Addressing Russian crimes against humanity in Ukraine now is good medicine

As human rights lawyers, U.S. policymakers and Western allies unite to formally recognize Russia’s aggression in Ukraine as crimes against humanity, physicians have a moral and ethical obligation to add their voices to a call for action.

The basic tenet encompassed in our Hippocratic oath is to respect and care for patients, to do no harm — a doctrine which, in our view, extends to those at risk of injury and trauma. Therefore, when barbarous acts are systematically committed against civilians — including torture, rape, forced deportation and executions — we must join legal experts like Oleksandra Matviichuk to hold Russia accountable for atrocities committed in Ukraine.

Matviichuk, an eminent attorney and civil rights leader, along with her colleagues at the Ukrainian Center for Civil Liberties who received the Nobel Peace Prize in 2022, have documented more than 30,000 Russian war crimes since Feb. 24, 2022, in their “Tribunal for Putin.”

This past weekend, Vice President Kamala Harris, a former prosecutor herself, announced the elevation of the United States’ official position on Russia’s actions in Ukraine to that of crimes against humanity, which carries significant weight. While falling short of labelling Russia’s actions in Ukraine genocide (despite Secretary of State Antony Blinken’s description of Putin’s war as attempting “to erase Ukrainian identity”), the modulation of the administration’s stance from war crimes to crimes against humanity is major. The commitment of America’s United Nations ambassador to continue supporting forensic lab data collection in Ukraine fuels potential outcomes related to this revised designation.

The U.S. political position is reinforced by the joint appeal of Sens. Chuck Schumer (D-N.Y.) and Mitch McConnell (R-Ky.) for bipartisan support to defeat Russia in Ukraine, which McConnell cites as “the single most important event going on in the world right now.” As Matviichuk describes it, this is a matter of freedom vs. totalitarianism, democracy vs autocracy. She told a reporter from Time magazine, “We are in the forefront of the battle between autocracy and democracy in this world. We are fighting for our right to have a democratic choice. And Putin? This work has not only a military but a value dimension. That’s why it’s not only the war between two states. It’s a war between two systems — authoritarianism and democracy.”

Russia cannot continue to act with impunity, Matviichuk emphasizes. We agree. Like untreated disease, repeated Russian aggression designed to wipe out the identity of Ukrainians and other national, ethnic, racial and religious groups, in whole or in part, and to alter international order will persist, fester and continue to metastasize. Similarly, medical practice teaches us that treatment delayed is often treatment denied. In other words, leaving disease to inflame and intensify can ultimately render any intervention ineffective.

The gathering of data via Ukraine’s Center for Civil Liberties’ tribunal record and forensic labs are diagnostic tools that can be applied for triage. But treatment for these inhumane acts must include applying the antidote of accountability while there still remains hope for recovery. Cases like the recently reported conviction of a 97-year-old German woman for her role in maintaining Nazi death-camp records 75 years ago appear to be too little too late.

We call for physicians, who carry the influence of the Hippocratic oath in their proverbial white-coat pockets, to gather the strength of beneficence and justice needed not only to maintain attention on Russia’s offenses (since the West’s focus is beginning to wane) but also to demand accountability. The latter is the intervention necessary to eradicate disease.

The White House, U.S. senators and international legal authorities affirming that Russia’s actions are crimes against humanity is critical. We join their voices, contributing our medical perspective which carries empathy, compassion and knowledge of human suffering — in this case, man-made — and add to that plea, the resolve to implement measures that both treat the current sickness and prevent such cruelties from happening again. Following the Holocaust, the world’s initial response was “Never again.” Yet, deplorably, there has been “again and again” in many international contexts, including Rwanda, Myanmar, Darfur and China.

Our medical experience also teaches us that ailments and illness tend to reside on a spectrum or continuum. Applying this clinical insight, Russia’s global power cannot remain since it seeks to seize and eliminate whole countries, societies and civil liberties.

The solutions proposed by Matviichuk and her colleagues are imperative to deliver:

• First, to begin the process of prosecuting current and past infractions as crimes against humanity now – not wait until this war has ended and morphed into yet another; 
• Second, as with the Nuremberg trials, to appoint a special international tribunal to charge and adjudicate Russia’s crimes in Ukraine;
• Third, to categorize the range of genocidal activities. Otherwise, like the actions in Nazi Germany, the incomprehensible becomes an extension of early efforts to purge an entire race, religion, ethnicity or sovereign nation. We cannot continue to allow erasure via pressure and propaganda to become violent eradication followed by outright extermination, as implied by the Elie Wiesel genocide prevention act passed in 2019. 
• Finally, to harness the political will to remove Russia from the UN Security Council as long as it persists in applying these tactics, as they have in Ukraine, Crimea, Syria, Chechnya, Mali, Libya, Moldova and elsewhere.

The solutions proposed by Nobel Laureate Oleksandra Matviichuk can serve as remedies for crimes against humanity — but only if the legal and policy interventions of the underlying “disease” occur with a sense of urgency and on a schedule that permits containment, cure and, ultimately, prevention.

Jacqueline A. Hart, M.D., works with organizations to develop solutions at the interface of housing and health, including providing medical care, services and opportunities for at-risk individuals, families and refugees. She has nearly 30 years of experience working in lifestyle, behavioral and integrative medicine, applying those principles to vulnerable populations and under-resourced communities, and is an original member of the Heal Ukraine Group. 

Mark C. Poznansky, M.D., PhD., FIDSA., is director of the Vaccine and Immunotherapy Center, Massachusetts General Hospital, and professor of medicine at Harvard Medical School. He is the co-founder of the Heal Ukraine Group and serves on the board of Lake Country Medical Aid.

Nelya Melnitchouk MD, MSc, FACS., is a colorectal surgeon at Brigham and Women’s Hospital and an assistant professor of surgery at Harvard Medical School. She is president and co-founder of Global Medical Knowledge Alliance and an original member of the Heal Ukraine Group.

Serguei Melnitchouk, MD, MPH., is a cardiac surgeon at Massachusetts General Hospital and co-director of the Heart Valve Program and an assistant professor of surgery at Harvard Medical School. Dr. Melnitchouk is co-founder of the Global Medical Knowledge Alliance and an original member of the Heal Ukraine Group.