Russia’s widespread and systematic attacks on Ukraine’s energy grid have harmed health care workers and endangered patients, according to a first-of-its-kind report published today by Physicians for Human Rights (PHR) and Truth Hounds. Ninety-two percent of 2,261 Ukrainian health care workers surveyed report experiencing power outages at their health care facility due to attacks on energy infrastructure. Health care workers reported these attacks also caused permanent health harms and even deaths.
“Russian forces must cease their ongoing bombardment of Ukraine’s energy and health infrastructure while prosecutors at the international and domestic levels should investigate attacks and hold perpetrators to account for these potential war crimes and crimes against humanity,” said Uliana Poltavets, report co-author and PHR Ukraine emergency response coordinator.
“Health Care in the Dark: The Impacts of Russian Attacks on Energy in Ukraine” documents how Russian attacks on the power grid have caused reverberating impacts on health care, including suffering and disruptions to the Ukrainian health system. The report details how the assault on Ukraine’s energy infrastructure led to interrupted or delayed surgeries, forcing surgeons to operate in darkness illuminated only by flashlights; failures in life support systems; discontinued flow of water to hospitals; diagnostic and treatment equipment becoming unusable; patients experiencing panic attacks and cardiac arrhythmia due to lack of power; impeded maternal care service delivery; and other impacts on health care provision.
PHR and Truth Hounds conducted an online survey with health care workers across Ukraine to better understand how attacks on health and energy infrastructure affect the health of Ukraine’s population, the working conditions of health care workers, and the experiences of patients. The results of the 2,261 health workers surveyed include:
- Two-thirds of health workers (66 percent) reported that power outages due to attacks on energy infrastructure affected medical procedures in their facilities.
- Eight percent noted delays in elective surgeries, two percent experienced interruptions during surgery, and two percent reported failures in life support systems due to outages.
- Outages disrupted communication systems (36 percent), water supply (22 percent), heating and ventilation (19 percent), and elevators (17 percent).
- Eight percent of respondents noted malfunctions in diagnostic equipment, such as X-ray machines and MRIs due to outages.
- Medication storage issues, leading to spoilage, were reported by 14 percent of respondents, and four percent informed about problems with storing biological samples like blood or embryos.
- Permanent health harms (36) and deaths (20) were also reported to result from attacks on energy that impacted power at health facilities.
- Eighty-three percent of health workers experienced increased stress, burnout, and other challenges due to these attacks on energy infrastructure and disruption of services.
The report is the first comprehensive study to show the links between attacks on energy infrastructure and health care in Ukraine.
“Russian attacks on Ukraine’s energy infrastructure have triggered a cascade of far-reaching consequences, disrupting countless aspects of daily life. These strikes go far beyond mere ‘inconveniences’ for civilians – they pose a severe threat to the lives and health of millions,” said Roman Koval, report co-author and Truth Hounds head of research.
“The Russian assault on Ukraine’s power grid has cut patients off from lifesaving medical care, plunging surgeries into darkness and disrupting critical equipment,” said Poltavets. “As Ukraine enters winter, international actors should support Ukraine’s courageous clinicians and work to end this deadly violence against civilians, including attacks on hospitals, power plants, and other civilian infrastructure. The global community must ignite efforts to hold Russia to account for violations of international law resulting from these attacks.”
Prior to the war, Ukraine had one of the most developed energy sectors in Europe but available capacity plummeted by 85 percent by June 2024 due to Russia’s systematic attacks on energy infrastructure. Russia has blocked gas transit to Ukraine, seized energy infrastructure assets, launched cyberattacks, and systematically bombed Ukraine’s energy infrastructure. As of September 2024, Russia has reportedly destroyed all thermal power plants and nearly all large hydroelectric power plants in Ukraine. The United Nations Office of the High Commissioner of Human Rights has condemned Russian strikes on Ukraine’s energy network, warning of the “grave risks” of these attacks for the health and well-being of civilians, particularly vulnerable populations in Ukraine as winter arrives. At least 1539 verified attacks on health care workers and infrastructure have been perpetrated in Ukraine since February 2022. At least 104 attacks have impacted hospital utilities, such as the water or energy system.
Despite clear protections for health and energy infrastructure during armed conflict under international law, attacks on the power grid and health facilities have been significant features of the Russian invasion. In many cases, these attacks amount to violations of international law, including the laws of war and the human rights to life and health, and may give rise to criminal culpability as a matter of international criminal law. The Health Care in the Dark report is informed by case studies of attacks on Okhmadyt National Specialized Children’s Hospital and Mariupol Regional Intensive Care Hospital, a detailed analysis of attacks on energy infrastructure, in-depth interviews with health workers, an open-source analysis, and a survey of health workers conducted from July-September 2024. The report findings, while not generalizable to the entire country, offer a snapshot into the experiences of the health workers surveyed and interviewed. Given the difficulties in reporting faced by clinicians, particularly in Russian-occupied regions of Ukraine, figures may undercount the true tolls of attacks on civilians and civilian infrastructure.
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.