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Correspondence to Professor Dr. Nikola BillerAndorno; billerandorno@ ibme. uzh. ch © Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. THE RATIONALE OF SANCTIONS Sanctions have become an increasingly used tool in national and international foreign policy to induce policy change in sanctioned states, either by applying indirect pressure on their governments to change their policies by targeting important business sectors or the economy at large or by impacting influential politicians and businessmen, as in the recent example of Western sanctions on Russia following the 2014 annexation of Crimea and the 2022 invasion of mainland Ukraine. Economic sanctions can be designed to aim at a variety of goals, such as resolving armed conflicts, countering terrorism or signalling opposition to nonconstitutional changes of a country’s government. In the recent case of sanctions against Russia, sanctions were set in place with the hope of halting the Russian invasion of Ukraine and to induce the Kremlin to reconsider its aggressive behaviour. The effectiveness of sanctions can be greatly increased if they are imposed by regional governmental organisations such as the EU or by international bodies, notably the United Nations (UN) Security Council. Over the past decades, institutions have become ever more aware of the rights of the populations of the sanctioned states. It is generally recognised that sanctions should be designed to be effective in a targeted way. While a certain degree of hardship inflicted on the population is in general unavoidable, this should not be the primary aim of sanctions. This means that sanctions should target regimes rather than people, avoiding civilian harm and human rights violations. In the words of Kofi Annan, former Secretary General of the UN: ‘[J]ust as we recognise the importance of sanctions as a way of compelling compliance with the will of the international community, we also recognise that sanctions remain a blunt instrument, which hurt large numbers of people who are not their primary targets. Furthermore, sanctions need refining if they are to be seen as more than a fig leaf in the future.’ That said, it is important to consider that UN targeted sanctions, which are packages of sanctions imposed by the UN Security Council, have been successful in leading to intended policy change only 10% of the times, and limited the policies they intended to change in 28% of cases, but led to a reduced life expectancy in the targeted countries by 1.2–1.4 years. Economic sanctions have also been criticised for the potential collateral damage to third states they can cause. For instance, the African Union has criticised the exclusion of Russian banks from the Swift payment system since this might seriously disrupt global food supply chains. For this reason, some authors suggest that economic sanctions should be banned, as they are having detrimental effects on health and nutrition of civilians. Summary box