Targeting civilians and health care in war is unconscionable

Gerald E. Harmon, MD , Past President

It’s impossible to watch the heartbreaking images from Ukraine and not feel a deep sense of loss for the proud people defending their homeland from this unprovoked attack by the Russian military. And the longer this war unfolds, the more dire it becomes for civilians and for courageous physicians and health care workers flocking to the region to save lives.

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This aggression, layered atop the still dangerous COVID-19 pandemic, has created an enormous humanitarian crisis in Ukraine that our global community of physicians cannot ignore.

In addition to more than 3,000 civilian casualties in the first six weeks of the campaign, the World Health Organization (WHO) Surveillance System for Attacks on Health Care said that more than 60 medical personnel and their patients have been killed or injured in Ukraine since early March. Russia’s aggression has also destroyed vital health infrastructure, such as hospitals and clinics, in and around Ukraine’s largest cities, making it impossible for thousands of people to access health care in a time of desperate need.

Physicians and health workers on the ground in Ukraine have movingly described their experiences treating patients despite severe shortages of supplies and medication, urgent evacuation warnings, and under a constant threat of attack. A recent JAMA article, “Physicians in Ukraine: Caring for Patients in the Middle of a War,” as well as a JN Learning™ podcast on the AMA Ed Hub™ online platform, “Ukrainian Doctors Share Current Experiences,” provide a closer look at the horrors unfolding in Ukraine through the eyes of Ukrainian physicians.

The AMA is outraged by the brutal assault of the Russian military in Ukraine, and we stand with the World Medical Association and our other international partners in calling for an immediate ceasefire and an end to all attacks on health care workers and facilities. And for however long this conflict continues, it is critical that international humanitarian and human rights laws are upheld and that we protect civilians and medical personnel at all costs. 

As a physician and a 30-year veteran of the U.S. Air Force who proudly served our country in the medical arena in the global war on terror and overseas operations after 9/11, I have experienced the intense environment that doctors and medical personnel encounter in a war zone. 

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Senseless war in Ukraine sparks physician aid response

Battlefield medicine is unlike anything else on the planet. Doctors and the other members of the health care team—universally known as “the medics”—are called upon and willingly deliver care in incredibly hostile environments. And we do so frequently at great personal risk for seemingly unending periods of time, often providing care to those who would attempt us harm while caring for them.

Our role as trusted deliverers of care and dispensers of lifesaving medicines in all times, but particularly in a health emergency, cannot be overstated. Our work is essential, not only in providing aid and comfort to the people of Ukraine but in helping neighboring countries safely welcome refugees—including children, mothers and pregnant women—across their borders. Even in active combat zones, doctors and medical personnel need safe spaces, and adequately resourced facilities, to administer care to those in urgent need.

Wherever war is, doctors help

Organized medicine is stepping up to help in different ways.

The AMA Foundation, for example, is providing $100,000 in aid to support the efforts of the International Medical Corps and Heart to Heart International to deliver much-needed medical supplies, such as medicine, hygiene kits and basic PPE, as well as health care personnel in some of the hardest hit regions.

The WHO says it has delivered more than 160 metric tons of supplies to Ukraine and neighboring countries and is actively accepting donations for more. The organization’s wish list of items is expansive, encompassing everything from potassium tablets and ventilators to overhead lights.

The WHO also continues to raise money to support urgent medical care through its emergency relief fund. They have set a target of $57 million to help all of those affected by the crisis, both in Ukraine and in bordering countries.

A joint relief fund organized by the World Medical Association, the European Forum of Medical Associations, and the Standing Committee of European Doctors, is also collecting money globally to help those caught in the conflict.

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Frequently asked questions on ethics

In a joint statement issued in February following Russia’s initial siege of Ukraine, the three partner organizations urged Russian leaders “to respect the work of doctors and nurses in the country and the neutrality of health care institutions.”

Targeting civilians in combat and taking action to prevent doctors and other personnel from providing necessary medical care to their patients violates humanitarian laws that virtually all countries have pledged to uphold. Those actions have also, rightly, been labeled “war crimes” by the international community.

There is no shortage of health emergencies around the world that are worthy of our attention and our support. But the unconscionable attacks on civilians and medical workers in Ukraine demand a unified response from our global physician community. I urge you to consider joining me in lending your support to these international relief efforts.