Operating under Fire: Explosive Weapons and the Harm to Healthcare in Ukraine

Publication Date: 
Tuesday, July 18, 2017

A previous version of this article appeared on the Human Rights@Harvard Law blog here.

Since armed conflict broke out in Ukraine in 2014, the use of explosive weapons has directly damaged hospitals, destroyed ambulances, and killed or injured health workers. It has also indirectly affected the health care system by shutting down infrastructure—causing loss of electricity, heat, water, and communications—and creating travel risks for ambulances, medical personnel, and civilians in need.

These impacts have interfered with the provision of health care to local civilians and forced many to go without.

A recent report, Operating under Fire: The Effects of Explosive Weapons on Health Care in the East of Ukraine, documents the situation, drawing on field research conducted in communities along the front line. The report was jointly released by Harvard Law School’s International Human Rights Clinic and the Dutch peace organization PAX.

As the report makes clear, the harm attributable to explosive weapons’ use in populated areas has infringed on the availability, quality, and accessibility of health care, which are three elements of the right to health.

Impacts of explosive weapons

Explosive weapons encompass a range of munitions, including air-dropped bombs, artillery projectiles, rockets, and missiles. Especially when such weapons have wide area effects and are used in cities and towns, they almost always cause humanitarian harm. They kill or injure civilians immediately through blast and fragmentation. They cause buildings to collapse and debris to fly, which can lead to more civilian casualties. In addition, explosive weapons have reverberating effects; for example, by damaging infrastructure, they can interfere with the operations of hospitals and schools as well as compel local people to flee.

In Ukraine, structural damage and shattered windows have forced hospitals to abandon buildings and cut back on services. Doctors have treated patients in frigid conditions and operated by candlelight due to heat and power outages. Health workers and civilians alike have had to dodge shells and risk their lives to reach local clinics.

The health care problems have exacerbated the conflict-related difficulties faced by civilians in the east of Ukraine. They also exemplify one of the many humanitarian problems associated with using explosive weapons in populated areas.

International concern and response

Concern about the use of explosive weapons, especially with wide area effects, in populated areas has grown over the past decade. States, the United Nations secretary-general, UN bodies, the International Committee of the Red Cross, and nongovernmental organizations have all condemned the humanitarian harm caused by the practice. Moreover, a proposal to develop an international political commitment on the topic has gained momentum.

In documenting the harm that shelling has caused to Ukraine’s health care system, the report aims not only to shed light on the serious and ongoing suffering experienced by the civilians of one country. It also provides recommendations to minimize the effects of fighting on the region’s civilian population. Parties to the conflict should cease using explosive weapons with wide area effects in populated areas, and take precautions to avoid harming medical facilities, transport, and personnel as well as the infrastructure essential for proper health care. Moreover, to prevent future harm from the use of explosive weapons in any part of the world, countries should adopt an overarching political commitment and end the use of explosive weapons with wide area effects in populated areas.

The full report is available here, and the summary and recommendations are available here.

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