Research by Physicians for Human Rights and partners shows that the 2,591 attacks on health since the start of the full-scale invasion are not isolated incidents but part of Russia’s systematic strategy with long-term consequences for civilian health and survival in Ukraine. From 2024 to 2025, documented incidents rose from 445 to 663—an almost 50 percent increase.
With the four-year mark of Russia’s full-scale invasion of Ukraine approaching on February 24, following over a decade of ongoing war, sustained attacks on health care continue driving widespread physical and mental harm across the country.
In 2022, when Russia launched its full-scale invasion, attacks on health care became one of the most visible symbols of the campaign against Ukrainian civilians. In the first month alone, Ukraine’s health system was damaged every day; four to five hospitals and clinics were attacked daily during the first two weeks.
To identify patterns behind the attacks and assess their impacts on population health, Physicians for Human Rights (PHR), eyeWitness to Atrocities, Media Initiative for Human Rights, Truth Hounds, and the Ukrainian Healthcare Center have been working with Insecurity Insight, which monitors and compiles data on these incidents.
“From the outset of Russia’s invasion in 2014—and with continued regularity since the full-scale invasion in 2022—attacks on health care have been a consistent part of Russia’s war. Our research shows that these attacks are not incidental and that they form part of a broader campaign against civilian infrastructure essential to survival, including energy, water, and sanitation systems,” said Uliana Poltavets, PHR Ukraine program coordinator.
“From bombed and pillaged hospitals to repeated power outages that shut down life-saving care and attacks on transportation that halt emergency response and the delivery of medicines, Russia’s relentless campaign undermines access to care, weakens community resilience, and places civilian lives at risk. Together, these assaults have steadily eroded civilians’ ability to survive, heal, and recover.”
Damage assessments and casualty figures from attacks capture only part of the harm being done to Ukrainians. Many more victims remain invisible, as attacks reverberate far beyond the point of impact.
“Access to medical care, especially specialized care, has become more difficult. The number of hospitals and doctors who can provide care is decreasing. Some are leaving, some are going to the frontlines,” said Dr. Lesia Lysytsia of Kyiv’s Okhmatdyt Children’s Hospital, which suffered a deadly missile strike in July 2024. “There are more neglected cases of disease. For example, people are afraid to seek help, and their illnesses progress. This applies to cancer, heart disease, endocrine disorders, and other conditions,” Lysytsia added.
Yet despite extensive documentation, accountability for attacks on health remains woefully inadequate. Critically, in both investigative efforts and peace negotiations, these violations risk being sidelined, threatening lasting harm to Ukraine’s people and its prospects for recovery.
The Scale of Attacks on Health in Ukraine
PHR and its partners have documented 2,591 attacks on health since February 2022, making this one of the most sustained assaults on health care in a modern war. “You can work in this mode for a couple of years, but not forever. […] For me, Okhmatdyt was a fortress. I thought a children’s hospital wouldn’t get hit,” said Dr. Lysytsia.
These attacks extend far beyond hospitals and clinics. Incidents documented by PHR, Insecurity Insight, eyeWitness to Atrocities, Media Initiative for Human Rights, Truth Hounds, and Ukrainian Healthcare Center include:
- 1,389 attacks damaging or destroying hospitals and clinics
- 235 attacks on ambulances
- 359 health workers killed and 379 injured
- 127 attacks affecting children’s health care
- 94 attacks affecting maternal health care
Early in the invasion, most incidents involved ground-launched weapons such as artillery and rocket systems. The rapidly expanded use of drones has transformed the conflict landscape. Surveillance and attack drone use has surged in recent months, disrupting medical evacuations, emergency response, and care delivery, often through repeated or “double tap” strikes targeting first responders.
“Our data shows that armed drones now pose a serious threat to safe medical care, increasing by over 1,000% since 2023, from 25 such incidents affecting health care in Ukraine in 2023, to 87 in 2024, to over 300 in 2025. Health workers operate under constant fear, patients delay or forgo treatment, and communities lose access to essential services. Under international humanitarian law, hospitals must never be targeted,” said Christina Wille, Insecurity Insight director.
The broader health consequences are severe. According to WHO Health Cluster reporting, prolonged conflict has driven a nationwide mental health crisis, deepened existing disease burdens, and created new risks for both communicable and non-communicable diseases.
In frontline areas, access to care is constrained by damaged facilities, high medicine costs, and lack of transport. Attacks on maternity hospitals across the country have forced women to give birth in increasingly dangerous conditions, contributing to a 37 percent rise in maternal mortality in 2024. Deaths now exceed births by nearly 2.8 times, placing Ukraine among the countries with the highest mortality rates globally.
Weakening Ukraine’s health care infrastructure has become part of Russia’s war strategy, yet the tactics have shifted through the years. From targeted and indiscriminate attacks on hospitals and clinics, and the critical infrastructure supporting them, to weaponizing health care in the occupied territories, Russia’s campaign has systematically reduced access to care, driven profound human suffering, and caused widespread preventable loss of life.
Health Care Under Occupation
The full impact of the war on health care in Russian-occupied territories—currently estimated to encompass about twenty percent of the country—remains unknown due to restricted access. However, available evidence suggests ongoing systematic obstruction and weaponization of health care, pushing already fragile systems toward collapse.
PHR and partners have recorded 32 incidents in which civilian hospitals have been repurposed into military bases. Dr. Oksana Kyrsanova, an anesthesiologist at Mariupol’s Regional Intensive Care Hospital, recounted how Russian forces occupied the hospital during their siege of the city: “On March 12, 2022, Russian military occupied the hospital. Their target was the hospital itself, because they could shoot from it and knew that [the Ukrainian military] would not fire back. The hospital became a human shield.”
In the 2023 report Coercion and Control, PHR and partners documented Russia’s use of health care to control and subdue Ukrainians living in the occupied territories. Among these practices is forced “passportization,” where access to health care is conditioned on acquiring Russian nationality. Health care workers in occupied oblasts are detained and persecuted, while those returning from Russian captivity report torture, ill-treatment, and inhumane conditions.
Attacks on Energy as Attacks on Health
Despite the extensive and well-documented suffering Russia is inflicting on Ukrainian civilians, it continues its targeted attacks on Ukraine’s energy infrastructure. PHR and partners have documented 229 attacks impacting hospital utilities since February 2022. A 2024 report by PHR and Truth Hounds, Health Care in the Dark, found that 92 percent of surveyed health care workers experienced power outages at their facilities as a result of the attacks on energy infrastructure. Two-thirds reported that outages disrupted medical procedures, including surgeries, dialysis, and maternity care.
Health care workers described postponed surgeries, interrupted life-support systems, and delayed emergency responses. Outages also affected hospital functions that are essential to ensure medical service delivery: communication systems, water supply, heating and ventilation, elevators, diagnostic equipment, and storage of medication and biological samples. According to Dr. Yevheniia Poliakova, a former director of a maternity hospital in Zaporizhzhya, “surgeries had to be performed with flashlights in cramped conditions, which meant that instead of a conventional hour, it took about 3 hours to complete the surgery.”
Russia’s systematic attacks on Ukraine’s energy infrastructure have had serious health consequences nationwide. Power outages have disrupted electricity, water, heating, and communications essential to medical care and basic survival, and have been particularly catastrophic for people reliant on home-based care, including dialysis and oxygen. PHR and Truth Hounds have documented how disruptions to medical devices, treatment routines, and basic services, often combined with water and heating outages, have led to heightened risks for people with chronic illness, disabilities, and older adults.
“Documenting harm caused by armed conflict requires looking beyond immediate, visible destruction. Systematic attacks on energy infrastructure produce serious consequences for civilian health that emerge over time and often remain undocumented by standard monitoring mechanisms. Our research shows that prolonged power outages create layered and cumulative risks for vulnerable groups — including older people with multiple chronic illnesses, individuals reliant on medical devices, and people with limited mobility,” said Dmytro Koval, PhD, co-director of Truth Hounds.
“Much of this harm occurs in private homes, develops gradually, and falls outside traditional frameworks for recording violations. By examining these overlooked forms of harm, we seek to strengthen the evidence base on how attacks on civilian infrastructure undermine health, dignity, and civilian protection. This exercise goes beyond classic accountability work and engages with the topic of reconstruction and rehabilitation. We believe that the data presented and analyzed in this research will inform interventions by other stakeholders from both accountability and rebuilding quarters,” Koval added.
An at-home dialysis patient, whose entire daily schedule must be organized around treatment and power cut schedules, described the impact of the power outages: “You connect to the machine in the evening, it works all night, and it cannot be interrupted –that’s how the system is programmed. When the first outages started at night, the machine began making strange sounds. I was terrified. My dad tried to connect it to some homemade batteries, but they were not enough.”
Power cuts also create mobility barriers, particularly for people depending on assistive devices, including those in wheelchairs who lose access to elevators, and others who rely on electricity for critical medical devices, leaving some effectively trapped in their homes due to non-functioning. The psychological toll is profound: patients, families, caregivers, and health care workers report heightened anxiety, burnout, depression, sleep disturbances, decline in productivity, social isolation, and worsening of preexisting mental health conditions.
Lesia Lytvynova, who leads a foundation working with palliative patients, explained: “A person who understands that they might die if the lights go out cannot be in a normal state. And a family who knows they are walking on the edge cannot be in a normal state either.”
These harms intensify in winter, particularly in cities such as Kyiv that are experiencing some of their coldest conditions in over a decade. Russia’s recent unrelenting attacks on Ukraine have crippled the energy infrastructure and left millions without power, heating, or water amidst freezing temperatures. While many people and communities in Ukraine tried to prepare for anticipated attacks by installing solar panels and other alternative heating sources, few anticipated the cold would be this intense or prolonged, forcing many to seek other improvised ways to stay warm. Given the circumstances of war, few can relocate to warmer areas.
“When homes cannot be heated, and water systems fail, the danger compounds, turning cold into a life-threatening public-health emergency. Russia’s attacks on Ukraine’s energy infrastructure are turning winter weather into a direct threat to civilian health and survival,” said Michele Heisler, MD, MPA, PHR medical director.
A lack of heating can have grave consequences for health, particularly for individuals whose medical conditions affect their temperature regulation. “Hypothermia can begin when indoor temperatures fall below about 60°F (15°C), as has been the case across much of Ukraine for many weeks. In these conditions, exposed skin can develop frostbite in minutes, and prolonged indoor cold dramatically increases the risk of heart attacks and the rapid worsening of chronic illnesses. Prolonged exposure to cold also increases the risk of strokes and can quickly worsen chronic conditions such as heart disease, lung disease, and diabetes. At 45°F (7°C), the body can lose heat faster than it can generate it. Children, older adults, and people who are already ill are at particularly high risk,” Heisler added.
Accountability and Next Steps
The sustained assault on health in Ukraine carries implications far beyond the country and this war. The scale, duration, and diversity of tactics documented since 2022 risk normalizing attacks on health care and life-sustaining infrastructure as a method of warfare, with grave consequences for civilians worldwide. The impact of these attacks extends far beyond immediate damage, creating cumulative reverberating effects that weaken health systems over time and disproportionately harm civilians who depend on stable access to care.
“International humanitarian law protects medical facilities, transport, and personnel. Attacks on energy and other civilian infrastructure that foreseeably undermine access to health care and endanger civilian lives may also constitute violations of international law,” said Sam Zarifi, JD, PHR executive director. “The patterns documented in Ukraine show that these protections have been repeatedly breached, likely constituting war crimes and potentially crimes against humanity.”
Yet accountability has lagged. Without meaningful investigation, prosecution, reparations, and immediate investment to address the country’s damaged systems, lost medical expertise, untreated trauma, and disrupted communities, the consequences of these attacks will persist long after the fighting ends.
Physicians for Human Rights calls on the Russian Federation to abide by international laws and refrain from attacks on health and other critical civilian infrastructure. We also urge for continued documentation of attacks on health and their population-level impacts; the prioritization of these violations within accountability mechanisms; and the integration of health system recovery and reparations for health-related harm into any future peace and reconstruction efforts.
Accountability for attacks on health is essential to protecting civilians today and preventing similar patterns of harm in future conflicts.
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.