Infectious Disease

Physicians weigh in as attacks on health care continue in Ukraine

March 25, 2022

5 min read


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WHO estimates there have been upwards of two attacks per day on health care infrastructure in Ukraine since Russia’s invasion of the country.

As of March 25, there were 72 incidents of attacks on health care, resulting in 71 deaths and 37 injuries.

WHO estimates there have been upwards of two attacks per day on health care infrastructure in Ukraine. Source: Adobe Stock.

The war has prompted 3.6 million people to flee Ukraine, seeking refuge in nearby countries like Poland and Moldova. Nearly 7 million Ukrainians are internally displaced from the war. Among them, one in three suffers from a chronic condition, according to the International Organization for Migration. About 1,000 health care facilities in Ukraine are near conflict lines or in “changed areas of control,” WHO said.

In a statement, WHO called for an “immediate cessation of all attacks on health care.” The organization described the violence as “an act of unconscionable cruelty.”

“Attacks on health care are a violation of international humanitarian law but a disturbingly common tactic of war. They destroy critical infrastructure, but worse, they destroy hope,” Jarno hawkMD, PhD, a WHO representative in Ukraine, said. “They deprive already vulnerable people of care that is often the difference between life and death. Health care is not — and should never be — a target.”

Healio discussed the challenges facing health care in Ukraine with several Healio Primary Care Peer Perspective Board members, including David B Duong, MD, MPH, the director of the Harvard Medical School Program in Global Primary Care and Social Change, Manu Jain, MD, a professor of medicine (pulmonary and critical care) and pediatrics at Northwestern University Feinberg School of Medicine, Alexander KowalskiTHU, the medical director of Rowan Family Medicine in Stratford, New Jersey, Rita K. Kuwahara, MD, MIH, a primary care internal medicine physician and health policy fellow at Georgetown University, and Fatima Cody Stanford, MD, MPH, FAAP, FACP, FAHA, FAMWA, FTOS, an obesity medicine physician and director of equity for the endocrine division at Massachusetts General Hospital.

Healio: What are you thoughts on the was in Ukraine?

David Duong

David B Duong

duong: The human life loss and suffering ensued by this war is devastating on both the individual and global level. It is hard to believe that a land war with modern weapons of war are taking place in this day and age — and yet, that is the reality. My hearts and prayers go to the people of Ukraine.

Manu Jain

Manu Jain

jain: I think the war in Ukraine is an absolute tragedy. It’s hard to wrap your head around how this can actually be happening, that a sovereign country can be so unjustly attacked. There was no provocation, and you feel for all the innocent people whose lives have been turned upside down, not to speak of all the people, including children, who have died or been severely injured.

Alex Kowalski

Alexander Kowalski

Kowalski: My first thoughts are always for the impact on the non-military personnel and how their lives and health care needs will be disrupted, as well as future health-related issues associated with the experience of trauma.

Rita Kuwahara

Rita K Kuwahara

Kuwahara: Russia’s military attacks on Ukrainian civilians have created a humanitarian crisis in Ukraine. The killing of civilians and attacks on health care facilities and health care professionals constitute war crimes and must end now. The growing number of refugees and internally displaced persons in Ukraine are at high risk of experiencing poor health outcomes from lack of medicines and access to care, in addition to significant psychological trauma, and the ongoing war will worsen health inequities for decades to come. Destruction of Ukraine’s health care infrastructure means that civilians can no longer seek vital health care services. We must call for an immediate ceasefire to protect civilian lives, and it is critical for physicians and medical organizations to speak out against the atrocities occurring in Ukraine.

For Ukrainian civilians who have been displaced, every effort must be made to immediately supply individuals with critical medicines such as insulin, prevent infectious disease outbreaks — including rises in COVID-19 — provide adequate nutrition to prevent nutritional deficiencies and malnutrition, provide mental health services , and, for Ukrainians seeking refuge in other nations, language interpreters must be made available to prevent medical errors due to language barriers.

Fatima Cody Stanford

Fatima Cody Stanford

Stanford: I never saw it as a good thing, and I believe this war should not be. War creates division, pain and angst. It brings out the worse in people. We have even seen racial/ethnic minorities face racism during this war, if there was not enough to worry about.

Healio: How will the was impact primary care in Eastern Europe?

Duong: There have been at least 71 verifiable attacks on health care facilities in Ukraine since the start of the war, with six attacks alone on March 20, according to WHO. Similar to all wars and conflicts, the health care system is left devastated, from hospitals to community-based clinics. From a primary health care perspective, I worry about the lack of access to health care for the Ukrainian people during this time, and the extra morbidity and mortality that will result in lack of medicines for chronic diseases and delays/lapses in treatment. For refugees, a similar picture will play out in terms of limited access to their ongoing treatments and medications as they attempt to establish care in their new localities. For both populations, the trauma and mental health fall out will be tremendous. Finally, I think about the frontline health care workers, working tirelessly to save lives, and the dangers that they find themselves in, and pray that this horror will be over soon, and the global rebuilding of Ukraine can start.

Healio: What are the pulmonary health risks that may result from living in a warzone?

Jains: There are a number of pulmonary diseases that can manifest in war conditions. There are trauma-related complications such as pneumothorax, lung contusions and acute respiratory distress syndrome. There are also injuries related to inhalation of noxious gases, which can cause both large and small airway damage. The best known of these gases may be chlorine and mustard gas, which have both been used as chemical weapons. But other causative gases include phosgene, sulfides and fluorides. In addition, there can be severe burn injuries, which can be life-threatening, and these include both thermal injury of the upper airway and smoke inhalation, which tends to cause injury to the lower airways. Also, depending on the local conditions, pulmonary infections can be a significant cause of morbidity and mortality. These complications can occur in otherwise healthy people, but if you happen to have asthma, exposure to dust or allergens may precipitate exacerbations. Finally, I will say that in warzone, one will have limited resources with which to take care of patients, which can take an otherwise treatable illness and make it fatal.

Healio: Are family medicine physicians trained to prepare for crises like this?

Kowalski: Specific training on crisis management is not usually a part of medical school or residency curriculum. However, the broad knowledge base needed for family medicine and treating patients of all ages allows family medicine physicians to support in a unique way during crises.

Healio: How do you think the lack of access to adequate food and water is impacting people who are trapped in the country right now?

Stanford: The lack of access to food and water will lead to poor health and nutritional outcomes, but the stress and trauma will likely be even more damaging. The stress and trauma can ravage generations to come through epigenetics.


Position statements. Published March 2022. Accessed March 25, 2022.

Stop attacks on health care in Ukraine. Published March 13, 2022. Accessed March 22, 2022.

Surveillance system for attacks on health care. Accessed March 22, 2022.

Ukraine emergency. Accessed March 23, 2022.


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