Prelude to Medic Work In Ukraine, part 4

 

Rule #5:  "Do Not Attack Medical Personnel, Facilities, or Equipment"

- From the United States Marine Corps Common Skills Handbook, Core Principles of the Law of War

14 January 2023, Encrypted text chain:

“Hey there, this is Pete, the Ukraine Country Director. I’d love to chat with you in the next few days when we

both have time. Let me know when you’re available. Hope you’re doing well.”

“Hi Pete, thanks for the text! I’m currently working in a remote village in Africa, with minimal service. I’ll try

to find a hill with enough service for a call and text you back about availability. Thanks!”

“Hey there, I’m outside a remote village in Ukraine for now so maybe we’ll stick to messaging for now lol”

24 January 2023, Encrypted text chain:

“Good evening, I’m in town and will have cell service today and tomorrow if you have time to chat”

“Morning. How about a call in 12-13 hours? I’ll be in and out of service.”

“Sounds good”

“In the meantime if you want to send me pictures of green places I wouldn’t be opposed. Ukraine ia a bit

grey and I live in Alaska.”

“Haha well things are pretty green here, underneath the harmattan dust. Here’s the village we work in”

“That looks gorgeous and humid”

“That reminds me of New England in November... Nice! I see you have a ‘rasputitsya paint job’ going on”

4 February 2023, Africa

My patient is a 25 year-old man, with a complaint of intermittent scrotal swelling for the past two years. The swelling is relatively painless, but he’s concerned that it will prevent him and his wife from having children. It is also beginning to interfere with the annual work rhythm of his West African farm: dry-season harvesting of  beans from the grassy hillsides, machete-clearing and burning brush, fishing and hunting, and the wet season activities of planting rice and vegetables. His daily routine begins with a five-mile pre-dawn walk, down from the hilltop village (sited away from mosquito-laden drainages) to the 5-acre patch of valley farmland, granted to his family by the village chief.

At my request, the patient undressed from the waist down and lay supine on the exam bed. Upon inspection, he had a soft, non-inflamed, volleyball-sized scrotal mass, which was mildly tender when palpated. My differential diagnosis included inguinal hernia, trauma, elephantiasis, undifferentiated hydrocele (fluid accumulation due to various possible causes), and orchitis. Lack of significant pain or obvious inflammation tended to rule out infection, history tended to rule out trauma. Come-and-go swelling could be caused by either hernia or elephantiasis. Hernias are extremely common (in Africa as well as the rest of the world), the man did not come from a known elephantiasis-endemic area. and I was pretty sure I could feel loops of bowel in the patient’s scrotum. I listened with a stethoscope and heard distinct bowel sounds. It was reasonably certain that the patient’s intestines had slid down through a tear in his abdominal wall, along his inguinal canal, and into his scrotum; a classic (though unusually large) inguinal hernia. Because it was painless and non-inflamed, medical direction allowed one attempt at manual reduction.

Hernias can be uncomfortable and unnerving, but are rarely dangerous. A hernia is dangerous if it becomes incarcerated (if the bowel cannot be reduced, i.e. returned to the abdominal cavity) or strangulated (if the blood supply of the herniated portion of bowel is cut off and it begins to die- a medical emergency). Most hernias don’t strangulate. However, because West Africa is a medical desert and hernias are common, many people here live and perform hard labor for years with hernias. This increases the likelihood that people here have both seen a family member experience a strangulated hernia, and that that family member died due to lack of available surgical care. This means that the diagnosis of a hernia causes disproportionate dread in our patients.

I’ll have to include some patient education as I explain the diagnosis and get the patient’s permission to attempt a reduction of his hernia. So, I’m glad to look up see one of our best translators, Aiah, walk into the room. Aiah, a local school headmaster, volunteers almost the entirety of his spare time to the clinic. He has just returned from the local tea house, where the village leadership listens to a shortwave radio broadcast of BBC news, every day at lunchtime. 

Patient consent obtained, I begin to gently push the loops of intestine back through the inguinal canal into the patient's abdomen. It's important to go slowly and gently, and not accidentally push a testicle into the wrong place. As I work, Aiah shares the latest news. Over 20 people have been killed by large wildfires in Chile. A train derailment has caused a hazmat fire in Ohio. China has sent a high-altitude balloon over Montana. An American aid worker has been "shot by Russians" and killed in Ukraine.

The reduction is successful; unfortunately the hernia immediately recurs when the patient stands up. We write the patient a referral; we will transport him by motorbike to a surgical hospital, and pay for his hernia surgery. He is quite happy with this news; the life-changing $30 surgery would otherwise be financially out of reach for him.

It's not until days later, when I travel into the city and get cell data coverage, that I learn who the American from Aiah's shortwave news brief was.

Pete Reed, NGO founder, Ukraine Country Director, non-combatant, and my colleague, was killed on Feb 2 2023, when his ambulance was hit by a Kornet anti-tank missile near Bakhmut. Serious injuries were sustained by other medics on scene. All present were non-combatant medical aid workers, who had stopped to help a civilian injured by artillery fire.

It is a violation of the Geneva Convention to attack medical personnel engaged in the care of patients. This protection also extends to ambulances and medical facilities that are used solely for treatment of the injured (i.e. not for offensive purposes). This applies to civilian facilities, vehicles, and personnel, as well as military ones. So, bombing the military medical unit in the fictional Korean War series M.A.S.H., for example, would have been a war crime. The 2015 American airstrikes that destroyed a civilian Medecins Sans Frontieres hospital in Kunduz, Afghanistan- regardless of whether it was treating civilian or military casualties- were a war crime. When an Austrian shell hit Hemingway's Red Cross ambulance in World War I Italy, that was a war crime. The destruction of Pete Reed's civilian, nonprofit ambulance, staffed by civilian volunteers, treating a civilian casualty, by a Russian antitank missile, was a very clear-cut war crime.

The Kornet antitank missile is fired from a tripod, using a laser targeting system. It has a range of approximately 10km and costs about $26,000. Kornets have a High Explosive Anti-Tank (HEAT) charge, which is designed to penetrate armor. When used on an ambulance, it creates a blast wave, along with a large cloud of sharp-edged and molten-metal shrapnel.

Given that Reed and the other aid workers were attacked only a minute after arriving on scene, it seems probable that the missile crew had their sights lined up on the injured civilians, waiting for medics to arrive. Russia frequently uses such "double-tap" tactics, in order to target and kill first responders.

Incredibly, the event occurred in the presence of Wall Street Journal reporters, and was captured on video. The result is frame-by-frame documentation of a modern war crime.

Due to operational security concerns, and out of respect for Pete Reed and his family, I am going to refrain from discussing details of this event, beyond what is already publicly available from open sources. I hope that full justice will eventually be served for this war crime, along with the many others which continue to be perpetrated in the Ukraine war.

Read more here:

https://www.nytimes.com/2023/02/14/world/europe/russian-attack-aid-worker-video.html frame-by-frame video of Kornet hitting Reed's ambulance and exploding

https://www.wsj.com/articles/the-russian-double-strike-that-killed-a-u-s-medic-in-ukraine-they-had-us-in-sight-442cd058 - Wall Street Journal Article