The Resilience of Ukraine’s Healthcare System

The July 2024 attack on Okhmatdyt Children’s Hospital in Keiv Ukraine reminded the world of the constant and routine devastation that the Ukrainian people have become accustomed to in the past two and a half years. On July 8th, 2024, Russian forces conducted a large-scale attack on multiple cities throughout Ukraine, killing 42 civilians of which 5 were children and injuring 190 others (1). One of the targets was the Okhmatdyt children’s hospital in Kyiv. Ohmatdyt is Ukraine’s largest children’s hospital. With over 80 departments, it is Ukraine’s primary pediatric facility for treating oncology, rare disease, injuries, kidney failure and genetic diseases (2). The attack damaged several departments including the intensive care units, trauma, oncology and surgical wings. Thousands of children, some in critical condition were evacuated out of the hospital amidst the bombing. Although this attack made headlines, sadly it was just one example of Russia’s ruthless attacks on those who are most vulnerable.

As of February, 2024, World Health Organization (WHO) confirmed over 1,500 attacks on healthcare facilities, infrastructure and personnel since the start of the war (3). In 2023 alone, 109 healthcare workers were killed and 36 healthcare facilities were occupied by the Russian army (4). Facilities closest to the front lines continue to bear the brunt, treating high number of casualties with limited resources, routine electric outages and staff shortages while under constant threat of attacks. Highest number of damaged and destroyed facilities were recorded in Donetsk and Kherson oblast in Eastern and Southern Ukraine with some facilities falling under fire multiple times. Beryslav Central District Hospital in Beryslav, Kherson Oblast withstood 6 separate rounds of attacks. Time and time again, staff and civilians rebuild the Beryslav Central District Hospital only to be damaged again. (5) (6)

Despite the harshness of the reality, Ukraine healthcare system prevails. Provision of healthcare needed to change and change quickly. With a reduction in over 50% of healthcare staff and mass population movements, healthcare needs were reprioritized (7). Healthcare facilities adjusted working hours to provide round the clock care and leaned into digital solutions especially in newly regained territories. Ministry of Health (MOH) and WHO launched mobile health units to provide essential care in hard to reach and conflict afflicted regions (8). Staff learned to operate in bomb shelters, with limited supplies, under the hum of generators. Teamwork and close collaboration has been the cornerstone of successful rebuilding and restoring Ukraine’s healthcare structure, while continuing to identify, modify and serve the changing landscape of care. 

Under the unwavering leadership of the MOH and with tremendous support from the international community, the Government has not only continued to provide care but have stayed true to their commitment to build back better. Prioritizing rehabilitative services to those wounded by conflict, MOH has supported the development of 6 rehabilitation centers of excellence, working with western donors to modernize rehabilitation services and incorporate assistive technology (9).  The First Lady Olena Zelenska has spearheaded a mental health program targeting 14 million Ukrainians at risk for numerous mental health conditions many of which are a direct result of the ongoing war. UN and international donors have supplied equipment, essential medicine, generators and strengthened Ukraine’s supply chain delivery to ensure essential services reach those who need them the most (10). 

Despite these gains, healthcare challenges in wartime Ukraine remain immense. Those living on the front lines have limited access to healthcare and over 50 percent do not have the means to pay for medical services (11). Over two years of war has had a devastating impact on the population, escalating mental health crisis with high rates of post-traumatic stress disorder, unmanaged anxiety and depression (12).  Amidst all this, healthcare facilities continue to be targeted and Ukrainians are reminded almost daily that no one is safe. 

Yet there is reason for hope. Attack after attack, Ukrainians band together and rebuild. They evaluate needs, reprioritize and healthcare providers show up time and time again providing care in bomb shelters, hospital basements, and makeshift units amidst the wail of air sirens. While the road is fraught with challenges, the Ukrainian healthcare system has proven to be adaptable and resilient, serving as a beacon of hope for the Ukrainian people during their darkest times.

(1) https://www.hrw.org/news/2024/07/11/russias-july-8-attack-childrens-hospital-ukraine

(2) https://ohmatdyt.com.ua/en/slider/the-hospital-is-working-and-standing-for-life/

(3)  https://www.politico.eu/article/ukraine-health-system-hans-kluge-war-world-health-organization/

(4) https://insecurityinsight.org/wp-content/uploads/2024/05/2023-SHCC-Ukraine.pdf

(5) https://insecurityinsight.org/wp-content/uploads/2024/05/2023-SHCC-Ukraine.pdf; 

(6) https://www.pravda.com.ua/eng/news/2023/10/5/7422775/

(7) https://www.who.int/ukraine/publications/m/item/continuity-of-essential-health-services-during-the-war-in-ukraine

(8) https://iris.who.int/bitstream/handle/10665/373340/WHO-EURO-2023-8275-48047-71206-eng.pdf?sequence=2

(9) https://www.undp.org/ukraine/press-releases/undp-launches-innovative-rehabilitation-initiatives-war-affected-ukraine

(10) https://www.politico.eu/article/ukraine-health-system-hans-kluge-war-world-health-organization/

(11) https://www.politico.eu/article/ukraine-health-system-hans-kluge-war-world-health-organization/

(12) https://ijmhs.biomedcentral.com/articles/10.1186/s13033-023-00598-3,  https://iris.who.int/bitstream/handle/10665/373340/WHO-EURO-2023-8275-48047-71206-eng.pdf?sequence=2