For a month now, Russian forces have repeatedly attacked Ukrainian medical facilities, striking at hospitals, ambulances, medics, patients and even newborns — with at least 34 assaults independently documented by The Associated Press.
With every new attack, the public outcry for war crimes prosecutions against Russian President Vladimir Putin, his generals and top Kremlin advisers grows louder.
To convict, prosecutors will need to show that the attacks are not merely accidents or collateral damage. The emerging pattern, tracked day by day by the AP, shows evidence of a consistent and relentless onslaught against the very civilian infrastructure designed to save lives and provide safe haven to Ukraine’s most vulnerable.
AP journalists in Ukraine have seen the deadly results of Russian strikes on civilian targets firsthand: the final moments of children whose tiny bodies were shredded by shrapnel or had limbs blown off;dozens of corpses, including those of children, heaped into mass graves.
“The pattern of attacks will help prosecutors build the case that these are deliberate attacks,” said Ryan Goodman, professor of law at New York University and former special counsel at the U.S. Department of Defense. “Prosecutors will draw inferences from how many medical facilities were targeted, how many times individual facilities were repeatedly struck and in what span of time.”
Deliberate attacks on hospitals will likely be a top priority for war crimes prosecutors.
This accounting of attacks on medical facilities is part of a larger effort by the AP and the PBS series Frontline to track evidence of potential war crimes committed during one of the largest conflicts in Europe since the end of World War II.
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The War Crimes Watch Ukraine project launched by AP and Frontline includes details of apparent targeted attacks as well as indiscriminate destruction of civilian buildings and infrastructure. The AP/Frontline online database will continue to be updated as long as the conflict lasts. The goal is to provide an independent accounting of events, apart from potentially inflated claims by advocates or misinformation spread by state-backed propaganda.
This story is part of an ongoing investigation from The Associated Press and Frontline that includes the War Crimes Watch Ukraine interactive experience and an upcoming documentary.
The AP's own reports include strong visual evidence such as photos and videos, along with witness accounts of alleged atrocities. AP journalists outside Ukraine have confirmed the details of other attacks by interviewing survivors and independently verifying the authenticity of videos and photos from the war zone posted online by local officials and residents.
The United Nations High Commissioner for Human Rights confirms at least 1,035 civilians, including 90 children, have died in the four weeks since the start of the war. An additional 1,650 civilians have been wounded. Those numbers are certainly an undercount since scores of bodies now lie under the rubble of demolished buildings or were hurriedly buried in mass graves, or the deaths occurred in areas now under Russian control.
Still, Russian officials have denied hitting civilian targets, deriding the mounting documentation of atrocities as “Fake News” and claiming without evidence that dead and wounded civilians photographed were “crisis actors.”
Speaking at talks in Turkey about a potential cease-fire, Russian Foreign Minister Sergey Lavrov dismissed concerns about civilian casualties as “pathetic shrieks” from Russia’s enemies and denied Ukraine has even been invaded.
Military attacks on civilian populations and their property are generally forbidden under international laws governing armed conflicts going back more than a century. Efforts are already underway by the International Criminal Court in the Hague and Ukrainian prosecutors to compile evidence for future criminal indictments.
Chief ICC prosecutor Karim A.A. Khan announced last month that his agency had opened an investigation after receiving referrals from 39 nations over potential evidence of war crimes committed in Ukraine. President Joe Biden has said he believes Putin is a war criminal, and the U.S. government has assessed that members of Russia’s armed forces have committed war crimes.
Attacks on medical facilities and staff are considered particularly heinous under international law, which stipulates they must be protected. Still, bombing a hospital is not necessarily a war crime. Prosecutors must show that the destruction is intentional or reckless.
But the evidence of such attacks in Ukraine verified by AP and Frontline is both mounting and horrendous, and belies Russian claims that they were staged, self-inflicted or militarily justified.
Russia is bombing “medical infrastructure on purpose, fighting sick people as if they were military,” said Pavlo Kovtoniuk, a former deputy minister of health and WHO consultant who co-founded the Ukrainian Healthcare Center, a think tank based in Kyiv that has been documenting attacks on hospitals.
“Bombing hospitals is especially cruel because it shows civilian people that there is no safe place for them on earth,” he said.
Among the most thoroughly documented strikes was the March 9 bombing of a children’s and maternity hospital in Mariupol. Two AP journalists, the last international media to remain in the city after it was encircled by Russian forces, arrived at the hospital minutes after the explosion.
They saw a smoldering two-story-deep crater in the interior courtyard, surrounded by the twisted and burned remains of several cars. The force of the explosion tore the facades off three surrounding buildings, blowing out the windows and wrecking rooms inside.
The AP journalists took photos and video of stunned survivors coming out of the hospital. A pregnant woman being carried on a stretcher held her belly, blood staining her sweatpants, her face pale. She later died following an emergency cesarean section at another nearby hospital, according to Dr. Timur Marin, one of the surgeons who tried to save her. The woman's baby also did not survive.
Another pregnant woman, Mariana Vishegirskaya, her face bloodied, clutched her belongings in a plastic bag and made her way down a set of debris-strewn stairs and out of the ruined hospital.
Vishegirskaya was taken to another nearby hospital, Mariupol Regional Intensive Care, where she gave birth the following day to a baby girl she named Veronika.
“We were lying in wards when glass, frames, windows and walls flew apart,” she told AP, lying next to her newborn.
Ukrainian authorities say three were killed by the airstrike, including a child, while 17 were wounded.
Kremlin officials admitted Russian aircraft had struck the hospital but insisted all patients and staff had been evacuated prior to the bombing. Russian state media claimed without providing any evidence that the hospital was being used as a base for the Azov Battalion, a small far-right nationalist group often used as casus belli by Putin for false claims that the Ukrainian government is rife with Nazis.
At a U.N. Security Council meeting the day after the strike, Russian Ambassador Vassily Nebenzia claimed the wounded pregnant women documented by AP journalists were “crisis actors,” playing the part of victims in an elaborate plot to frame Russia.
On Twitter, the Russian Embassy in London posted two AP photos side-by-side, one depicting Vishegirskaya and another of the pregnant woman who died. Each was branded in red as “FAKE.” Twitter removed the tweet for violating its rules against denying violent events.
Vishegirskaya is a blogger in Mariupol who before the war posted about skin care, makeup and cosmetics; there is no evidence that she was anything but a patient at the hospital. She posted multiple photos and videos on Instagram documenting her pregnancy in the past few months.
The AP journalists also saw no evidence that the facility was being used as anything other than a hospital. They saw no military hardware or vehicles among the burned-out wrecks in the courtyard. Hospital rooms were filled with beds and medical equipment.
The contention that the victims were actors and the hospitals were military targets “is preposterous, and no court of law would give it any credence,” said David Scheffer, who served as U.S. ambassador at large for war crimes issues during the Clinton administration. ”Imagine them trying to say it in front of a seasoned panel of judges as if it can be credibly believed.”
Scheffer and Goodman both said prosecutors in any future trial are likely to argue multiple strikes against medical facilities are evidence of an intentional strategy to break the morale of the enemy population.
Russian commanders used similar airstrikes during the Syrian war. Physicians for Human Rights, an advocacy group that tracked attacks on medical workers in Syria, documented more than 250 attacks on medical facilities and staff after Russia intervened in the conflict in 2015.
The assaults on medical facilities in Ukraine began with at least two attacks on the very first day of the war.
On Feb. 24, a local media organization posted a photo on Twitter of City Children’s Hospital No. 1 in Donetsk, struck by an artillery shell that damaged its top floor. AP found that the photo matches the pictures of the hospital from before the war; the building is clearly marked as a medical facility on maps of the area.
Another photo posted on Twitter showed a large explosion and fire at Central City Hospital in Vuhledar. AP matched the building in the photo to pre-war images of the hospital in Vuhledar, which is clearly marked as a medical facility on maps.
The advocacy group Human Rights Watch obtained additional photos from the hospital’s chief doctor, Natalia Sosyura, who provided the names of the four civilians who died in the strike. Ten others were reported to have been wounded.
Additional photos published by a Ukrainian media organization showed two burned out vehicles in the hospital’s driveway with two bodies covered by blue sheets. Another photo showed the crumpled nose cone of a rocket.
Chris Weakley, a former U.S. Army explosive ordnance disposal technician and private intelligence analyst, identified the cone as coming from a Russian Tochka ballistic missile,used to carry cluster munitions. As a former Soviet republic, Ukraine also has access to some Russian weapons systems, but there is no evidence Ukraine has been attacking its own hospitals.
In a statement issued March 12, a spokesperson for the U.N. high commissioner for human rights in Geneva, Liz Throssell, said the agency had received “credible reports of several cases of Russian forces using cluster munitions” and specifically cited the attack in Vuhledar.
The stockpiling and use of cluster munitions is banned under an international convention signed by 110 countries, but Russia and Ukraine are not among them. However, their use in civilian areas is by definition indiscriminate — a violation of international humanitarian law — since the munition scatters small grenade-sized bomblets over a wide area.
On the second day of the war, three more Ukrainian medical facilities were reported to have been hit, including a children’s hospital and cancer center.
Kharkiv Regional Children’s Clinical Hospital No. 1 also was struck by a cluster bomb munition, wounding one staff member. Photos posted on the hospital’s social media accounts show numerous impact craters on the hospital campus, including one in a playground. One of the photos shows an unexploded bomblet about the size of a soda bottle on the ground near the front entrance. Weakley identified it as a Russian-made 9N235 cluster submunition.
A different video verified by AP shows a series of explosions in a building identified on maps as the oncology department of Melitopol City Hospital No. 1. The building in the video matches pre-war imagery of the hospital, which features a large red cross on the facade.
Statistics for the number of Ukrainian medical facilities damaged since Russia invaded vary widely. The Ukrainian Health Ministry says 248 medical facilities have been damaged, with 13 completely destroyed. The World Health Organization, by contrast, said 58 Ukrainian medical facilities have been damaged, some more than once. The AP and Frontline have only counted those they could independently confirm.
Russian shelling in Lysychansk caused extensive damage to Luhansk Regional Children’s Clinical Hospital in early March. Sergei Haidai, a local government official, said the hospital was hit by at least 10 shells over a two-day period, wounding a surgeon.
AP video from March 11 shows damage to ambulances and buildings at Dergachi Central Hospital, which Mayor Vyacheslav Zadorenko says resulted from a Russian attack on his town. That video also shows expended cluster rocket canisters impaled in the ground. Weakley identified them as Russian-made 9M27K cargo rockets, which carry the same bomblets found at the children's hospital in Kharkiv.
Okhmatdyt Children’s Hospital in Kyiv, which houses Ukraine’s primary pediatric cancer center, has repeatedly been rocked by explosions since the war began. Dr. Serhii Chernyshuk, the hospital’s medical director, said the blasts and shrapnel from Russian missiles and rockets landing nearby have blown out windows and doors.
To try to keep their patients safe from the ongoing bombardment, Ohmatdyt’s staff moved them into the basement. An AP journalist who visited the facility on Feb. 28 photographedthree young cancer patients, their heads bald from chemotherapy. Two held up sheets of notebook paper with a handwritten message in English: “Stop War.”
Chernyshuk said he and his staff have been largely living at the hospital, working long hours on little sleep.
“We must support our patients because, in Kyiv and Ukraine, it’s terrible for everybody,” he said. “But our patients have a different problem, they cannot help themselves. We must do it.”
Yulia Ablamskaya was one of 17 employees inside the Mediland Clinic Kyiv when she says a loud "boom” rocked the building in the early morning hours of March 16. As the chaos unfolded, she hurried to get the three remaining patients at the center to a safer place. The patients, she said, are all awaiting operations and unable to travel.
“We felt the walls of the building shivering,” Ablamskaya, an administrator at the clinic, recounted. “So, we of course jumped up and went to take the patients.”
Once they were safe, she returned to take photos and videos of the damage, which she provided to AP. They show cracked walls and shattered windows.
There's also evidence Russian forces have intentionally targeted ambulances and medics, including multiple photos posted by Ukrainian health officials showing ambulances riddled with bullet holes.
Video posted online Feb. 26 shows an ambulance is engulfed in flames on a rural road outside Kherson after Ukrainian officials say it was struck by Russian heavy weapons fire. Medics from a second ambulance work feverishly to save a wounded man wearing a red paramedic's uniform who is on the ground, bleeding from his head. Ukrainian media and government authorities reported the ambulance's driver, Volodymyr Vasyliovych Kovalchuk, and a patient died in the attack, which appears to match a confirmed incident in the WHO database.
Ukrainian Health Minister Viktor Liashko said in a Facebook post on Wednesday that Russian forces have hit 58 emergency vehicles and killed six medics, forcing the government to outfit emergency medical workers with body armor.
David Crane is a former senior inspector general in the Department of Defense who served as chief prosecutor of a United Nations-sponsored war crimes tribunal over atrocities committed during Sierra Leone’s civil war. What is happening in Ukraine, he said, is worthy of prosecution.
“The bottom line is this is medieval warfare in the Ukraine,” Crane said. “It’s precisely the sort of warfare that the laws of armed conflict were designed to prevent.”
For more on the Russian attacks on medical facilities, including information on each attack, go to https://www.pbs.org/wgbh/frontline/interactive/ap-russia-war-crimes-ukraine/
AP Investigative Reporter Michael Biesecker reported from Washington and News Verification Reporter Beatrice Dupuy from New York. AP reporters Mstyslav Chernov and Evgeny Maloletka in Mariupol, Ukraine, Sarah El Deeb in Beirut, Lebanon; Jason Dearen and Larry Fenn in New York; Juliet Linderman in Baltimore; Joshua Goodman in Miami; Richard Lardner and Helen Wieffering in Washington; Lori Hinnant in Paris; and James LaPorta in Wilmington, North Carolina, contributed.
Follow Biesecker at twitter.com/mbieseck, Kinetz at twitter.com/ekinetz and Dupuy at twitter.com/Beatrice_Dupuy
Contact AP’s global investigative team at Investigative@ap.org.