Mariana Vishegirskaya stands outside a maternity hospital that was damaged by shelling in Mariupol, Ukraine, on March 9. Vishegirskaya later gave birth to a girl in another hospital in Mariupol. Mstyslav Chernov/AP hide caption
Mariana Vishegirskaya stands outside a maternity hospital that was damaged by shelling in Mariupol, Ukraine, on March 9. Vishegirskaya later gave birth to a girl in another hospital in Mariupol.
The immediate toll of the Russian airstrike that devastated a maternity hospital in the Ukrainian city of Mariupol last week was three people dead and 17 injured, but the impact did not stop there. In the AP photo that has come to symbolize the attack, a wounded pregnant woman lies on a stretcher, holding her lower belly and splattered with blood, being rushed out of the hospital by emergency workers seeking care for her elsewhere. Neither she nor her baby survived.
An injured pregnant woman is carried from the maternity hospital damaged by Russian shelling in Mariupol, Ukraine, on March 9. The woman and her baby subsequently died. Evgeniy Maloletka/AP hide caption
An injured pregnant woman is carried from the maternity hospital damaged by Russian shelling in Mariupol, Ukraine, on March 9. The woman and her baby subsequently died.
The attack was condemned worldwide. The World Health Organization issued a statement: "To attack the most vulnerable babies, children, pregnant women, and those already suffering from illness and disease, and health workers risking their own lives to save lives is an act of unconscionable cruelty."
WHO further pointed to the ongoing ripple effects such attacks pose by limiting access to health care as well as potentially endangering those who seek it and also straining and threatening the viability of the health-care system itself.
Yet this was only one of 31 attacks on health-care workers, medical sites and facilities documented thus far in the Ukraine conflict by WHO's Surveillance System for Attacks on Health Care (SSA). Moreover, health facilities have been targeted in other wars, including those led or supported by Russia, like Syria's ongoing civil war and the war in Chechen from 1999 to 2009.
What happens to the health needs of the local population in the short-term and what are the long-term consequences of this kind of destruction? How can what happened in past conflicts help us gain insight into the plight of those in Ukraine now?
To learn more, we spoke with Leonard Rubenstein, professor at the Johns Hopkins University school of public health and author of Perilous Medicine: The Struggle to Protect Health Care from the Violence of War; Dr. Michele Heisler, medical director at Physicians for Human Rights and a professor of internal medicine and of public health at the University of Michigan; and Dr. Houssam al-Nahhas, the Middle East and North Africa researcher at Physicians for Human Rights. Their comments have been edited for length and clarity.
Physicians for Human Rights has documented 601 deliberate attacks on 350 medical facilities in Syria from 2011 onward. Why target medical facilities?
Heisler: It is a devastatingly effective weapon of war because there are few greater ways of terrorizing the population, of breaking their will and lowering morale, than through attacking health care. An article in The Lancet called this strategy "the weaponization of health care."
Al-Nahhas: When a country attacks health-care facilities they are sending the message that they don't have any boundaries to what they can do. This is targeting people who cannot defend themselves and who cannot pose a threat because they're patients. It is a way to break people's resilience. Going to the hospital becomes dangerous, going there to get help means risking your life.
In this photo from May 2016, citizens and firefighters gather at the scene after a rocket hit the Dubeet hospital in Aleppo, Syria. As attacks have continued during the war, some health-care facilities have moved underground to try and serve their patients in relative safety. SANA via AP hide caption
Was that one of the immediate consequences you saw in Syria and elsewhere?
Al-Nahhas: We documented this in a case history of what happened after three airstrikes hit al-Altareb hospital in Aleppo in March 2021. Afterward, there was a significant decrease in consultations and beneficiaries of health care due to the risk of being bombed at the facility.
There was a decrease of 78% of prenatal and reproductive care consultations. We also witnessed a 27% decrease in normal deliveries. Many would elect to do a C-section in order to know when they will come in and when they will go out and to limit the time spent in the facility.
That is also what I witnessed in Aleppo during my time there as an emergency physician between 2014 and 2016, when we saw a spike of C-sections in conjunction with military escalations in 2014.
What else happens when health-care facilities are attacked?
Heisler: In the short-term there is chaos. Supplies, medications, oxygen are in short supply. People are not getting IV fluids or necessary surgery or other treatments, such as dialysis, and there are needless deaths as a result.
Rubenstein: On top of that, the hospitals may not have a track record of dealing with the complex injuries resulting from these powerful weapons. There may also be fewer staff members. In Syria, many of the most experienced physicians left, leaving behind the less experienced and younger physicians. There was an effort at quick training and a shifting of inexperienced people doing more complex things. For instance, technicians who supported the anesthesiologists may have to do the anesthesia or dentists [may have to] do oral surgery.
A man walks with crutch in a hospital in western Aleppo, Syria, damaged by attacks by the Bashar al-Assad regime during the country's ongoing civil war. Muhammed Said/Anadolu Agency via Getty Images hide caption
A man walks with crutch in a hospital in western Aleppo, Syria, damaged by attacks by the Bashar al-Assad regime during the country's ongoing civil war.
Are there additional ramifications for health care as the conflict continues?
Rubenstein: Childhood vaccinations tend to decline because the vaccinators are attacked as in Afghanistan and whole vaccine initiatives have to be suspended. Measles vaccinations have to be suspended either because of attacks on the vaccinators or because of the general insecurity, where it's too dangerous to go house to house. Attacks on a health-care facility in Zemio in Central African Republic [in 2017] led to HIV and AIDS programs being suspended.
In Yemen the Saudis have bombed both hospitals and water and sanitation infrastructure, such as pumping plants, which then led to a cholera epidemic that affected more than 2 million people.
Heisler: In Syria, hospitals went underground. You go from flying the white flag and when you realize that might indeed be a target, you take down the flag and you go underground. In Syria there was a whole system of underground hospitals.
Al-Nahhas: If all the intensive care units are occupied by people with war injuries, that equipment is not available to be used to help COVID patients or heart patients or any non-war related illness.
And what longer term consequences have you seen from such attacks?
Rubenstein: Even after a conflict ends it often takes a very long time to restore health capacity. And in the meantime people's health continues to suffer in ways similar to during the conflict.
Heisler: The concern is this might lead to the complete collapse of the health-care system. The continuing shortage of health-care workers and no supplies and no system to provide necessary care that is devastating. In Yemen, and in Tigray [Ethiopia, where a war began in 2020 and is still going on] almost all health-care systems are not functioning.
A nurse moves scrap from a damaged part of the Wukro General Hospital, which was shelled as government-aligned forces entered the city in the Tigray region of Ethiopia on February 28, 2021. EDUARDO SOTERAS/Eduardo Soteras/AFP via Getty Images hide caption
A nurse moves scrap from a damaged part of the Wukro General Hospital, which was shelled as government-aligned forces entered the city in the Tigray region of Ethiopia on February 28, 2021.
What about the impact on the physicians and health-care workers? The stress must be acute.
Al-Nahhas: I think it's important for people to know what the health-care workers are experiencing in Ukraine especially when health care is not protected in conflict.
It's knowing that you are in a hospital and treating patients and yet you can be targeted and killed at any moment. You need to provide the best care for your patients but you're also worried about your own safety.
I was in Syria for two years literally living in the hospital. It was rewarding to see the impact of [our] the work on people, but it was not sustainable because of the stress on all the health-care providers. We were not used to seeing so much trauma. We had to learn as we went along how to treat war-related injuries that we had never seen before.
This sense of how bad things can get the flashbacks from Syria are still with me after eight years.
What is being done to stop such attacks? Three international courts are now investigating possible war crimes committed by Russia in Ukraine. Could that make a difference?
Heisler: We need to establish accountability by documenting and gathering evidence of what has happened. That is the role of organizations like ours. If we live in a world in which you can bomb hospitals in war, killing patients and health-care workers, then we really would be returning to no-holds barred wars where no one is safe. We have to be sure that this does not continue.
Diane Cole writes for many publications, including The Wall Street Journal and The Washington Post. She is the author of the memoir After Great Pain: A New Life Emerges. Her website is DianeJoyceCole.com.
Excerpt from:
Russia's bombing of Ukraine hospital reflects a terrible wartime pattern : Goats and Soda - NPR
- Russia and Putin's Ukraine war may have been preventable - MSNBC [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Boris Johnson warns of 'even darker days ahead' over Russia's invasion of Ukraine - Sky News [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- PayPal suspends its services in Russia over Ukraine war - CNBC [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Russians Face Sanctions and Anxieties of a Costly War - The New York Times [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Invasion Brings Russia Global Repudiation With Cold War Echoes - The New York Times [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Trump renews NATO criticism after Russia's invasion of Ukraine, and also says "vote counter" can be more important than candidate - CBS News [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Shunned by Others, Russia Finds Friends in Africa - The New York Times [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Russia's War With Ukraine Is Already Costing Russian Economy - The New York Times [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Russia threatens to block VOA unless it removes Ukraine invasion coverage - Axios [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Russia appears to have no way out as Putin goes all in - The Guardian [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- With Sanctions, U.S. and Europe Aim to Punish Putin and Fuel Russian Unrest - The New York Times [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Russian Prisoners and Ukrainian Soldiers Describe Two Sides of the Conflict - The New York Times [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- How China Embraces Russian Propaganda and Its Version of the War - The New York Times [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Accounting firms KPMG and PwC to exit Russia - Reuters [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Russia's war on Ukraine is dire for world hunger. But there are solutions - NPR [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Blinken vows to escalate sanctions on Russia but warns war could last some time - The Guardian [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Visa, Mastercard to suspend operations in Russia - Al Jazeera English [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Opinion | The Cancellation of Mother Russia Is Underway - The New York Times [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Ukrainians Find That Relatives in Russia Dont Believe Its a War - The New York Times [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Inside the U.S. Race to Arm Ukraine Against Russia - The New York Times [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Russia-Ukraine live news: Zelenskyy says sanctions not sufficient - Al Jazeera English [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- As Biden predicts Russia will invade, U.S. rushes weapons ... [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Russia seizes Ukraine nuclear plant - msnbc.com [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- Russia - Simple English Wikipedia, the free encyclopedia [Last Updated On: March 6th, 2022] [Originally Added On: March 6th, 2022]
- U.S. Intelligence Tells Congress Putin Is Unlikely to Be Deterred - The New York Times [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- US and Allies Will Strip Russia of Favored Trade Status - The New York Times [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Honeywell CEO says suspending business in Russia wont be a major headwind - CNBC [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- What is the threat of a 'cornered' Putin as the Russia-Ukraine conflict drags on? - ABC News [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- The Growing Fear of a Wider War Between Russia and the West - The New Yorker [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- How Russian and Ukrainian Orthodox Churches Are Handlng the War - The New York Times [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Russia's wars in Chechnya offer a grim warning of what could be in Ukraine - NPR [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Russia's Ukraine invasion and space impacts: Live updates - Space.com [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Opinion | Russia. Invasion. And Polands Very Long Memory. - The New York Times [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- A Scholar of Stalin Discusses Putin, Russia, Ukraine, and the West - The New Yorker [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- The letter Z is becoming a symbol of Russia's war in Ukraine. But what does it mean? - NPR [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Can the west slaughter Putin's sacred cash cow? - The Guardian [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Analysis: Can the UAE be a safe haven for Russian oligarchs? - Al Jazeera English [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Ukraine and Russia: What you need to know right now - Reuters [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Russia-Ukraine war LIVE UPDATES: Zelensky calls on Russian troops to surrender - The Australian Financial Review [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Ukraine-Russia war live updates: Ukrainians claim Russian strikes have hit apartment building in Kyiv, China denies claims Russia asked for military... [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- A Conductor on Why He Stayed in Russia After the Invasion Began - The New York Times [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Could Putin actually fall from power in Russia? - Vox.com [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- My mother says I am betraying Russia: Putins invasion divides the generations - The Guardian [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Lukashenko dodges and weaves over joining Russia in attacking Ukraine - POLITICO Europe [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Once, cultural ties to Russia were deliberate and hopeful. Now, they're eroding - NPR [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Russia Deploys a Mystery Munition in Ukraine - The New York Times [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- China's reputation is at risk if Beijing were to help Russia in its war on Ukraine - CNBC [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Why is India standing with Putins Russia? - Al Jazeera English [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Russia-Ukraine war: what we know on day 20 of the Russian invasion - The Guardian [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Russia Maps & Facts - World Atlas [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Russia keeps up attacks in Ukraine as two sides hold talks - The Associated Press - en Espaol [Last Updated On: March 15th, 2022] [Originally Added On: March 15th, 2022]
- Invasion jolts Russia's friends in tiny West-leaning Moldova - The Associated Press - en Espaol [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- Russia-Ukraine: Ugly truths in the time of war - Al Jazeera English [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- Russia's invasion of Ukraine will lower car production by millions of units over two years, S&P says - CNBC [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- How much can and will China help Russia as its economy crumbles? - CNBC [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- 400 Companies Have Withdrawn from RussiaBut Some Remain - Yale School of Management [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- Russia sanctions Biden and Blinken in retaliation for US sanctions - NPR [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- Without sending troops, the U.S. wages 'hybrid warfare' against Russia - NPR [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- Why Russia's attempt to bend Ukraine to its will could have the opposite effect - MSNBC [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- How close are China and Russia and where does Beijing stand on Ukraine? - The Guardian [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- How China's Response to Russia's Invasion of Ukraine Could Upend the World Order - TIME [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- Uneasy wait in Kyiv continues as Russian advance appears to have stalled - The Guardian [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- Russia-Ukraine war: What happened today (March 16) - NPR [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- Russia may aspire to a China-style internet, but it's a long way off - CNBC [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- Russia claims its close to a PEACE DEAL after Putins ... [Last Updated On: March 17th, 2022] [Originally Added On: March 17th, 2022]
- Renault Halts Operations in Russia - The New York Times [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- Russia is considering selling its oil and gas for bitcoin as sanctions intensify from the West - CNBC [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- Opinion | Russias War, Driven by the Grand Theory of Eurasianism - The New York Times [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- More Russian Mercenaries Deploying to Ukraine to Take On Greater Role in War - The New York Times [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- Opinion | Russias Neighbors Are Worried That, After Ukraine, Theyll Be Next - The New York Times [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- Russia reasserts right to use nuclear weapons in Ukraine - The Guardian [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- Russia May Nationalize Carmakers' Assets amid Ukraine Invasion - Car and Driver [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- Indians reluctant to denounce Russian brothers over Ukraine - The Guardian [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- Is the Ukraine war weakening Putins position in Russia? - Al Jazeera English [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- Russia-Ukraine war: what we know on day 33 of the Russian invasion - The Guardian [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- Russia-Ukraine war: What happened today (March 27) - NPR [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- Russian Soldiers Suffering Frostbite as Ukraine Invasion ... [Last Updated On: March 27th, 2022] [Originally Added On: March 27th, 2022]
- Russia's military is under pressure in Ukraine and refocusing on the east is likely to be a bloody campaign - ABC News [Last Updated On: March 29th, 2022] [Originally Added On: March 29th, 2022]
- Will Western-Russian Confrontation Shake the Middle East? - War on the Rocks [Last Updated On: March 29th, 2022] [Originally Added On: March 29th, 2022]
- Russia will 'always' be a part of OPEC+, UAE energy minister says - CNBC [Last Updated On: March 29th, 2022] [Originally Added On: March 29th, 2022]