased from the Russian Federation would not be distributed to Ukrainian citizens. Similar accounts of deprivation of access to insulin and other essential medicines have been reported from areas like Genichesk of Kherson oblast.
Health care workers were also reportedly forced to hand over their Ukrainian passports and obtain a Russian passport within a strict time frame or face being dismissed from their positions. These practices profoundly affect civilians’ access to crucial health care services and medications, as well as the health and safety of Ukrainian health care professionals.
During the occupation of Hostomel in Kyiv oblast in March 2022, Olena Yuzvak, head of the Hostomel Primary Care Center, was taken for interrogation by Russian soldiers where she had a plastic bag put over her head and was suffocated for up to 30 seconds : “On March 20, Russian soldiers came to our home in a private house. The Russian soldiers shot my husband in the knee and thigh with a gun, put him on the ground, and put the gun to his head. My son came out of the house [….] They put the three of us in an armored personnel carrier, blindfolded us and took us to their headquarters in Hostomel in the Yagoda residential complex. The interrogation was tough [….] Moreover, my husband was not provided with medical care, he was bleeding from the leg, he had two bullet wounds. During the interrogation, they asked me what I do, and I said that I am a doctor and that I have been working only in health care for more than 20 years. And after the interrogation, they put us in the corridor, put bags on our heads, tied our hands with tape, and started twisting and strangling us with tape around our necks. [….] As a doctor, I understand that asphyxiation is an easy death [….] I accepted it, that that’s the way it should be. Then, when they saw that we started to suffocate, they cut holes in our bags and took us all to Antonov airport for further interrogation. They left my husband and son there. And I was brought back to this Yagoda residential complex, where I was held captive for a day.”
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Threats and Harassment of Health Care Personnel
Healthcare professionals in occupied areas face immense duress, working under constant threat of detention and violence. Many have been forced to adopt Russian practices or face dismissal, with some even abducted or killed for refusing compliance. For instance, a doctor from the Kherson Regional Clinical Hospital described how medical personnel were commanded to transfer confidential patient data to Russian authorities. The database stored confidential information, including home addresses and phone numbers, which the Russians sought to exploit, including detaining and torturing anyone with a medical record of having fought against Russia in 2014.
Healthcare workers have been killed, detained, arrested, or otherwise persecuted by Russian forces. These detentions and abductions severely impact the ability of healthcare workers to provide necessary care to the civilian population. Incidents have been frequent in Donetsk and Kherson oblasts and several in Kharkiv, Kyiv and Zaporizhia oblasts. Although the exact numbers are unclear, “Military Medics of Ukraine,” a nongovernmental organization, indicates that approximately 500 medics, both military and civilian, are currently thought to be held captive by Russian forces and there have been numerous reports of torture and ill-treatment. Our friend and charity partner Dr. Rudi from CMA shared countless stories of doctors and medics being actively ‘hunted’ by Russians. “One less medic is several less Ukrainians whose lives they would have saved,” he explained.
The psychological and physical toll on these professionals is profound, exacerbating the already dire situation in the health care sector. Doctors and other healthcare workers find themselves working in incredibly challenging conditions, often amid constant shelling. Many healthcare workers have become displaced, increasing the burden on the existing staff.
The Human Toll of Healthcare Disruptions
The attacks on healthcare infrastructure have led to a significant reduction in access to critical health services and vital medicines. Routine vaccinations are missed, and there is a rise in heart disease, strokes, and infectious diseases in regions hosting internally displaced people. The mental health crisis is also escalating, and there is a massive need for rehabilitation services.
The destructive impact of a compromised healthcare system threatens to impose long-lasting and severe hardship on Ukraine’s people. As of April 2024, there have been 1,442 attacks on healthcare facilities, workers, and infrastructure. Hundreds of hospitals and clinics have been destroyed, and many have been hit more than once. For example, the clinic I attended in the Kherson region in July 2023 has been hit three times since I left, and indeed as I was writing this blog I received an alert that this little village had been shelled again today. These attacks directly affect civilians by reducing access to critical health services and vital medicines. The shortage of medical supplies, medications, and equipment further exacerbates the health crisis, leading to increased mortality and morbidity rates.
Ukraine’s Ministry of Health has described the current supply levels of medicines to healthcare facilities and pharmacies in the areas currently occupied by Russian forces as “catastrophic,” as there are no deliveries to the occupied areas of Kherson and Zaporizhia oblasts, and the information from Donetsk and Luhansk oblasts is scarce.
The Role of the Christian Medical Association (CMA) of Ukraine (Link)
Our charity partner, CMA, is at the forefront of addressing these issues. They provide medical supplies and support to the beleaguered healthcare system in Ukraine. The CMA’s efforts are vital in ensuring that despite the ongoing conflict, medical care remains accessible to those in need. They have been instrumental in delivering critical supplies, supporting healthcare workers, and ensuring that medical services continue to operate under the most challenging conditions. Supporting CMA through regular donations can make a significant difference in sustaining these vital efforts and saving lives.
The work of the CMA brings hope in the midst of the ongoing war and humanitarian crisis. I witnessed their dedication to providing medical care and support to the affected populations. Your tax deductible contributions, especially through regular giving, are crucial in sustaining their efforts and ensuring that Ukrainian civilians continue to receive the care they desperately need. We make sure that every dollar goes straight to them.
Support CMA today and help us stand with Ukraine in this critical time.
How You Can Help
To make a tax-deductible donation and support the CMA’s vital work, please DONATE HERE.
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The systematic targeting of Ukraine’s healthcare system by Russian forces is a profound violation of international laws and human rights. The Christian Medical Association of Ukraine is working tirelessly to counter these effects, providing essential medical support under harrowing conditions. Your contributions, especially through regular giving, are crucial in sustaining their efforts and ensuring that Ukrainian civilians continue to receive the care they desperately need. Support CMA today and help us stand with Ukraine in this critical time.
References
- Médecins Sans Frontières. (2023). [Attacks on hospitals in Ukraine: A tragic toll on lives and infrastructure] (https://msf.org.au/article/project-news/attacks-hospitals-ukraine-tragic-toll-lives-and-infrastructure).
- Ukrainian Healthcare Centre. (2023). [Ukrainian Healthcare System Under Russian Occupation] (https://uhc.org.ua/en/home).
- Physicians for Human Rights. (2023). [Coercion and Control: Ukraine’s Health Care System Under Russian Occupation] (https://phr.org/our-work/resources/coercion-and-control-ukraines-health-care-system-under-russian-occupation/).
- Attacks on Health Care in Ukraine. (2024). [Database on Health Care Attacks] (https://www.attacksonhealthukraine.org/).
