Akira playbook quarterly context — Q1 2026 healthcare concentration; Qilin remains the dominant operator on German healthcare victims

W1 horizon research added Q1 2026 healthcare quarterly context to the Groupe 3R item in § 1. Across Q1 2026, Akira posted 84 victims in March alone (second-most-active month on record) and claimed 5 healthcare victims; Qilin led healthcare at 23 claims (with RENAFAN GmbH and Suchthilfe direkt Essen gGmbH as Qilin's confirmed German victims), and The Gentlemen at 10 healthcare claims (Comparitech Q1 2026 Healthcare, 2026-04-29 · CyberMaxx Q1 2026). Akira's documented attack chain for healthcare: initial access via unpatched VPN (Cisco ASA, SonicWall, Fortinet) or compromised RDP credentials; lateral movement via T1021.001 Remote Services: Remote Desktop Protocol and T1047 Windows Management Instrumentation; LSASS credential harvesting via comsvcs.dll / Mimikatz; AV termination via PowerTool weaponising the Zemana AntiMalware driver (BYOVD); data exfiltration; double extortion. The cross-finding for Swiss / DACH operators reading after Groupe 3R: at least two ransomware-as-a-service operators (Akira and Qilin) are hitting European healthcare in Q1–Q2 2026 via the edge-device / unpatched-VPN attack surface, and the operator that hits a given hospital is less salient defensively than the shared initial-access funnel they exploit.