Assessing Intent: Repetitive Strikes on Ukrainian Health Care Facilities

Area of Science:

• International Humanitarian Law
• Conflict Medicine
• Digital Open Source Investigations

Background:

• Attacks on healthcare facilities, potential war crimes, are increasing in armed conflicts.
• The full-scale Russian invasion of Ukraine has seen continued attacks on health infrastructure.
• Documenting repeated attacks on health facilities is crucial for establishing intent in war crime prosecutions.

Purpose of the Study:

• To assess the frequency and patterns of repetitive attacks on Ukrainian health care facilities.
• To analyze data on attacks from February 24, 2022, through October 24, 2023.
• To evaluate the potential implications of repeated attacks for establishing intent.

Main Methods:

• Utilized the Berkeley Protocol on Digital Open Source Investigations for data collection.
• Documented facility type, location, attack and weapon types, casualties, and damage.
• Recorded temporal factors, including the number and timing of attacks on individual facilities.

Main Results:

• 397 attacks on 281 health care facilities were recorded.
• 53 facilities (18.9%) were attacked more than once, with a median of 2 attacks per facility.
• 110 attacks (27.7%) were part of a series of recurrent attacks on specific facilities.

Conclusions:

• Approximately one-in-five targeted health care facilities in Ukraine faced repetitive attacks.
• Nearly one-in-four attacks on health care involved recurrent targeting.
• The pattern of repeated attacks suggests a potential for intentional targeting of health care facilities in Ukraine.