Initial summary

Location of incident: 2 provulok Zalikarnianyi, Izium, Kharkiv Oblast 64300 (approx. 49.18941, 37.27371)
Sites affected: Izium City Central Hospital
Date of attack: 07 March 2022
Time of attack (local time): between 7 March at 10:48 and 8 March at 08:00
Reported damage: Loss of essential healthcare services in the city
Type of attack/munition likely used: Likely artillery or tank round

Introduction

The Izium City Central Hospital, located in Izium, Kharkiv Oblast, suffered what appears to be a direct hit from a munition on 7 or 8 March 2022. The main entrance to the hospital was destroyed, while other parts suffered considerable damage. The damage to the hospital’s ability to treat patients was significant, while medical staff working at the hospital claimed few repairs were made during subsequent Russian occupation and that medical staff faced risk of summary execution and freedom of movement.

First published image of attack aftermath.

Methodology

This investigation examines open-source documentation pertaining to alleged attacks affecting Izium City Central Hospital, in Kharkiv Oblast on 7 or 8 March 2022, during the second week of the full scale invasion of Ukraine. A variety of open source materials have been preserved and analysed pertaining to the incident by cross-referencing a combination of open-source visual content and other public information. More in-depth description of specific methodologies are described in greater detail in the Methods section of Ukrainian Archive’s website.

This investigation was also undertaken with an awareness of international humanitarian law, which imposes limits to how parties to a conflict may conduct hostilities and under which civilians and civilian objects – including in particular hospitals, medical personnel, and objects indispensable to the survival of the civilian population – are protected. If proved, actions that violate these protections may constitute war crimes and human rights violations.

Through collection, verification, and analysis of the investigative findings from these incidents, the authors hope to preserve critical information that may be used for advocacy purposes or as evidence in future legal proceedings seeking accountability.

Data ethics

The authors have strived to incorporate a “risk minimisation” ethical framework into its research processes. Due to the repeated targeting of hospitals, medical facilities, and medical personnel since 2014, allegedly by Russian-backed DPR/LNR “people’s militias” and by Russian Federation armed forces in particular, additional precautions and ethical issues were taken into consideration. Such measures include censoring any identifying features such as license plates on photographs and only providing names of witnesses and victims if they have spoken to the press.

Ukrainian Archive supports transitional justice, as without accountability sustainable peace is very difficult to achieve. In order to help establish that digital content is what it purports to be, rigorous verification steps, guided by the Berkeley Protocol, have been taken to authenticate the findings.

Background on the affected area

Izium

Izium is a city in the Kharkiv Oblast and is an important railway and road juncture connecting Kharkiv with Luhansk and Donetsk. Due to its logistical value, Izium was one of the main objectives of the initial invasion wave in February and March 2022. The city lies in a valley created by the Siverskyi Donets River which divides the city into northern and southern halves, with higher elevation overlooking the city from both sides of the river. On the topographic map below, the impact site is annotated by a red dashed box, while the strategically vital train station is annotated by a blue dashed box. Note that the river divides the two areas. As Russian troops approached Izium around 06 March 2022, Ukrainian forces withdrew to the southern shore of the Siverskyi Donets. Open source documentation describes Russian forces having occupied the northern half of Izium at the time of the attack, but not having managed to cross the river. The battle for Izium continued until 01 April 2022, when Ukraine officially conceded that Izium had been captured by Russian forces. Izium was returned to Ukrainian control on or around 10 September 2022.

Location of hospital annotated in red; location of train station annotated in blue

Izium Central City Hospital

Before the war the hospital was the largest and best-equipped medical facility in Izium. According to Misto.ua, a registrar of Ukrainian hospitals and their capabilities, the hospital offered the following services prior to the war:

Anesthesiology and Intensive Care
Biochemistry lab
Blood lab
Cardiologist
Dentistry
Diagnostics lab
Drug testing lab
Emergency dentistry
Emergency Room
Endocrinology
Endoscopy
Forensics laboratory
Gastroenterology
General Medicine
Infectious diseases ward
Inoculation and Immunization
Maternity ward
Neurology
Oncology
Ophthalmology
Otorhinolaryngology
Pediatric Department
Pharmacy
Physical Rehabilitation
Physical Therapy
Psychiatric ward
Surgical Ward
Trauma center
Ultrasound and Diagnostics
Urgent Care
Urology
Women’s Health Specialist
Workplace injury documentation
X-Ray

What happened (and when)?

Location #1: Izium City Central Hospital

Summary of online reporting

The first mention of the attack is from Deputy Mayor of Izium Volodymyr Matsokin. He states that “This is the emergency room of our City Central Hospital. Probably another secret NATO base [sarcasm]. The patients had to dig themselves out of the rubble.” However, a Ukrainian investigative outlet Censor.net had reported that “hospitals and schools” in Izium had been under bombardment several days before the attack, indicating that this incident may be part of a broader pattern of attacks on healthcare infrastructure in the city. News of the attack was also reported by Suspilne, a Ukrainian public broadcaster. Kanal Dom, another Ukrainian news outlet, also ran a story on the attack, largely based on Matsokin’s post. On the same day, UK-based Sky News also reported on the attack, having verified the authenticity of Matsokin’s initial video. The attack was also reported by Gazeta Wyborcza, a major Polish news outlet. Ukrainian Archive was unable to find any mention of the attack on Russian news networks as of the time of publication.

Geolocation

The precise impact site is easily identified. Video from outside the hospital posted by Volodymyr Matsokin provides both spoken and visual claims of the attack. In the video, Matsokin states that it is indeed the Pishchanskoyi Bohomateri Izium City Central Hospital and notes that the most heavily damaged part of the building is the emergency department. A search revealed that there is a 360° street view photograph on Google Earth posted in August 2021 from approximately the same spot Matsokin’s video is filmed from. The photograph is from just outside the entrance to Izium City Central Hospital. On the set of images below, the side of the entrance to the emergency room is marked in red. The number, shape, and position of the windows appear similar between the two photographs, as does the yellow color of the exterior wall of the building. The brown awning in the corner where the entryway meets the main building is also clearly visible in both photographs.

Hospital following the attack and before the war

The following two images are another collection of screenshots from the prewar photo and Matsokin’s March 8 photo. In this series of photos, there are two more identifiable features: the first is the building outlined in green (the distinctive shape and layout of the structure can be observed in both photographs); the second, marked in yellow, is a red concrete barrier around the stairway and access ramp.

Image of hospital in the aftermath of the strike

Image of hospital before the war

These observed characteristics provide a strong indication that the damaged building is indeed Izium Central City Hospital. The damaged entrance is marked as the impact site below; a red rectangle marks the side of the entrance, and a green rectangle marks the oddly shaped building in the previous set of images.

Damaged part of hospital annotated in red and uniquely shaped building annotated in green

In the image below, the impact site is marked by a yellow marker. The blue dotted line indicates the assessed areas of control, which at this point ran along the Siverskyi Donets River, with Ukrainian forces positioned to the south and Russian forces to the north of the river.

Approximate location of munition impact on map of Izium, with the Siverskyi Donets River marked in blue

Chronolocation

The first news of the attack was shared by Volodymyr Matsokin on 08 March 2022 at approximately 15:07 local time (~13:07 UTC). All other reports on the attack were published later, and many were based on Matsokin’s post. Damage to the hospital had been previously reported, with Volodymyr Matsokin stating on 07 March 2022 at 17:48 local time (15:48 UTC) that:

“The center of town from the market to School No.1 is completely ruined. There are piles of stone, craters, destroyed trees, fires, and holes made by shells in the apartment blocks.

The bus station, courthouse, railway station, executive committee building, medical college, police station, draft office, and dozens of stores and offices are gone. All the windows in part of the hospital were broken, the sports school was hit by a shell. The central park became the scene of bloody carnage. The bridges are out.

And all this in a city where there was never any military presence.

But people come first. There’s no food, not even something as basic as bread. There is no water, power, gas, heating, or phone reception.

There is no way to leave in an organized fashion. There are new mothers in the basement of the hospital with their infants, and there is no medicine for them!!!”

It is unlikely that Matsokin would have only mentioned broken windows when much more extensive damage was present. This suggests that the attack took place at some point between 17:48 local time on 07 March and about 15:07 local time on 08 March. However, a third-party source, which was not found in this initial investigation, would be needed to externally corroborate the timing of the attack based on Matsokin’s posts.

The general time frame of the attack is consistent with increasingly severe Russian shelling of the city. A local Territorial Defense fighter stated:

“The northern half of the city was captured very quickly by Russian forces. On 6-7 March they were already in control of the railway station located there.

They were afraid to enter the center of town for a long time, probably fearing possible Ukrainian units there. So, for two weeks they shelled the city with tanks and artillery, a city with no military presence.

…

Everything near Kremenets Hill (the highest point in Izium) has been 100% destroyed. There is basically not a single house left standing there.”

Due to a lack of observable shadows in a sufficient number of images after the attack, it was not possible to conduct a shadow analysis to determine a more precise time of the attack.

Damage

Open source documentation acquired by Ukrainian Archive includes extensive photo, video, and witness evidence documenting damage to the hospital. Matsokin’s initial images from the impact site show part of the building badly damaged, likely from a direct hit by a munition.

Images of damage to hospital

In Matsokin’s video, damage to some surrounding structures can be observed as well. While it is unable to be determined whether or not this damage was a direct result of the same incident or part of another incident in which neighboring sites were affected, documentation shows a building (marked in green) showing signs of fire damage, impact markings, and broken windows.

Damage to another building on the hospital grounds

And in the below image, damage to the rooftops of large buildings nearby can be observed. Satellite imagery analysis allows for nearby buildings to be identified as part of the hospital, while the farther, larger building has been determined to be Izium Public School No. 4.

Damaged roof of Izium Public School No. 4

Hospital buildings and Izium School No. 4 in satellite imagery taken prior to the attack

The widespread damage from the attacks is consistent with Matsokin’s reporting, the accounts of a territorial defense member, and an interview with the hospital staff. A physician at the Izium hospital reported that aerial bombardment began on 1 March and became increasingly severe to the point where on 7-12 March an evacuation of staff and patients to Slovyansk was carried out by Ukrainian emergency services.

An image posted to Facebook by the Kharkiv Oblast State Administration on 23 September after liberation captures the attack site. It remains almost unchanged, indicating that little if any attempts to repair it were made during the occupation. The skeletal supporting beams of the roof are clearly visible in both images.

The image on the left was posted to Facebook on 08 March 2022; the image on the right was posted to Facebook on 23 September 2022, after liberation of Izium by Ukraine earlier that month.

Munitions used

The city was the site of heavy bombardment throughout early March. At this time Russian Armed Forces controlled territory less than 500 meters away from the hospital on the other side of the Siverskyi Donets River. Due to such proximity, there are many possible types of munitions that could have caused the damage. Open source documentation did not reveal any visible characteristics of weapons fragments or traces of weapons fragments in the materials studied. The hospital may have been hit by either tank or artillery fire, as bombardment of the city center was reportedly conducted using such weapons systems. This is consistent with the damage caused to the building, with the projectile impacting the upper right side of the northern part of the structure.

Northern facade of building shortly after the attack with probable impact site marked in orange.

However, mortars, rocket-propelled artillery, and air-launched munitions cannot be ruled out. Based on the scale of the damage, we can, however, remove from consideration cruise missiles or 152 mm and greater caliber artillery, since we would expect that those munitions would create far more destruction.

Map of areas of control in Izium with the hospital marked with a white cross within a red rectangle. The hospital was located less than half of a kilometer from Russian-held territory, which is marked in transparent red and roughly follows the path of the river in the area depicted.

Victims of the attacks

There are no known fatalities linked to this specific attack. It has been alleged that there were patients and staff inside the hospital during the attack. Matsokin reported that there were mothers with children in need of medicine sheltering “in the hospital basement” on 07 March 2022. The presence of medical staff and patients at that time is also confirmed by Dr. Yuri Kuznetsov, who continued working at the hospital throughout the entire occupation. In an interview, he states “From 7-12 March emergency workers evacuated the patients and staff to Slovyansk. After that there were only two doctors left at the hospital. Me and one other person.”

Following the liberation of Izium by Ukrainian troops, Ukrainian journalist Yelyzaveta Sokurenko conducted a series of interviews with medical staff who worked at the hospital during the occupation. She found that “When the artillery bombardment of the city commenced on 1 March, the hospital issued a plea for patients to be evacuated from the hospital by their relatives. Just five days later Izium became the target of air strikes, forcing the patients and staff from all four floors of the facility to relocate to the basement. Altogether there were 72 people there.” Matsokin’s initial report claimed that “patients had to climb out from under the rubble.” However, given that multiple reports, including by Matsokin himself, state that patients and staff were sheltering in the basement at the time of the attack, it is likely that timely and effective safety precautions by the hospital staff prevented any death or injury as a direct result of the strike on the hospital.

Resulting damage

As a result of the damage and the continued fighting, the hospital conducted all its work in the basement for several months. “Surgeries were also performed in the basement inside a separate large room that was kept locked. We performed surgery and stabilized patients there before transferring them to the hallway,” as reported by ZMINA. According to one of the doctors who stayed at the hospital for the entirety of the Russian occupation, the conditions there were “completely unsanitary.” The same doctor reported that only he and one other doctor were there for the first month; they had to rely on their training and the scant few reference materials available. Such conditions evidently created a lack of access to many types of medical care, leading to avoidable death and suffering among the civilian population. The shortage of medical staff is best illustrated by the near absence of trained OB/GYNs to help with delivering children and related complications. Out of 11 OB/GYNs practicing in Izium before the war, only Dr. Olha Besedina remained. She recounted having to assist women who were giving birth at the Russian military hospital.

“I had to perform a delivery in a Russian military hospital. A woman was brought there, it was the only place they could get her to. But what are they going to do with her there? These are military doctors. They came to my house in a BTR and took me at gunpoint to bring me there.”

Dr. Besedina also had to perform two deliveries in her home. She recounted that on one occasion she had to apply stitches to a tear resulting from childbirth using a veterinary needle and a specialized silk thread intended for stitching sails.

“The Russians didn’t provide me with any medical equipment. I had some bare essentials at home, but not even enough to properly perform a delivery, so I had to improvise.”

But perhaps most harrowingly, the only medical examiner in the district was summarily executed by Russian soldiers. Besedina recounts the incident, which is also confirmed by a surgeon from the same hospital in Izium, Dr. Anatoliy Kovalenko.

“They shot our medical examiner Fedor Havrylovych Zebskyi. They shot him right there at work. It sounds like they wanted to take away his car, to which he replied with a pro-Ukrainian statement… and they just shot him dead.”

The narratives of three medical professionals who were all practicing in Izium during the occupation demonstrate that the attack on the hospital had severe effects on access to healthcare by the local population.

Potentially responsible

The incident occurred during intensive shelling of Izium by Russian forces. While it is impossible to establish responsibility with absolute certainty, there is extensive evidence that the munition originated from Russian-held territory. This is evident by the damage caused by the projectile. The heavily damaged part of the structure faces north, toward Russian-controlled territory.

Impact site on a map of Izium

The part of the structure which took a direct impact, as well as the debris field around it, indicate that the munition could have come in from the north. The most heavily destroyed parts of the building are on the northern facade of a wing which is much lower in elevation than the building it is connected to directly to the south. It is highly unlikely that a munition coming from territory under Ukrainian control would strike the building at that angle. Furthermore, the north side of the structure suffered the most serious damage, which is an indicator that the munition could have come in from the north.

View of damage, observed from a northwest direction in relation to the hospital building

A satellite image (from Maxar Technologies acquired via Google Earth Pro) from 18 July 2021 shows the hospital building prior to being damaged in the incident in question.

Satellite image from Maxar Technologies captured on 18 July 2021.

On a satellite image from 22 March 2022, damage to the hospital building marked with an orange dashed box on the north side of the building can be observed.

Satellite image from Planet Labs captured at 11:16:53 UTC on 22 March 2022.

Conclusion

The damage to the hospital occurred as part of a broader bombardment of the civilian infrastructure of central Izium in the first half of March 2022. Whether or not the hospital was the specific target of bombardment, or whether it was inadvertently hit by indiscriminate fire cannot be established. The possibility that the hospital was hit by the Armed Forces of Ukraine or territorial defense units was considered, but given the location of the damage and topography of the site, this scenario is unlikely, as the damage points to a munition fired from Russian-held territory. Taken together, open source analysis presented above suggests that Russian Armed Forces are likely responsible for this incident.

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Investigation into attack on Izium City Central Hospital

INVESTIGATIONS