Does Russia's Invasion of Ukraine Constitute Biological Warfare?

— Invading in the midst of a pandemic surely begs this discussion

War can be the cause of, and the perpetuation of, a public health emergency. The current Russian-Ukrainian conflict is no exception, and warrants a discussion of whether invading a country in the midst of a global pandemic constitutes an act of biological warfare. A look back in history can help us explore this question.

The First Act of Biological Warfare: The "Black Death"

In the year 1346, in the port city of Kaffa (now modern-day Theodosia) on the Crimean Peninsula of the Black Sea, the consequences of a different war were unfolding. In that time, Italian notary Gabriele de' Mussi wrote:

"One infected man could carry the poison to others and infect people and places with the disease by look alone. No one knew, or could discover, a means of defense...the scale of the mortality and the form which it took persuaded those who lived...that the last judgement had come."

We know now that de' Mussi was in fact describing the horrors of Yersinia pestis, in what came to be called bubonic plague or the Black Death.

The city of Kaffa came under attack by a Mongol army controlled by Kipchak khan Janibeg, a descendant of Genghis Khan. Janibeg laid siege to the city to remove Genoese forces from an important defensive position in order to alter the European sphere of trade influence. But the Mongols miscalculated the level of resistance and the war dragged on for years, until, as de' Mussi later wrote:

"...the whole army was affected by a disease which overran...and killed thousands every day...all medical advice and attention was useless."

Janibeg eventually called off the siege, but not before ordering that the bodies of soldiers felled by the plague be launched via catapult into the city in the hopes of decimating the population. This has been seen as the first intentional act of biological warfare in recorded history and contributed to the explosion of arguably the most devastating pandemic in world history. It has been postulated that Italians fleeing the carnage on ships brought the plague to their home ports (amongst other routes of transmission). Within a year, the plague had gained a firm grip on the European continent. Within 5 years it has been estimated that as much as 40% of the global population was killed, corresponding to 200 million people.

Flash Forward to Modern Day: The COVID-19 Pandemic

Though over 600 years have passed since that pandemic (to use the modern term), we find ourselves in the midst of a new war during a global pandemic in the same region where the Black Death exploded. As expected, the risk of greater spread of COVID-19 and threats to an already strained healthcare system are significant.

We posit that launching this invasion in the midst of the COVID-19 pandemic constitutes a form of a biological warfare, intentional or not. Biological warfare occurs when a state uses a disease-causing agent in waging war. While the 1972 Biological Weapons Convention specifically bans microbial or other biologic agents for use other than peaceful or protective purposes as well as the production of weapons or equipment designed to deliver these agents during conflict, the Soviet Union, parent of the current Russian government, has a long history of treaty noncompliance. While exacerbating the spread of COVID-19 may not have been Russia's primary goal when invading Ukraine, it is an obvious side effect that Russian leaders had to be aware of when they made the decision to invade. Accordingly, this may constitute biological warfare, especially when hospitals and healthcare workers are indiscriminately targeted, violating international rules of war.

As the war grinds on, the world sits on a precipice. Up to now, impasse is leading to escalation. When war stops, the full impact on the health of the population will ultimately be revealed.

Gavin Harris, MD, is an assistant professor of infectious diseases and critical care at the Emory University School of Medicine in Atlanta. His clinical expertise and research interests include disaster preparedness and biosecurity, medical education and the care of critically ill patients, and scholarly work in military history and the history of medicine. Joel Zivot, MD, is an associate professor of anesthesiology/critical care at Emory University School of Medicine. His clinical expertise and research interests include care of critically ill patients in the OR and ICU, education, and scholarly work in bioethics, the anthropology of conflict resolution, law, policy, and a variety of topics related to anesthesiology/critical care monitoring and practice.

Read more on: ukraine