Russia’s War in Ukraine – The Destruction of Health and Human Rights
Since February 24, 2022, Russia has been waging a war of aggression in Ukraine, blatantly attacking civilians and civilian infrastructure. The recent shift in Russian strategy toward a war of attrition has ominous implications for civilian survival, Ukraine’s future as a nation-state, and the restraint North Atlantic Treaty Organization (NATO) countries must exercise to ward off Russia’s threat of nuclear escalation. This conflict, sparked by an unprovoked Russian invasion, has caused death and widespread suffering to Ukrainian civilians and military personnel. More than 7.1 million Ukrainians have been displaced within their country and around 5.3 million have crossed borders to become refugees in other European countries. Fittingly, the war has prompted a massive humanitarian response – but Russia’s onslaught has intensified and time is running out.
In the 1990s, the medical and scientific community began to improve their ability to assess and respond to armed conflict.1 Recent wars and brutal conflicts have prompted important debates on the epidemiology of war-related morbidity and mortality, civilian suffering, mid-war health care capacities, consequences of abrupt displacement and parameters of humanitarian response, as well as legal and normative debates on the human rights and international rights dimensions of armed conflict .
In Ukraine, as in the early stages of other wars, inadequate security, inaccurate or incomplete reporting, malfunctioning data systems, displacement of populations, and indirect, distant and delayed health impacts have made it impossible to collect accurate morbidity and mortality data. As of June 20, the United Nations had confirmed 4,569 deaths and 5,691 nonfatal injuries among Ukrainian civilians, mostly caused by the indiscriminate use of long-range explosive weapons, including heavy artillery shells, rockets and bombs. But the real numbers of dead and injured are likely much higher. For example, according to CNN, municipal officials in Mariupol believed at least 22,000 townspeople had been killed as of May 25.
As in other recent wars, the strategy of attacking health facilities and medical personnel now results in both immediate deaths and injuries and the adverse consequences of reduced health care availability.2 Between February 24 and June 24, the World Health Organization reported 323 attacks on health facilities in Ukraine, killing 76 and injuring 59.3
A significant portion of civilian morbidity and mortality in Ukraine is undoubtedly due to diseases caused by forced displacement and damage to food and water supply systems, health care and public health facilities, and other civilian infrastructure.4 Communicable diseases are more easily transmitted due to cramped living conditions, limited access to clean water and food, compromised sanitation and hygiene, inadequate medical care, and failures in immunization campaigns. During the war, civilians are at particularly increased risk of diarrheal diseases such as cholera and respiratory diseases such as measles, Covid-19 and tuberculosis. In addition, resistance to antimicrobials often increases during war.
Another risk is malnutrition – a particular problem for infants and young children, which can result in adverse effects on physical and cognitive development and increased morbidity later in life. As a deliberate strategy of war, Russian forces have disrupted agriculture, damaged food storage and distribution systems, and restricted access to food. Indirect impacts on nutrition can reach well beyond Ukraine; Destruction of farmland and grain stores, grain theft and blocking of food exports will contribute to malnutrition in low- and middle-income countries dependent on Ukrainian grain exports.
Rates of pregnancy complications, maternal mortality, preterm and low birth weight infants, and neonatal deaths will increase due to limited access to maternal and infant care. The incidence of some NCDs will increase and existing cases will worsen as access to medical care and essential medicines is limited. Rates of depression, post-traumatic stress disorder, and other mental and behavioral disorders — with short- and long-term consequences — are rising due to trauma, family separation, death of loved ones, loss of employment and education, forced displacement, and witnessing atrocities. In addition, the great loss of men, the mass displacement of women and their shift in status towards single householders may significantly affect the age and gender distribution of Ukraine’s population for decades to come.
Russian forces are also causing extensive environmental destruction. Explosions and fires contaminate the surrounding air with toxic gases and particles and threaten the integrity of nuclear reactors. The destruction of industrial plants contaminates water and soil with dangerous chemicals. Russian military activities in the Black Sea are reportedly causing widespread pollution and disturbance of marine life. The use of anti-personnel mines and cluster bombs, as well as the presence of duds, pose short- and long-term health and safety threats.
The war has resulted in many documented violations of human rights and international humanitarian law, which should seriously concern us all. Russian forces have targeted health facilities, schools and residential areas. They executed unarmed civilians. They raped women. The Russian military has claimed to have deported 1.9 million Ukrainian civilians, including 307,000 children, to Russia. Russia has inflicted widespread damage to cities, villages, farmland, forests and water sources that will plague Ukraine long after the war is over.
On February 28, the International Criminal Court (ICC) announced its jurisdiction over possible war crimes in Ukraine, based on recent inquiries from its government. On March 2, the governments of 39 signatory states to the Rome Statute that created the ICC also submitted formal requests for ICC jurisdiction in the case. However, when the ICC assumed jurisdiction over the international humanitarian crime of aggressive war in 2018, it specified that it applied only to signatory states to the Rome Statute. Neither Russia nor Ukraine are signatory states. The prosecution of war crimes and restitution will be complex and likely to take years.
National and local government agencies in Ukraine and humanitarian organizations from the United Nations and many countries have provided robust assistance to civilians in Ukraine and in the countries of refuge. These efforts included protecting civilians; direct provision of food, water, shelter, medical care and other humanitarian assistance; and support for Ukrainian government agencies and non-governmental organizations caring for displaced people and those who choose or are forced to remain in their homes.
However, protecting civilians by getting them out of harm’s way has proven difficult. Many civilians chose to remain in their homes, which became increasingly unsafe as Russian troops captured and executed civilians and bombed civilian neighborhoods. In addition, limited access to food and clean water made it increasingly unsustainable for many Ukrainians to stay put. Still, it was often impossible to set up safe corridors for civilians trying to leave the country, as illustrated by the widely reported deadly attacks on civilians in transit, such as the Kramatorsk train station bombing that killed at least 50 people.
It has become extraordinarily difficult to protect civilians who remain in their communities, particularly in eastern and southeastern Ukraine, where Russian forces have implemented scorched-earth strategies, mainly with long-range missile and mortar attacks that have devastated Mariupol and many other cities and cities. These attacks have accelerated the killing of civilians and further damaged health and educational facilities.
During the same period, humanitarian aid has greatly expanded and many countries are taking in Ukrainian refugees. Still, since late April, the conflict has turned into a war of attrition as Russia seeks to wear down Ukraine through slow, relentless depletion of its resources, including manpower, supply chains and weapons.5 This strategy now aims to inflict increasingly brutal casualties through the use of powerful weapons that kill indiscriminately, often from great distances. Russia has also blocked Ukraine’s access to the sea.
At this difficult time, it is important to increase humanitarian assistance to Ukrainians in need and to support local, national and international efforts to collect and preserve evidence of possible war crimes committed by Russia. And it is imperative to seize this moment of peril to reflect on—and address—the profound and existential threat posed by nuclear weapons.
Russia’s war of aggression in Ukraine is the latest demonstration of the war’s disastrous health consequences, dwarfing Russia’s previous destruction of Chechnya and bombing of health facilities and neighboring populations in Syria. As nations and their peoples take essential action to isolate this dangerous condition, we also believe that health professionals have a responsibility not only to address the needs of current victims, but also to work to end the devastating, long-lasting, intergenerational effects of war preventing human health and life.