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As war broke out between Ukraine and Russia, everyone on earth can’t help but wonder, “Are we getting closer and closer to the gates of hell?”

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While political leaders were still trying to deescalate (or to further escalate) the conflict, irreversible damage has already been done. From a healthcare perspective, what have past data and science told us about wars?

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As obvious as it is, attacks on healthcare during armed conflicts are a violation of the International Humanitarian Law. However, amidst the chaos and other ‘more pressing matters’ in the warzone, this aspect of war remains a frequent, but underreported facet of armed conflicts. Most studies were published between 2010 and 2019, demonstrating a growing interest in this problem.

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Collating evidence from these articles, the authors summarised that attacks on healthcare could be motivated by an agenda to weaken civilians’ perception of the local government’s concern for their people, to intimate, or to destroy hopes to rebuild the war-devastated areas.

The vulnerability of health personnel to attacks is also a major research area. Emblems intended to designate protected services or other markers of healthcare such as white coats could heighten the risk of a targeted attack. In Burma, health workers had to hide in the forest until soldiers were asleep or moved away. In South Sudan, health workers would sleep in the hospital amongst the patients, or frequently changed their sleeping locations.

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Deployment of expatriate staff was also discussed as a double-edged sword, while attacks on expatriates are likely to cause international outrage, these staff could also raise the profile of the health facilities. In some cases, their higher standards of living could cause resentment amongst the locals.  

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This research aims to generate knowledge to curb the frequency and scale of attacks on health and mitigate their negative impacts. But research in the context of wars is challenging, partially due to difficulties in obtaining reliable data during times of insecurities, especially on gender-sensitive information and the motives of perpetrators. Quantitative research in particular is extremely important to understand the causal pathways of effects of specific attacks on various negative impacts. However, the most important question which scientists would not be able to answer is perhaps, ‘Is there accountability for these crimes?’