Medical terrorism: Russia blocks access to healthcare to foist its citizenship and overcome resistance in occupied Ukraine

Russia is confronting Ukrainians in occupied parts of Ukraine with the bitter choice of either accepting Russian citizenship or risking their health, even life. As of 1 January 2024, only those who have a Russian ‘mandatory medical insurance policy’ will have access to public healthcare, with such policies only issued to those with Russian citizenship.  The aggressor state, which has imposed strict media censorship and propaganda as soon as it seized control of any Ukrainian territory is now also making access to the Internet only available to those who have Russian citizenship.  All of the above is in grave violation of international law, with the situation especially shocking since the aggressor state is then using the fact of Russian citizenship as a method of forcibly mobilizing Ukrainians to fight its war against their own compatriots.

The Centre for Journalist Investigations [CJI] has learned from their own contacts, as well as from open sources, that medics in occupied parts of Zaporizhzhia oblast are being forced to demand that patients have such a mandatory medical insurance policy, with this demanded even of ambulance staff.  All doctors have received instructions to insist on patients having the OMS [mandatory health insurance) from 1 January 2024  

CJI was told by an ambulance paramedic in Melitopol that they can decide whether to respond to urgent calls, but that the response will not be paid if the person does not have a policy.  She stressed that the management have not directly told them not to provide medical care, but warn them of such ‘consequences’ for themselves.

Melitopol residents have also confirmed receiving warnings that, from 9 January, when medical establishments return after the New Year and Christmas break, they will need to come with the package of documents demanded. .

The Russian invaders answers for the lives of those forced to live under their occupation and such methods of coercion directly jeopardize the lives of those needing medical treatment in an emergency, as well as the very many who would not be able to afford private medical care.

The use of healthcare as a weapon to foist citizenship began earlier, however it was initially critical mainly for those in need of regular medication.  In September 2023, it was learned that people were being refused insulin, which many diabetics need on a daily basis, unless they took Russian citizenship.  At least one person was reported to have died after not receiving medical care because he did not have a Russian passport.  In June, during the flooding caused by the destruction of the Kakhovka Dam in occupied Kherson oblast, there were numerous reports that rescue from homes almost totally submerged had been made contingent upon whether the residents had Russian citizenship.

All the measures of coercion are especially telling in the light of the absurd Russian claims of near total support for their fake ‘referendum on joining Russia’.  You would hardly need to place Ukrainians before a choice of “Russian citizenship or your life” if, as claimed, they were all rearing to ‘become part’ of the invading state.

An important case study, entitled Coercion and Control: Ukraine’s Health Care System under Russian Occupation, published in late December 2023, documents  the ways in which Russian is using health care to try to overcome resistance and to establish control over the civilian population on occupied territory.  This is a joint study by Ukraine’s Media Initiative for Human Rights and the international NGOs Physicians for Human Rights; eyewitness to Atrocities; and Insecurity Insight.  It follows an earlier report from February 2022 which showed how Russian “appeared to have both deliberately and indiscriminately targeted Ukraine’s health system as part of a broader attack on Ukraine’s civilian population and infrastructure”  

One of the methods investigated in the new study is that described above, namely forced changes of nationality as a precondition for gaining access to health care”, or ‘passportization’.  The authors cited 15 reported incidents where people without Russian citizenship had been refused medical care, or where people had been forced to obtain citizenship in order to have access to healthcare.

The study was, however, only up till the end of September 2023. The situation is now on a totally new level with the invaders’ official refusal to treat anybody without a Russian passport.

This was, moreover, only one of the methods deployed by Russian forces to obstruct access to healthcare. The researchers also found numerous cases where health facilities, including even a children’s hospital, had been taken over by the Russian forces, and used as military bases or for storing weapons.  In other cases, civilian patients had been removed from healthcare facilities or denied access to treatment in them, with the facilities then used for wounded (Russian) soldiers. Medical supplies in many cases had also been requisitioned for the invading army.

During the reporting period (from 22 February 2022 to the end of September 2023), they were aware of 68 healthcare workers having been detained in 17 separate incidents.  There had also been many occasions where medics had been forced to violate their professional and ethical obligations to their patients.  This is certainly the case now also where the Russians are making medics complicit in the denial of vital healthcare for those Ukrainians, living on Ukrainian territory, who do not want to cake the invader’s citizenship.