Since the beginning of the full-scale Russian invasion of Ukraine in February 2022, the UHC team has been documenting and collecting evidence regarding attacks on medical facilities. In a new analytical report, UHC experts analyzed how the Russian military destroyed the medical infrastructure of Mariupol. This document covers the period from the outbreak of the full-scale aggression of the Russian Federation against Ukraine on February 24, 2022, namely, when the airfield in Mariupol and antiaircraft systems in the city were hit for the first time, until May 20, 2022, when all the Ukrainian soldiers who were on the territory of the Azovstal plant were displaced to the temporarily occupied territory, and the city was completely controlled by the Russian army.

In recent years, the development of Mariupol has been one of the most dynamic in Ukraine. However, in 2022, the city became the scene of mass destruction and war crimes, almost unparalleled since World War II. The destruction of Mariupol can only be compared with the destruction of Grozny in Chechnya or Aleppo in Syria. The Russian Federation did its utmost to destroy each of these cities.

Violation of the Geneva Conventions and terror of civilians

A fundamental principle of international humanitarian law is that the parties to a military conflict must distinguish between military and civilian objects and do their best within the permissible limits to reduce the impact of military operations on the civilian component of life. Among all civilian facilities, medical institutions have a special status. The Geneva Conventions expressly prohibit harming them under any circumstances unless medical facilities lose their humanitarian function and act as military facilities. 

The Geneva Conventions also prohibit interfering with the operation of medical facilities, using them for an improper purpose or as “human shields.” Russia ratified the Geneva Conventions and, as a member of the UN Security Council, also approved Resolution No. 2286 of May 3, 2016, which additionally makes the implementation of the conventions regarding the healthcare infrastructure mandatory.

However, Mariupol became a symbol of the fact that during the aggressive war against Ukraine, the Russian Federation did not only violate certain regulations of international humanitarian law — it waged war as if this law did not exist.

82 out of 106 points of healthcare services provision in Mariupol were damaged or destroyed.

According to the estimates of the Ukrainian Healthcare Center (UHC), almost 8 out of 10 places, where medical assistance was provided to the Mariupol community and the southern part of Donetsk Oblast were damaged or destroyed.

Before the Russian invasion in 2022, the city had an extensive network of medical care facilities. Now, Russian troops destroyed almost all the civil infrastructure of Mariupol, including nearly 80 percent of the healthcare infrastructure — 82 out of 106 points of healthcare services provision damaged or destroyed. In 40 cases, the UHC team has direct verified facts of damage, and in 42 cases — evidence of a high probability of damage.

Regarding critical healthcare infrastructure, it is almost completely destroyed — the city has practically no primary care, general hospitals, children’s hospitals, maternity hospitals, or psychiatric facilities left. 33 out of 46 primary care outpatient hospitals were destroyed. This, along with the destruction of hospitals, could have led to depriving whole city districts of any medical care.

Central and Livoberezhnyi districts were the most affected: densely populated areas of the city remained without any medical infrastructure 

Most of the healthcare facilities were damaged or destroyed in the Central and Livoberezhnyi districts of the city. In the Central district, 84 percent of the PHSPs were damaged; in Livoberezhnyi, the number reached 93 percent. In fact, entire (once) densely populated areas of the city remained without any medical infrastructure and had no opportunities to get medical assistance. It was in the area of these two districts that active advancement by the Russian troops took place, which explains the scale of the destruction. Areas with fewer healthcare facilities were also severely damaged.

The massive and random shelling of civilian infrastructure, including healthcare infrastructure, aims to instill terror among civilians. It cannot be considered legal since such actions are aimed primarily at the moral welfare of civilians and not at reducing the military power of the armed forces. This type of attack is prohibited by international humanitarian law”, experts of the Ukrainian Healthcare Center comment. 

Mariupol is one of the cities where the Russian military used tactics similar to those they resorted to in Syria, namely targeted aerial attacks on hospitals. The use of unguided bombs shows that the Russians did not intend to launch pinpoint strikes on specific targets. Their real goal was to destroy civilian facilities.

Most of the damage caused to Mariupol and its healthcare system resulted from brutal and massive indiscriminate shelling of civilian infrastructure. On the main lines of attacks, the Russians tried to actually raze the city to the ground along with all the facilities needed to support the life of people.

These tactics involve an unprecedented scale and intensity of attacks, systematic, deliberate, and repetitive nature, and extreme brutality.

Under the conditions of occupation and constant hostilities, there is evidence of provoking a humanitarian disaster in the city. In particular, there is a lack of medicine, the threat of epidemics, and the lack of access to citizens by humanitarian organizations.

How the team collected and verified the data for the report? 

The temporary annexation of Mariupol and the attempts of the Russian occupation administration to hide the traces of its actions make it difficult to fully collect evidence of crimes, but there is still a lot of evidence.

Given that the city has been under active shelling since the beginning of the hostilities, and since May 20, 2022 it is actually under Russian occupation, the UHC team did not have the opportunity to visit the locations and collect evidence on their own.

Analysts used their own methodology — they collected, verified and analyzed information in four stages.  The estimates and calculations presented in the UHC analytical report are based on information from open sources, information from eyewitnesses, as well as satellite images provided by the Humanitarian Research Lab (HRL) based at the Yale School of Public Health. 

More information in the analytical report: