A Bazar start: How one hospital thwarted a Ryuk ransomware
outbreak
By Brian Donohue
Published: 2020-10-29 · Archived: 2026-04-05 20:33:08 UTC
In mid-October, a variety of detection analytics alerted the Red Canary CIRT to execution, reconnaissance, and
lateral movement activity on the network of a medical center. Within minutes, we observed Cobalt Strike and
other malicious tools that all pointed toward a troubling conclusion: the hospital was probably a few hours away
from a full-blown Ryuk ransomware outbreak. Thanks in no small part to our incident response partners at Kroll,
whose Responder team rapidly engaged and began active containment steps as we detected threats, that didn’t
happen.
This week, news has spread that many hospitals in the United States are being attacked by Ryuk ransomware—
and are very likely experiencing some version of what we’ve just described. Despite being in the throes of a
pandemic that’s already over-burdening global public health infrastructure, ransomware crews have been
escalating their operations against hospitals for months now.
These attacks are abhorrent. The people responsible for them are despicable. And we, like DHS CISA, Mandiant,
and others in the information security community, want to help the hospitals that care for all of us however we
can. So we’re sharing the details of how we thwarted these operators earlier this month—in the hopes you can
take this information and better protect your own organizations.
Background
We’ve been following all the recent reporting and tweets about hospitals being attacked by Ryuk ransomware. But
Ryuk isn’t new to us… we’ve been tracking it for years. More important than just looking at Ryuk ransomware
itself, though, is looking at the operators behind it and their tactics, techniques, and procedures (TTPs)—
especially those used before they encrypt any data. The operators of Ryuk ransomware are known by different
names in the community, including “WIZARD SPIDER,” “UNC1878,” and “Team9.” The malware they use has
included TrickBot, Anchor, Bazar, Ryuk, and others.
Many in the community have shared reporting about these operators and malware families (check out the end of
this blog post for links to some excellent reporting from other teams), so we wanted to focus narrowly on what
we’ve observed: BazarLoader/BazarBackdoor (which we’re collectively calling Bazar) used for initial access,
followed by deployment of Cobalt Strike, and hours or days later, the potential deployment of Ryuk ransomware.
We have certainly seen TrickBot lead to Ryuk ransomware in the past. This month, however, we’ve observed
Bazar as a common initial access method, leading to our assessment that Bazar is a greater threat at this time for
the eventual deployment of Ryuk.
What we’ve seen and how you can detect it
https://redcanary.com/blog/how-one-hospital-thwarted-a-ryuk-ransomware-outbreak/
Page 1 of 6

While every ransomware outbreak can play out in different ways, we want to focus on the attack we saw in mid-October and stopped before ransomware was deployed. As we walk through this specific attack, we’ll identify
10 detection opportunities that work for us—and we hope they’ll work for you too. This attack can serve as a
functional example for what you might expect to see if you’re responsible for defending a healthcare organization.
If you’re interested in the MITRE ATT&CK® techniques covered by this incident, check out the ATT&CK
Navigator layer here. You can learn more about ATT&CK Navigator here.
This graphic provides an overall representation of how the attack unfolded. We’ll dive into the details, complete
with detection opportunities, below.
https://redcanary.com/blog/how-one-hospital-thwarted-a-ryuk-ransomware-outbreak/
Page 2 of 6

https://redcanary.com/blog/how-one-hospital-thwarted-a-ryuk-ransomware-outbreak/
Page 3 of 6

Initial access came by way of a phishing email containing a PDF attachment. The user opened this attachment and
clicked on a link in the PDF, which connected to Google Drive and downloaded a file named Report[mm]-
[dd].exe (for example, the file name would be Report10-29.exe if the email was delivered on October 29).
This .exe is known as Bazar, which has different components known by the community as BazaLoader,
BazarLoader, and BazarBackdoor.
Detection Opportunity 1: Process hollowing of cmd.exe
This .exe file used process hollowing techniques to inject into cmd.exe . You can identify this process
hollowing, as we did, by looking for instances of the Windows Command prompt ( cmd.exe ) executing without
any command-line parameters and establishing a network connection. If that’s too noisy, you could try limiting the
network connections to port 443 or 53. You could also limit false positives by looking for child processes spawned
by the hollowed cmd.exe process. Typical child processes associated with Bazar include: cmd.exe ,
svchost.exe , explorer.exe , nltest.exe , and net.exe , as shown in the process tree below.
https://redcanary.com/blog/how-one-hospital-thwarted-a-ryuk-ransomware-outbreak/
Page 4 of 6

Detection Opportunity 2: Enumerating domain trusts activity with nltest.exe
We then observed several reconnaissance commands associated with Bazar. Specifically, we observed the
adversary using nltest.exe to make domain trust determinations. While you probably can’t disable
nltest.exe , looking for instances of it executing with a command line that includes /dclist:<domain> ,
/domain_trusts or /all_trusts has proven to be a very high-fidelity analytic for us to catch both Bazar (in
this incident) as well as TrickBot (in past incidents). In fact, based on this overlap, it appears likely that Bazar may
be reusing some code from TrickBot, which could lead to some confusion over which malware family is which.
Detection Opportunity 3: Enumerating domain admins with net group
We also saw the adversary attempting to enumerate Windows domain administrator accounts, a behavior that we
commonly associate with ransomware operators. In particular, we find it useful to look for net group "domain
admins" /dom and net group "domain admins" /domain .
Detection Opportunity 4: Process hollowing of explorer.exe
During this phase, we also saw the adversary use process hollowing with both explorer.exe and svchost.exe .
We observed explorer.exe spawning svchost.exe —this isn’t normal, so you should look for that in your
environment. More broadly, you can look for svchost.exe processes where the parent is not services.exe to
identify this and other malicious activity. (If you’ve never checked it out, we highly recommend looking at the
SANS Hunt Evil poster!)
https://redcanary.com/blog/how-one-hospital-thwarted-a-ryuk-ransomware-outbreak/
Page 5 of 6

Another way we detected this activity was by looking for svchost.exe with no command-line options.
Legitimate instances of svchost.exe should almost always have command-line options that include -k and the
name of a service the process manages. Instances of svchost.exe with no command-line options are suspicious
and may indicate that svchost.exe has been spawned to host injected code—like we saw in this incident.
Detection Opportunity 5: Attempted lateral movement via WMI + PowerShell +
Cobalt Strike
Next, a Cobalt Strike binary was dropped on the endpoint as a .dll file and executed by rundll32.exe . With
that, the intrusion began spreading laterally via Cobalt Strike. The operators used Windows Management
Instrumentation (WMI) in their lateral movement attempt. WMI spawned cmd.exe , which subsequently spawned
PowerShell with an encoded command line. This encoded PowerShell creates another Cobalt Strike Beacon.
We’ve found that looking for encoded PowerShell is a great way to catch this specific evil and a lot of other evil,
too. In this incident, we saw a command line that began with:
Source: https://redcanary.com/blog/how-one-hospital-thwarted-a-ryuk-ransomware-outbreak/
https://redcanary.com/blog/how-one-hospital-thwarted-a-ryuk-ransomware-outbreak/
Page 6 of 6