Inna LytvynenkoInna Lytvynenko always puts on her bright orange body armour when she’s out on an emergency call.
Last June, the paramedic was sent out in Kherson to treat a woman injured in a Russian drone attack, when an FPV drone smashed into her ambulance.
Seconds later, she heard a buzzing sound in the sky. Another drone was flying straight towards her, fast.
“I panicked. I grabbed my trauma bag and started running,” she recalls. “I shouted and screamed. I knew that if I stopped, I would die.”
But what she called the “safari hunting” continued. Drones hit two more vehicles that arrived to take the injured woman to hospital. Hours later, a third police car finally managed to get her out.
After another “safari” attack earlier this week, Ukraine’s President Volodymyr Zelensky called to put greater pressure on Russia in order to stop deliberate “hunting attacks” on civilians.
Provided by a third partyHospitals and ambulances in Ukraine are increasingly coming under Russian drone and missile attack, even though, according to the international rules of war known as the Geneva Conventions, they must be protected by all parties to the conflict.
“This is a new normality, which should not be the normality,” says Dr Jarno Habicht, the World Health Organization’s (WHO) representative in Ukraine.
The WHO has registered 3,118 attacks on healthcare since the start of the Russian invasion in February 2022. “That’s two cases per day,” Habicht says.
Since 2023 the number of attacks on healthcare has steadily grown. In 2024 it went up by 30%. Last year there was another 20% increase. This trend is expected to continue this year.
A recent Doctors Without Borders (MSF) report says that Russia systematically and often deliberately targets Ukrainian medical facilities. The frequency of attacks on healthcare suggests that they are “a sustained feature of the war rather than an episodic consequence of large scale offensives,” the report said.
Last month Russian missiles hit a hospital in Kherson, badly damaging the building and killing one doctor.
Hospital director Olena Tymoshenko believes it was a targeted attack. “It wasn’t just one missile, there were three missiles that hit the hospital within a few minutes from each other. It cannot be an accident,” she told the BBC.
Moscow also often uses a “double-tap” tactic, when they target the same location twice within a short period of time. Many believe that the second attack is deliberately aimed at first responders who arrive at the scene of the initial strike to rescue survivors.
During a recent massive Russian air attack on Kyiv, seven people were killed, including a police officer and a volunteer, after a second strike on the same location.
And lately Russian forces have been also targeting warehouses of humanitarian organisations. Last month alone, warehouses of three UN agencies, including the WHO, were damaged during air strikes. According to Habicht, the organisation shares coordinates of its facilities with both Moscow and Kyiv specifically in order to protect them from strikes.
While missile and drone strikes can be indiscriminate, first-person view (FPV) drone strikes are almost always intentional. A drone pilot can see the target in a live feed from the drone’s camera. So when it hits an ambulance, it has to be on purpose, says Robin Meldrum, MSF country coordinator in Ukraine.
Dr Inna Lytvynenko says that she was wearing a uniform identifying her as a medical worker. The ambulance was also clearly marked. So, she believes the drone operator consciously chose to target them.
Provided by a third partyAccording to the WHO, strikes on ambulances make up 20% of all attacks on Ukraine’s healthcare system, which suggests these are part of a calculated strategy.
The result of such sustained attacks is that the civilian population close to the frontline are getting increasingly cut off from health services.
The majority of people left in these areas are elderly people who often chronic diseases. Even if they survive air strikes and shelling, without medication and occasional check-ups they face a slow death.
And ambulances may not be able to reach them if the risks are high.
Lytvynenko and her colleagues constantly monitor social media to learn about threats.
“It’s really scary,” she says. “Every time when we take a patient to hospital, we just pray. These drones can appear from anywhere, they can even get through anti-drone nets.”
In some cases, police are dispatched instead of ambulances.
Since the danger zone where FPV drones operate is growing – as both Ukraine and Russia develop drones with greater and greater ranges – mobile clinics run by various health organisations have had to shift their operations further and further away from the frontline.
“Two years ago, we could go up to 5-8km (3.1-5 miles) from the frontline,” says Meldrum. “Now we won’t go anywhere within 30km and this distance keeps growing.”
Over the past 18 months, MSF stopped regular visits to about 80 villages near the front where they had provided health services, says Meldrum. And recently it has paused ambulance services in Sloviansk, a major city in eastern Ukraine.
“It doesn’t feel like we’re protected in this environment, and in the way that Russia is conducting the war,” Meldrum says.
“We don’t feel that the rules of war are being respected.”
