Recent reports warn of the high risk of a major cholera outbreak in Mariupol (BBC, Reuters, VoA). This extremely virulent water-borne disease affects both children and adults alike.
Although only isolated cases of cholera have been reported in the past month, the conditions in Mariupol are alarmingly similar to those in Yemen since 2016. In Yemen, after hospitals and water facilities were damaged in airstrikes, the cholera outbreak quickly worsened (compare May 2017: 49,495 total suspected cases and 362 total deaths and June 2017: 96,219 total suspected cases and 746 total deaths). GRC has previously highlighted and reported on the devastating impact of the cholera outbreak in Yemen (see here, here and here).
Cholera is caused by ingestion of contaminated water or food. In severe cases, it can kill within hours if untreated. Therefore, clean water and medical assistance are the two key lifelines in an outbreak. Where parties to the conflict deliberately deprive civilians of objects indispensable to their survival (OIS), in this case clean water and healthcare services, they may violate the prohibition of starvation.
First, the access to clean water in Mariupol is threatened and severely restricted by extensive damage to the city’s water supply and sanitation facilities. According to deputy mayor Sergeii Orlov, the sea and water bodies are polluted by garbage and sewage water. Meanwhile, many corpses are hastily buried or left uncollected due to the security risk created by bombing and fighting. Improper burials of the dead pose an elevated risk of contaminating rivers and other water sources, increasing the risk of a cholera outbreak. As such, deliberate targeting of water facilities and relentless attacks preventing proper body disposal could be characterised as conduct falling under the purview of the prohibition of starvation.
Second, access to medical assistance in Mariupol is severely undermined by the attacks on medical facilities and supplies. The treatment of cholera is simple and cheap: oral or intravenous hydration and, for patients with severe acute malnutrition, the use of antibiotics. However in Mariupol, hospitals and clinics have been destroyed or are no longer safe to visit; medics qualified to administer or prescribe treatment are lacking; and medical supplies are scarce.
As seen in Yemen, cholera can be particularly deadly where the country’s health infrastructure is decimated. Attacks on medical facilities and supplies, along with any other acts that hamper the availability of medical assistance, could amount to acts of starvation.
Furthermore, civilians’ access to medical care is jeopardised as external medical aid personnel and supplies struggle to reach the city. Where the whole or part of the civilian population has inadequate supplies essential for its survival, the occupying power may not withhold consent to relief operations and access of humanitarian assistance. Failure to consent could constitute an act of starvation.
The situation in Yemen is a sombre lesson. By December 2020, as the conflict enters its sixth year, over 131,000 people are estimated to have died due to indirect causes such as lack of food, health services and infrastructure. In Mariupol, if access to food, water, adequate healthcare and other basic necessities continues to be restricted, we will be facing yet another humanitarian and food insecurity crisis, putting the lives of hundreds of thousands of women, children and men at risk, all of which would have been preventable.
GRC will continue closely monitor the situation and the conduct of both sides to the conflict. For the last 100 days, GRC has continued to monitor attacks on OIS, the obstruction of humanitarian assistance and any other starvation-related conduct and has provided rapid expert legal analysis.
GRC is currently co-leading the US, the EU and the UK’s Atrocity Crimes Advisory (ACA) Group, along with Ambassador Williamson, the Arizona State University Sandra Day O’Connor College of Law. The ACA will provide critical support to the Ukrainian Office of the Prosecutor General (OPG), to document, preserve, and analyse evidence of war crimes and other atrocities committed in Ukraine, with a view toward criminal prosecutions. To this end, GRC will set up mobile justice teams (MJTs) to assist Ukrainian investigators and prosecutors on the ground, bringing together leading domestic and international experts in the field of international criminal law, mass atrocity crimes investigations, including forensic experts, and case-building to provide support to the OPG, including victims and witnesses.
