In the midst of brutal war, healthcare and humanitarian aid workers represent hope. They travel to areas riven by conflict and ease the suffering of the most vulnerable through moving displays of humanity. Coming from a range of international organisations, they administer healthcare, distribute donations and support and manage emergency response. Humanitarian workers are committed to neutrality, impartiality and independence, helping anyone who needs it in a conflict area. In theory, they are protected from attack by international humanitarian law. But in practice they are frequently targeted, bombed and shot at by warring parties.
Russia’s conduct of the war in Ukraine is hauntingly familiar of its intervention in the Syrian civil war, which began in 2015. I have worked in Syria as an aid worker, and conducted research in areas while they were under Russian bombardment. I am familiar with the difficulties of trying to deliver humanitarian assistance in situations of extreme insecurity.
Russian authorities have claimed that in the “special operation” in Ukraine, Russia has only engaged in the targeting of military infrastructure. They have denied killing civilians or hitting civilian infrastructure, despite a wealth of evidence to the contrary.
The most glaring example is the attack on the Mariupol maternity hospital, which killed five, injured 17 and destroyed 90% of the hospital’s building. The number of people killed in the attack will be exceeded by the unnecessary deaths and illness from a lack of healthcare – women who will no longer have a safe place to give birth and newborn children who won’t receive necessary postnatal care.
This attack is far from unique. By March 22, the World Heath Organization listed a shocking 59 attacks on healthcare in Ukraine, more than one per day since the start of the invasion.
Read more: Ukraine war: how Russian denial of civilian casualties follows tactics used in Syria
Russia has accused the west of staging the attack, a piece of disinformation that is disturbingly reminiscent of its obfuscation of another war crime – the use of chemical weapons in Syria. One of the most famous of these attacks was in the opposition-held Damascus neighbourhood of Ghouta, where hundreds of civilians were killed and many more injured. Despite ample evidence suggesting the contrary, Russian authorities also claimed that the well-documented chemical attacks were staged.
Aid workers targeted in Syria
There are other parallels between the Russian invasion in Ukraine and its past intervention in Syria – including attacks on civilians, denial of humanitarian access and the spread of disinformation. Lessons from history would suggest that the true crisis in Ukraine may have only just begun.
Russia’s intervention to help its beleaguered ally Bashar al-Assad came in the form of air and missile strikes. During the next 12 months there was a dramatic spike in attacks on humanitarian aid workers, and healthcare infrastructure was systematically targeted by both Russian and Syrian militaries. Hundreds of facilities were destroyed, and hundreds of aid workers were killed.
When faced with such attacks, humanitarians often respond by sharing their GPS locations with both sides of an armed conflict. This strategy operates on the logic that if aid workers and hospitals are clear about where they are located, belligerents will avoid attacking them. Syria showed this to be a false assumption, as the Russian and Syrian militaries bombed hospitals with impunity, endangering healthcare and humanitarian workers instead of protecting them.
Aid workers are not armed – they cannot defend themselves, and there is nothing they can do to protect themselves from an airstrike or artillery barrage once it has been launched. When they are systematically targeted, as in Syria, their only choice is to leave.
The worst may be yet to come
Perhaps the most concerning thing about Russia’s strategy in Syria is that it worked. Under the weight of the Russian intervention, the opposition was crushed, millions of people were displaced, and hundreds of thousands were killed. Putin’s Syrian ally remained in power, and Russia’s strategic aims were met.
The Russian military has a long history of ignoring humanitarian corridors, killing civilians and attacking aid workers. If the similarities between Syria and Ukraine continue, the scale of the crisis is likely to increase.
Civilians on the ground suffer the most when aid workers are targeted. So far, the attacks in Ukraine have been against local healthcare workers and facilities, and not international humanitarian staff. There are several reasons for this, part of which is the strength of the pre-conflict Ukrainian healthcare system, which reduces the need for international aid workers. As the number of attacks on healthcare continues to increase, so will the need for international aid. But if targeted by one or both sides of the conflict, humanitarian aid workers will be forced to withdraw, just as they did in Syria.