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The images of the massacred civilians in Bucha showed that Russia committed war crimes during its war against Ukraine. Recent studies on the micro-dynamics of conflicts have advanced our understanding of when and why civilians are attacked in irregular warfare, but the dynamics of modern interstate warfare are less understood.
In this article we ask when and why Russia targeted civilian infrastructure in Ukraine, with a specific focus on attacks against healthcare. We propose that Russia primarily directs its attacks on healthcare following its own battlefield losses. Such actions undermine the healthcare system, which not only poses long-term public health risks but also deprives already vulnerable populations of critical care. By disrupting healthcare services, Russia penalizes both the Ukrainian civilian population and the Ukrainian military, which relies on these services to treat its wounded soldiers. We combine several datasets on attacks on healthcare and educational facilities, baseline data on the location of healthcare and educational infrastructure, and data on conflict events. We focus on the timing of attacks to evaluate whether they fit a pattern of retaliation.