Tag Archives: healthcare

A question of attitude

A couple of Ukraine-related items caught my attention this week.

The first is a report by Baylor University professor Serhiy Kudelia which discusses how to bring peace to Donbass. Kudelia starts by saying that Western states have regarded the resolution of the war in Donbass as being dependent on changing Russian behaviour. This is insufficient, he says, for ‘the successful reintegration of Donbas into Ukraine … rests on designing a new institutional framework that can provide long-term guarantees to civilians and separatist insurgents.’ Kudelia says that academic literature on conflict resolution would suggest four elements to such a framework:

  1. Autonomy for Donbass within Ukraine. Such autonomy would come with risks, by entrenching local rulers with patronage networks outside of central control and with the means to challenge central authority. To reduce these risks, Kudelia suggests giving autonomy not just to the territories currently controlled by the Donetsk and Lugansk People’s Republics (DPR & LPR), but to the whole of Donbass, thereby bringing within the autonomous region some more pro-Ukrainian elements of the population as well as groups not connected to the DPR/LPR power structures. He also suggests devolution of power within the autonomous region to weaken the potentially disruptive consequences of hostile elements controlling the region’s government.
  2. Transformation of the rebel state and military structures into political parties. Experience in other countries suggests that when this happens, the prospects of a successful transition increase substantially.
  3. Comprehensive and unconditional amnesty for everyone involved in the war. For obvious reasons, rebel leaders won’t agree to the first two proposals without an amnesty. Past experience speaks to the necessity of this measure.
  4. No elections in Donbass for two to three years. Kudelia notes that, ‘Holding elections in a volatile post-conflict environment creates ample opportunities for voter intimidation, electoral fraud, and disinformation campaigns that could build on conflict-related divisions.’ Kudelia doesn’t say who would rule Donbass in the meantime. I would have to assume that it would mean that the existing authorities would remain in place. That could be problematic.

With the exception of that last point, these are sensible suggestions. But when boiled down to their essentials, they don’t differ significantly from what is demanded in the Minsk agreements – i.e. special status for Donbass and an amnesty. As such, while I don’t think that the leadership of the DPR and LPR would like these proposals, my instincts tell me that they would be quite acceptable to the Russian government, which would probably be able to coax the DPR and LPR into agreeing to them. If implemented, the results would be something Moscow could portray as a success of sorts.

And there’s the rub. For that very reason, I can’t see Kiev agreeing to any of this. Kudelia’s argument is founded on the idea that there’s more going on in Donbass than Russian aggression. Accepting that something has to be done to ‘provide long-term guarantees to civilians and separatist insurgents’ means accepting that there are civilians and insurgents who need reassuring, not just Russian troops and mercenaries. And that means changing the entire narrative which Kiev has adopted about the war. So while Kudelia’s proposals make sense (after all, what’s the alternative? How could Donbass be reintegrated into Ukraine without autonomy and an amnesty?), what’s lacking is any sense of how to get there.

A large part of the problem, it seems, is the attitude in Kiev. This becomes very clear in the second item which caught my attention – an article on the website Coda entitled ‘Now Healthcare is a Weapon of War in Ukraine.’ The article describes how the DPR and LPR are encouraging Ukrainians to come to rebel territory to receive free medical treatment, and then using this as propaganda to win support for their cause. This is despite the fact, as the article shows, that the medical facilities in the two rebel republics are in a very poor state. Author Lily Hyde isn’t able to confirm how many Ukrainians have taken up the rebel offer of free medical aid, but does repeat a claim by the rebel authorities that 1,200 people have done so.

What interests me here is not the sensationalist headlines about healthcare being weaponized, but the question of why Ukrainians might feel it necessary to go to the effort of crossing the front lines to get treatment. And the article provides an answer, namely that parts of Donbass ‘are trapped in a precarious limbo, still under Ukrainian government control but cut off from key services like healthcare.’ The war destroyed much of the healthcare system in Donbass, but ‘Ukraine provides no financial or other incentives for medics to work in frontline areas’, and has done little to repair shattered infrastructure. Healthcare seems to be a lower priority than fighting ‘terrorism’.

While the DPR and LPR use healthcare as a ‘weapon’ by providing it to people, Kiev has ‘weaponized’ health in another way – by depriving people of it. As the article reports:

Kiev has not outlawed receiving medical treatment in occupied Donetsk or Luhnaks. But collaborating with the separatists – or supporting their propaganda efforts – is illegal. How exactly such charges are defined is not clear, but past experience has taught both individuals and organizations to be wary of such accusations. The Ukrainian authorities have investigated non-governmental organizations (NGOs) based in Ukraine who have provided foreign-funded medicines and other supplies to occupied Donetsk and Luhansk. NGOs working there have been banned by the de fact authorities [of the DPR and LPR] on similar charges. Doctors have found themselves placed on blacklists by both Ukrainian officials and the separatists, accused of being ‘terrorist collaborators’ by one side, or of being spies by the other.

Hyde contrasts the Ukrainian government’s policies towards the DPR and LPR with that of Georgia, where:

The government offers free healthcare for people from Abkhazia, a breakaway territory it still claims which is now under de facto Russian occupation. The government is building a modern hospital in the nearest town to the boundary line, aimed at people from Abkhazia.

Essentially, says Hyde, it’s ‘a question of attitude’. She cites Georgy Tuka, Ukraine’s Deputy Minister for Temporarily Occupied Territories – ‘“There’s a wish to punish people,” Tuka acknowledged.’

That’s quite an admission from a government minister.

Even if the details need fleshing out, the institutional framework required to reintegrate Donbass into Ukraine has been pretty obvious for a long time now. The problem has been getting people to accept it. It is indeed, therefore, ‘a question of attitude’. Sadly, the prevailing attitude stands firmly in the way of the institutional changes required for peace. The desire seems to be to punish people, not to reach agreement with them in order to promote reintegration and reconciliation. The issue, then, is whether this attitude can be changed (and if so, how) or whether it is now so firmly entrenched that there is nothing which can be done. Sadly, I fear that it may be the latter.