As the war in Ukraine continues into its third year, the country’s healthcare system faces unprecedented challenges. Medical facilities are under constant threat from attacks, healthcare workers are experiencing burnout, and the risk of disease outbreaks is steadily rising. Despite these hardships, doctors and nurses in Ukraine are finding ways to adapt and ensure that their patients receive necessary care.
The Resilience of Healthcare Workers Amid Attack
On July 8, 2024, Dr. Lesia Lysytsia, a specialist at Okhmatdyt, Ukraine’s largest children’s hospital, was preparing a young patient for eye cancer surgery when air raid sirens began blaring. The warning signaled a potential missile attack from Russian forces. Despite the warning, Lysytsia hesitated for only a moment before continuing with the surgery. Stopping at every air raid alarm would leave too many patients without treatment, and she also needed to return home to care for her two young children.
Then, disaster struck. A Russian missile hit Okhmatdyt, killing three people and injuring dozens more. At the time, around 630 children were in the hospital. Despite the destruction, part of Okhmatdyt reopened just a week later. Lysytsia now says the hospital is “mostly operational,” noting that healthcare workers have mentally adjusted to the constant threat of attack. “We have a goal and are responsible for others, so we don’t show our fear,” she explains.
Overwhelmed and Under Attack
When Russia invaded Ukraine on February 24, 2022, Ukraine’s healthcare system was not prepared for the demands of a full-scale war. The conflict has displaced millions, and the United Nations (UN) reports that more than 10 million people have fled the country. Healthcare workers are now performing amputations, operating without electricity, and constantly managing the psychological toll of working in a warzone.
The World Health Organization (WHO) published a report last year commending Ukraine’s healthcare workers for their “significant resilience” in the face of ongoing warfare. However, the impact on the system has been devastating. Government reforms in 2017 aimed to modernize Ukraine’s healthcare, but the war has exacerbated the country’s medical challenges. While the western regions of Ukraine are more stable, the eastern regions—near the frontlines—continue to suffer due to frequent attacks and limited access to medical resources.
Dr. Tankred Stöbe, an emergency medicine specialist with Doctors Without Borders (MSF), pointed out the stark contrast between regions. “If you travel from Lviv to Kyiv, the country seems accustomed to war, but this is not the case for the eastern regions,” he said. His outlook from Berlin remains “more bleak than hopeful.”
Attacks on Healthcare Facilities
The attacks on healthcare facilities in Ukraine have been relentless. Since the start of the war, Russian forces have launched over 1,760 attacks on hospitals, clinics, and ambulances, according to Physicians for Human Rights (PHR). These attacks, which average more than 1.5 per day, are not only destabilizing healthcare delivery but may also be considered war crimes under international law.
British intelligence has revealed that Russian forces are deliberately targeting medical facilities and Ukraine’s energy grid, aiming to cripple the ability of healthcare workers to care for the wounded. In the aftermath of the missile attack on Okhmatdyt, at least 41 more attacks on medical facilities have been documented. Just in January 2024, two centers were completely destroyed, and 22 others were heavily damaged.
The widespread damage to medical infrastructure has severely limited access to healthcare. A recent survey by the Kyiv School of Economics and the University of Oxford found that 16% of Ukrainian households are unable to access medical treatment due to the destruction of healthcare facilities or staff shortages. The situation is even more dire in eastern Ukraine, where frequent airstrikes make hospital visits incredibly dangerous.
The Rise of Health Risks Beyond the Battlefield
In addition to the ongoing injuries from the war, Ukraine is now facing an increasing number of health threats related to the conflict. Infectious diseases, including tuberculosis (TB), HIV, and hepatitis, are on the rise. The 2024 Global Tuberculosis Report shows an increase in TB cases in both 2022 and 2023. Ukraine remains one of the 30 countries with a high burden of multi-drug-resistant TB, complicating efforts to control the disease.
Beyond infectious diseases, chronic health conditions are also on the rise. Cancer, diabetes, and heart disease are now classified as “very high” risks across the country. Conflict-related sexual violence, along with rising mental health problems, further complicate Ukraine’s healthcare crisis. According to a 2024 study, more than 30% of households are experiencing “severe psychological stress.”
Halyna Skipalska, CEO of the Ukrainian Foundation for Public Health, has raised alarms over the potential long-term effects of untreated mental health conditions. “If untreated, these issues could lead to depression, suicide, and eating disorders, especially among children and adolescents,” she warned.
Shortages of Healthcare Workers
Ukraine’s healthcare system is facing a growing shortage of workers, which is only getting worse as the war continues. Many healthcare professionals have fled the country, while others have retired, joined the military, or lost their lives in the conflict. Since the beginning of the war, 262 healthcare workers have been killed.
In larger cities like Kyiv, there are still enough doctors, although the number of specialists remains insufficient, making it challenging to treat chronic illnesses and trauma. In regions closer to the frontlines, the shortage of medical professionals is even more severe. Some doctors temporarily leave when bombings intensify, but others, like Dr. Yevheniia Poliakova, stay despite the risks. “I like my job, and I like my city. I won’t leave unless my city falls under occupation,” she said.
Nurses are particularly hard to come by. Ukraine already faced a nursing shortage before the war, and the situation has only worsened. The country has only half as many nurses per 10,000 people as the European Union. Many nurses have sought jobs abroad, while doctors struggle to obtain foreign medical licenses.
Looking ahead, healthcare worker shortages are expected to persist for years. More than half of Ukraine’s primary care doctors are over the age of 50, and many are nearing retirement. Applications to medical schools have dropped by 21% between 2019 and 2023, raising serious concerns about the future of the healthcare workforce.
A System Under Strain, But Still Standing
Despite these immense challenges, Ukraine’s healthcare system is still functioning, thanks in large part to international aid. However, experts worry about the future as foreign funding becomes less predictable. “In the end, the healthcare system has survived. That means its foundation is strong,” says Inna Ivanenko from Patients of Ukraine.
As the conflict continues, the resilience of Ukraine’s healthcare workers will remain a crucial factor in the survival of the system. With foreign aid, medical evacuations, and an unwavering commitment from healthcare workers, Ukraine’s healthcare system endures, though its future remains uncertain.
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