Evacuating Child Cancer Patients From Ukraine While Highlighting Rise of Attacks on Hospitals and Health Workers Around the World
The Spring 2023 issue of Dædalus—the journal of the American Academy of Arts & Sciences—focuses on the delivery of humanitarian and health aid in areas of violent conflict. Paul Wise, one of three co-editors of the three-year project, writes about how international humanitarian law has lost purchase with many 21st-century combatants.
Stanford Health Policy’s Paul Wise is once again on the border of Poland and Ukraine helping to evacuate child cancer patients whose medical treatment has been disrupted by the war — ever the academic who navigates between campus and conflict.
Wise first went to help coordinate the evacuation of the child cancer patients in March 2022, shortly after Russia’s invasion of the sovereign European nation. Today, he continues to work with the Ukraine Ministry of Health, St. Jude Children’s Research Hospital and pediatric oncologists and cancer programs throughout Eurasia. Nearly 1,400 Ukrainian children with cancer have been evacuated and sent to hospitals in Europe, the United States and Canada.
A pediatrician, Wise said the primary goal of the current efforts in Ukraine is to help strengthen systems of pediatric care in Ukraine so that children with cancer and other serious disorders can receive high-quality care in their home country.
“The Ukrainian physicians caring for these children in very difficult conditions are heroes and it is critical that we work closely with them to support the Ukrainian health system for children in a sustained collaboration,” said Wise, the Richard E. Behrman Professor of Child Health and Society at Stanford Medicine, a professor of health policy and a senior fellow at the Freeman Spogli Institute for International Studies.
When he leaves the Poland-Ukraine border, Wise heads to the U.S.-Mexico border. The U.S Federal Court appointed Wise a special expert and the official Juvenile Care Monitor to independently assess the treatment of migrant children in U.S. custody. No stranger to conflict, Wise has also traveled to Iraq with colleagues from Johns Hopkins School of Public Health for the World Health Organization to evaluate its system of treating civilians injured in the battle for Mosul.
Advocate and Academic
As the pediatrician finds himself on the ground advocating for children in Ukraine and the U.S.-Mexico border, a collection of essays co-edited by Wise and colleagues at the American Academy of Arts & Sciences explores the delivery of health services in violent conflict and the alarming increase in violations of humanitarian law around the world.
And as the number of casualties continue to climb in Ukraine, the ground war is the focus of the preface of the new issue of Daedalus, the journal of the academy.
Nearly 9,000 Ukrainian civilians have been killed and 15,442 injured since Russia launched its military efforts in February 2022 to take back the former Soviet republic. The U.S. military estimates that each side has suffered 100,000 casualties among its soldiers on the ground. The researchers believe some 5.9 million Ukrainians have been internally displaced; another 7.9 million have fled to neighboring countries. Relief organizations, meanwhile, estimate that 17.7 million people in Ukraine are in urgent need of urgent humanitarian assistance—including life-saving medical care.
“In the closing months of 2022, Russia began bombarding the country’s power grid, water supply, and other key facilities with the aim of turning the cold and dark winter into another weapon of war,” Wise and his co-editors write in the Daedalus preface.
According to the World Health Organization, there have been more than 1,000 Russian attacks on health-care facilities, personnel, and transportation units since the beginning of the war. And nearly one in every 10 hospitals in Ukraine has been damaged by Russian attacks.
Wise and his co-editors — Jennifer M. Welsh of McGill University and UCSF’s Jamie Sepúlveda — note that for humanitarian actors on the ground, these attacks “are blatant violations of basic principles of international humanitarian law through denial of access to imperiled civilians or indiscriminate attacks on both populations and critical infrastructure.”
And while the conflict in Ukraine has attracted intense diplomatic and media attention, “there are many forgotten crises unfolding outside the glare of the spotlight, where populations suffer systematic violence or are denied life-saving humanitarian assistance.”
Dr. Paul Wise in Poland in March 2022 to help Ukrainian child cancer patients and their families board a State Department jet bound for the United States.
The co-editors note that Russia’s systematic assault on health care in Ukraine is an extension of the war strategy already employed by the Russians and their Syrian allies during Syria’s protracted civil war, where more than half the country’s health facilities have been destroyed.
Then there is the civil conflict in Ethiopia’s northern Tigray region and the sociopolitical and economic crisis in Venezuela, with other Latin American contexts with high rates of violent death and sexual and gender-based violence.
“These snapshots of contemporary violent conflict point to the enormous strain being placed on traditional humanitarian strategies and actors, and particularly on the delivery of effective health responses,” they write.
International humanitarian law contains obligations to distinguish between civilian populations and combatants and protections of medical and humanitarian personnel, their means of transport and equipment, and their facilities.
“Yet today’s warring parties—whether non-state armed groups or state militaries—routinely dismiss or override this normative framework through strategies and day-to-day battlefield decisions that put both civilian populations and humanitarian health workers at risk.”
The editors point out two worrying trends:
The increasing rollback of political commitments to upholding humanitarian principles by UN member states and signatories of the Geneva Conventions.
And the ongoing impact of counterterrorism policies that have inadvertently created new obstacles of humanitarian health by constraining the provision of services in areas controlled by non-state armed groups.
“As co-editors with diverse scholarly backgrounds and varied policy experience, our work has been based on a central premise: that innovative approaches are best derived from a deeper, transdisciplinary understanding of the changing political, military, legal and health dimensions that are dramatically redefining humanitarian action across the globe,” they write.
Wise, Welsh and Sepúlveda conclude the most catastrophic challenge facing the humanitarian health community today is perhaps the growing prospect of armed conflict between great powers, noting the war in Ukraine has provided a preview of what large-scale combat operations may continue to look like moving forward.
“Over the past decade, the U.S. and allied militaries have pivoted from a preoccupation with waging counterinsurgency to intense preparation for conducting large-scale military operations against peer or near-peer militaries,” they write. “It is not clear that the humanitarian health community has responded accordingly and expanded its planning and capabilities to meet the potential humanitarian demands of such a conflict.”
The AAAS issue includes an introduction by former British Foreign Secretary David Miliband, president and CEO of the International Rescue Committee, and a collection of essays by legal and security experts, health professionals, historians, policymakers, and representatives of conflict-affected communities. The issue includes poetry, fiction and nonfiction essays set in conflict, and artwork such as the photograph by Mark Neville running with this story.
