The destruction of healthcare infrastructure in the Russia-Ukraine war is shocking in its scale and brutality. In the first phase of the invasion (lasting 42 days), Russian troops committed a total of 184 attacks on health facilities, on average four episodes daily.

Healthcare infrastructure, including medical personnel, have special protection under international humanitarian law (IHL). Hospitals remain operational even amid active military action to ensure the continuous provision of medical aid to civilians. They are considered protected territory in a conflict, and military forces must take additional precautions to avoid putting health facilities at risk.

This report combines an analysis of the evidence gathered by the Ukrainian Healthcare Center’s team from open sources, local witnesses, and site visits.

The report displays the main patterns of attacks against healthcare facilities in Ukraine. They include targeted assaults, indiscriminate attacks, abuse of facilities during the occupation, and cluster munition use.

In addition, we analyze the massive scale of destruction as constituting an overarching pattern. By doing so, we want to stress that in addition to considering separate hospital attacks individually, it is essential to look at them as a whole to understand the nature of Russian aggression.

Hospital attacks were not a result of occasional mistakes or local execution failures. Our finding is that the massive destruction of healthcare infrastructure was not a unique phenomenon, appalling as it is in itself. Rather, it illustrates the overall strategy Russian forces and political leadership have applied against Ukraine. It is the strategy of deliberate disregard of distinguishing between civilian and military targets. In other words, terror.

This picture of all-pervasive terror is formed by episodes such as mass civilian killings in Bucha and Irpin, missile attacks on a railway station in Kramatorsk, the targeting of malls in Vinnytsia and Kremenchuk, and cluster munitions used against a children’s hospital in Chernihiv.

Our documentation of hospital attacks intends to contribute to the legal prosecution of war crimes and crimes against humanity committed by Russian military and political leaders. In addition, we urge international organizations, the World Health Organization (WHO) in particular, to take a more active stance against the mass destruction of healthcare in Ukraine.

This report was supported by the Agency for Legislative Initiatives within the program “Public Health” of the International Renaissance Foundation.