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    • Ukraine's health care on the brink after hundreds of attacks

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    KRASNOHORIVKA, Ukraine -

    Valentyna Mozgova sweeps shattered glass and other debris from the vacant halls of the bombed-out hospital where she began her career. Living in the basement, the 55-year-old lab technician now works as its solitary guard.

    Russian artillery strikes targeted Marinskaya Central District Hospital in 2017 and again in 2021. But numerous barrages over the last seven months forced the hospital's medical staff to flee, destroying key departments such as neurology and gynecology, as well as a general medical clinic in the process.

    Mozgova chose to stay. Having worked in the hospital's laboratories since graduating from medical school in the late 1980s, she agreed to act as the hospital's security guard for 10,000 hryvnia (US$250) a month. She and her husband were soon joined in the basement shelter by five others who had lost their homes to bombing, a dog and a cat.

    Mozgova picks up the broom at 8 a.m. sharp every three days to inspect the hallways, carefully avoiding the fragments of Russian Grad rockets strewn across the floors for fear of yet another explosion.

    "Everything is decaying and falling apart," she told The Associated Press. "But I'm so sick of it. I want to live my life normally, sleep in my bed, watch my TV, not jump at the sound of an explosion, go to work calmly and do my job."

    A year into , hundreds of attacks against the health care system have begun to take a toll. More than 700 attacks have targeted health care facilities and staff since the Feb. 24 Russian invasion , according to data verified by five organizations working inside Ukraine.

    The World Health Organization has similarly documented more than 750 attacks and 101 deaths, and Ukraine's health minister said recently that more than 1,200 facilities have been damaged either directly or indirectly, with 173 hospitals damaged beyond repair.

    The report released Tuesday, which was shared in advance with the AP, said Russia has targeted the Ukrainian health care system "deliberately and indiscriminately" -- an allegation that the organization said amounted to a war crime.

    The attacks were at their most ferocious early in the war, according to the report, which found a total of 278 attacks in the last four days of February and all of March -- an average of eight per day.

    The report defines attacks not just as weapons strikes, but also threats aimed at forcing doctors to keep working in occupied territories, and incidents of theft in areas that Russian forces failed to hold on to.

    In the city of Kherson, residents said retreating Russian forces took most of the ambulances with them. As they captured the city of Mariupol, the Russians took over the city's last functioning hospital, days after a Russian airstrike devastated a maternity ward.

    "Russian soldiers were on all the floors. They counted the patients, counted the employees, so that no one would leave. They said that if the doctors left, they would shoot," Maryna Gorbach, a nurse from Mariupol Hospital No. 2, told the AP in an interview in December.

    Gorbach, like most of the staff, managed to flee a few days later.

    In Izium, explosives ripped through the main hospital's walls in March, shredding its wiring and forcing doctors and patients into the basement.

    "Before we went to the basement we covered our patients with mattresses because we thought they would protect patients from shrapnel," said Dr. Yurii Kuznetsov, a trauma surgeon who for a time was the only doctor still at the hospital. At this point, three of the four floors are functional. Water drips from the roof. But patients have already seen how much repair has been accomplished.

    For a year, AP journalists across Ukraine have also witnessed the result of attacks on hospitals, ambulances and medical staff firsthand.

    "They follow specific patterns, and it is those patterns that are important, not even the number," said Pavlo Kovtoniuk of the Ukrainian Health Care think tank, which was among the groups gathering data. "Because patterns mean that that most likely was a deliberate policy, not just a coincidence or separate events."

    Russia claims Ukraine has also hit hospitals in territory it occupies. But Kovtoniuk said there's a vast difference between the huge number of systematic attacks recorded and what he described as accidents that happen in the course of a war for survival.

    The international organization Physicians for Human Rights long documented Russian attacks on medical facilities in Syria and said the war in Ukraine indicated a continuation of that policy. The U.K. defence mnistry said that Russian attacks on medical and educational facilities intensified in January.

    The attacks show keen awareness of "the cascading effects that attacks on health have on the civilian population," said Christian De Vos, director of research and investigation for Physicians for Human Rights, who contributed to the report. "It's part of a destabilizing tactic to sow fear in the wider population."

    In the short term, attacks have forced many hospitals to shut down or sharply reduce services. In Izium, which was liberated by Ukrainian troops last fall, around 200 people from a staff of 500 have returned to work, and one of the damaged wings is operating again after repairs. At least one pharmacy has reopened as well, enabling people whose medication ran out during six months of occupation to be resupplied.

    Ukraine had the second-highest number of HIV infections in Europe and Central Asia and one of the highest rates of drug-resistant tuberculosis. But since the invasion, the number of people being treated for these ailments has dropped precipitously. Drug quantities aren't an issue thanks to a steady supply from donations. But it's harder to follow-up or track new infections because of the mass displacement of Ukrainians within the country and across Europe.

    Andriy Klepikov runs the Alliance for Public Health, an organization whose mobile clinics reach towns near the front lines. He worries about cases of tuberculosis or HIV that are going undiagnosed, but remains optimistic about his country's capacity to overcome.

    "The health system is (not about) walls or buildings or even equipment. It is about people," he said. "The Ukrainian military are known for their strength and resilience, but in the area of public health, we are equally strong and resilient."

    Back in Krasnohorivka, a tank shell took out the signal for a Russian television show about the lives of doctors that Mozgova enjoyed. Despite the loss of what little made life comfortable for her, Mozgova said neither she nor her husband have any plans of permanently rejoining their adult children in the western city of Lviv, considered among the safest in Ukraine.

    "They tell us to come and they have space, but what will I do? I'll be a guest there. So I'll be here as long as I have work. I'm trying to be useful here," she said. "However good it was with my children and grandchildren I still think about this place because it's my home."

    ------

    Lori Hinnant reported from Paris. Vasilisa Stepanenko reported from Izium. Inna Varenytsia contributed to this report from Kyiv.

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