Maintaining Health Care in Occupied Ukraine: Criminal Collaboration or Conscientious Professionalism?

Following Russia's occupation of Eastern Ukraine, local health care professionals, particularly hospital administrators and public health officials, have faced criminal charges of medical collaboration for taking senior managerial positions in the occupation regime and allocating resources to the Russian army. Although Ukraine is entitled to prosecute collaborators who threaten its national security, the grounds for criminalizing medical administration during military occupation are much weaker and essentially indefensible. During occupation, international humanitarian law requires Russia to maintain adequate health care services with the assistance of local officials, protects these officials from prosecution, and ensures their independence as they weigh their professional duties to maintain essential health care for the civilian population. An analysis of representative legal cases charging health care professionals with treason and collaboration demonstrates the shortfalls of Ukrainian policy that (a) does not clearly differentiate between charges of collaboration, aiding and abetting the enemy, and treason, (b) rejects public health officials’ duty to cooperate with an occupation regime, and (c) ignores health care administrators’ right to condition their decision to cooperate on its attendant costs and benefits. Recognizing a policy of humanitarian cooperation rectifies these deficiencies by highlighting the independence of health care officials, their protection from prosecution by Ukrainian and Russian authorities, and each party's duty to maintain adequate medical care for the local population during military occupation.