I will never forget when violence broke out during Ukraine’s Revolution of Dignity in 2013-2014. On a very cold winter day in Kyiv, confrontation between police and protesters escalated. I watched a bus burn in front of me on a central street. Even then, it seemed to me like an omen. Those of us who hoped the protests would bring about a brighter future in Ukraine knew the country would never be the same. Many lives were lost, but Ukraine chose a path of transformation. What followed, however, was beyond what any of us could have imagined.
Russia’s annexation of Crimea in 2014 felt almost physical – like losing a part of your own body. As Russian-backed militias took over Ukrainian administrations in Donetsk and Luhansk, we waited for the world to react. The response was timid. With time, we turned inward, focusing on reforms and making sure the sacrifices of those years were not in vain.
-
(Video: Protests during the Revolution of Dignity near Maidan Nezalezhnosti/ Independence Square in Kyiv, January 19, 2014. From the author’s personal archive.)
I was in the United States when Russia launched its full-scale invasion of Ukraine in February 2022. My friends and family back home were under bombardment, trying to evacuate or joining the fight. I spent sleepless night thousands of miles away, waiting to hear if they were alive. I did what I could do from afar – protests, donations, volunteering. But I knew I had to return. I knew I had to let the world see, hear, and understand what was happening to Ukraine.
I found my purpose in documenting war crimes in Ukraine with Physicians for Human Rights (PHR), ensuring that what was happening to Ukraine was being witnessed around the globe.
Attacks on Health as a Strategy of War
Soon after the invasion, my team at PHR began documenting attacks on health care workers and facilities, which quickly emerged as a dominant tactic of Russian warfare. Drawing on years of experience investigating and verifying evidence on attacks on health in Syria and other conflicts, we formed partnerships with Ukrainian human rights defenders as well as other international partners to expose these atrocities.
We knew that documenting these attacks was critical not only for collecting evidence but also for capturing patterns of violence in conflict and analyzing the broader impacts on the population. Documentation is so much more than gathering facts: it is also about memorialization, ensuring that truth is preserved to help future generations remember their history.
Documentation is so much more than gathering facts: it is also about memorialization, ensuring that truth is preserved to help future generations remember their history.
As we reach three years since Russia’s full-scale invasion in February 2022, the scale of destruction in my country is staggering. From the outset, health care was in the crosshairs. Russia immediately began attacking hospitals and health care workers, a tactic it honed for years in Syria, meant to break resistance and terrorize civilians. This assault on the health care system is not incidental – it is a war strategy. The destruction of hospitals, targeting of medical personnel, and coercive measures against health care workers and patients in occupied areas all serve to weaponize Ukrainians’ access to medical care, and maximize suffering, ultimately jeopardizing our way of life and making it impossible to lead a normal existence on these territories.
In the first year of the war, Ukraine accounted for nearly 40 percent of all global attacks on health care. Today, three years later, there have been more than 1,700 attacks on health in Ukraine. Hundreds of Ukrainian health care workers have been detained, arrested, or otherwise persecuted by Russian forces. Those who return from captivity report inhumane treatment, torture, including sexualized torture, and psychological abuse.
Russia’s attacks on energy infrastructure routinely disrupt power supply for our daily life; At my home in Kyiv we deal with power blackouts and utility shutdowns regularly. But many have not fully appreciated how these attacks also triggered a cascade effect on health care. Ninety-two percent of health care workers surveyed by PHR reported power outages in their facilities due to Russian attacks on energy. Two-thirds of the health care workers we surveyed told us these outages affected medical procedures, with surgeries postponed and interrupted, water supply interrupted, diagnostic equipment rendered unusable, and medication storage affected leading to spoilage.
The destruction of hospitals, targeting of medical personnel, and coercive measures against health care workers and patients in occupied areas all serve to weaponize Ukrainians’ access to medical care, and maximize suffering, ultimately jeopardizing our way of life.
The war is in every darkened operating room where doctors perform surgeries by flashlight and in every occupied hospital where Russian forces dictate which patients receive care.
Since 2022, Ukraine’s health care workforce has shrunk by 20 percent, and those who remain, continue to care for their patients under impossible conditions. An overwhelming majority – 83 percent – of health workers surveyed by PHR reported increased stress, burnout, and other challenges due to attacks on energy infrastructure and disruption of services.
Pathways to Justice
Attacks on health in conflict zones around the world are on the rise. Health facilities and workers are protected under international humanitarian law: in conflict settings, attacks on health facilities and workers can amount to war crimes or crimes against humanity. Yet these attacks have gone unpunished for decades. From Chechnya to Syria, from Sudan to Myanmar, Russia and other perpetrators have destroyed hospitals and clinics with impunity. The barrage of attacks on health in Ukraine is a chance for the international justice system to finally take a stand.
In 2024, the International Criminal Court (ICC) issued charges against Russian commanders for war crimes related to attacks on Ukraine’s energy infrastructure, citing “alleged strikes … directed against civilian objects” and “the expected incidental civilian harm and damage … clearly excessive to the anticipated military advantage.” This is an important step, but it is not enough.
Attacks on health must be prosecuted as the international crimes that they are. The ICC, national courts, and mechanisms of the United Nations must ensure these violations are investigated. Additionally, the international community should pressure those states which provide Russia with the weapons used to destroy hospitals – accountability must extend to those who enable these attacks.
Justice, however, is not just about courtrooms. For survivors of attacks, conflict-related sexual violence, torture and other violations, justice means recognition, safety, and support. Survivors in Ukraine need access to medical and psychological support, as well as trauma-informed forensic documentation. The Ukrainian government has taken important steps in this direction, creating new investigative units and support centers. But much more is needed: better training for health professionals, an enabling legal and policy environment, stronger coordination between legal and medical sectors, and survivor-centered approaches to justice.
Justice, however, is not just about courtrooms. For survivors of attacks, conflict-related sexual violence, torture and other violations, justice means recognition, safety, and support.
Health care workers, hospitals, and civilian infrastructure need urgent financial assistance, and survivors require continued support. Recent cuts by the United States to its international aid has put millions at risk in Ukraine.
Resilience and Hope
By the end of the third year of the full-scale invasion and after 11 years of war, we are understandably tired. International support is wavering and the Trump administration is embracing Russian talking points. But this is not the time to turn away. The consequences of disengagement are not just about Ukraine; they are about the future of international law, state sovereignty, and global stability. Strongmen of the world are emboldened by impunity and are testing the limits of international resolve. By ensuring accountability for the crimes being committed in Ukraine, we are all safer from the threat of aggression and tyranny.
By ensuring accountability for the crimes being committed in Ukraine, we are all safer from the threat of aggression and tyranny.
There are a lot of ways in which our lives in Ukraine have changed over the last few years. Falling asleep and waking up to the sounds of explosions, swooshing missiles, and buzzing drones, trying to squeeze life in between blackouts, and getting painfully used to losses – all of this does not come easily. But this is also the most rewarding place for me to be as Ukrainians and people from other countries come together in their resolve to support a more just future.
The countless stories of Ukrainian clinicians’ resilience give me hope:
The doctor from a town near Kyiv who provided care for her whole community during Russian occupation, despite knowing her husband and son were being held captive by Russian forces.
A doctor in an occupied city who refused to transfer identifying information about his patients to the new Russian authorities at grave personal risk.
The medic held in a Russian prison camp, trying to treat his comrades despite inhumane conditions and no available medications.
A doctor performing surgeries under bombardment and threats of the Russian army.
A pediatrician rushing to save colleagues and patients after a cluster munition attack on the hospital.
An obstetrician in a bomb shelter, caring for pregnant women and new mothers, and the youngest generation of Ukrainians.
These stories of defiance and dedication in the direst of circumstances, though, demand more than admiration. It’s up to all of us – in Ukraine and globally – to ensure their courage is met with documentation, memorialization, justice, accountability, and redress.