Damage classification.

Medical facilities are civilian objects specially protected by international humanitarian law. Despite the need for systematic documentation of the effects of war on medical facilities for judiciary accountability, current methods for surveilling damage to protected civilian objects during ongoing armed conflict are insufficient. Satellite imagery damage assessment confers significant possibilities for investigating patterns of war. We leveraged commercially and publicly available satellite imagery and cross-referenced geolocated facility data to conduct a pre-post quasi-experimental study of damage to medical facilities in Mariupol, Ukraine as a result of Russia’s invasion. We found that 77% of medical facilities in Mariupol sustained damage during Russia’s siege lasting from February 24—May 20, 2022. Facility size was not associated with damage, suggesting that attacks on medical facilities are not random but instead may have been the result of intentional targeting. This is the first cross-referenced pre-post census study of the effects of an ongoing conflict on specially protected medical infrastructure.