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Crisis in Ukraine

Crisis in Ukraine

ConfMedicallict and war
After weeks of speculation, Russian forces launched attacks on multiple cities in late February 2022. Millions of Ukrainians are now at risk.

 

MedicalRefugees and displaced persons
More than nine million people have fled to neighbouring countries since the war began, with an additional six million currently displaced within Ukraine. 

 

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The current situation

Following continuous low-level conflict in eastern Ukraine, in Donetsk and Luhansk oblasts (provinces) since 2014, in late February 2022, Russian forces attacked multiple cities across all of Ukraine, leading to full-scale war.

The intense fighting and shelling have led to over five million people leaving Ukraine and becoming refugees, with seven million displaced within the country. Médecins Sans Frontières (MSF) teams had been working in eastern Ukraine and have now suspended our usual medical activities, including our HIV and tuberculosis programmes, in order to address the current crisis.

We have been in contact with hospitals that are receiving patients wounded as a result of the fighting. The conflict is putting a huge amount of pressure on health facilities that have limited staff and supplies; many hospitals are facing shortages. It is difficult to find medical and other crucial supplies in the country, as these are in high demand to meet the needs of so many patients.

 

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Our history in Ukraine

MSF first worked in Ukraine in 1999, supporting the Ministry of Health to treat HIV. From 2011 to 2014, MSF ran a drug-resistant tuberculosis programme within the regional penitentiary system in Donetsk.

MSF responded to the conflict in eastern Ukraine from 2014 onwards and has also continued to provide specialised programmes to treat infectious diseases, such as hepatitis C.

When the current war broke out in February 2022, MSF was running a drug-resistant tuberculosis project in Zhytomyr, an HIV project in Sievierodonetsk and working to improve access to primary healthcare for people affected by conflict in eastern Ukraine. These projects were temporarily suspended as we reoriented our activities to respond to the needs created by the war.

How MSF is responding

MSF teams remain in Ukraine, and we are currently seeking ways to adapt our response as the conflict situation evolves.

Our current emergency response

  • We currently work with approximately 133 international staff in Ukraine and employ around 580 Ukrainian staff. More are joining the team every day. They work as medical staff (doctors, nurses); psychologists; logistics and administration; and management.
  • We currently have teams based in Dnipro, Ivano-Frankivsk, Kharkiv, Kyiv, Lviv, Mykolaiv, Odesa, Poltava, Pokrovsk, Kochubeivka, Kostiantynivka, Kryvyi Rih, Uzhhorod, Kropyvnytskyi, Vinnytsia, Zaporizhzhia and Zhytomyr.

Assisting displaced people 

Many displaced people are now sheltering in Lviv and other towns in western Ukraine. Often, they have left their homes with only what they can carry. Local volunteers and civil society organisations are working hard to help them, but conditions are harsh, with available accommodation already full to overflowing and temperatures as low as -10 at night. MSF is donating a large supply of cold weather items (sleeping bags, warm clothes, tents) to civil society organisations supporting displaced people and refugees. 

Overlapping medical needs

So far, the focus has been on surgical, trauma, ER (Emergency Room) and ICU (Intensive Care Unit) equipment and drugs. But a broader picture of other key medical items is starting to emerge insulin for diabetes patients, medicines for patients with other chronic diseases such as asthma, hypertension, or HIV. 

Medical train

The medicalised train run by MSF takes patients from overburdened Ukrainian hospitals close to active warzones to Ukrainian hospitals with more capacity that are further from active warzones.

Between 31 March and 4 November, 65 referral journeys have transported a total of 2,010 patients with their family members and caretakers. Of the patients transported, 33% have been trauma cases.

Regional responses

Central Ukraine

Kyiv

  • MSF continues to support outpatient medical care services in Hostomel on the outskirts of Kyiv, for example by supplying medication. We also provide mental healthcare in nine different locations outside of Kyiv. 

  • In the city of Kyiv, in July we began to provide physiotherapy services in a hospital managed by the Ministry of Interior where 70 beds (out of a total of 200 trauma beds) are dedicated to physiotherapy for war-wounded people. Our teams are both treating patients and providing bedside training to local health staff, in order to respond to a major need and bridge a significant gap in the Ukrainian healthcare system. The brutality of this war is generating a huge number of people with major injuries and the need for post-operative care is enormous. However, rehabilitation and physiotherapy were not particularly developed in the local healthcare system prior to the war. The high number of trauma patients are at risk of developing long-term mobility issues without proper care.

  • We also provide self-care and psychological first aid training for railway staff, who often end up acting as psychological first responders, as they serve people who are evacuating from areas heavily affected by the war and who have suffered particularly difficult experiences. 

Kropyvnytskyi

  • The MSF team here has provided medical donations to 17 health facilities in Kirovohrad oblast, where Kropyvnytskyi is located. Between March and August, we provided 97 training sessions for health professionals, psychologists and first responders on aspects such as managing a high influx of war wounded, decontamination, trauma and mental health. A total of 1,495 people participated in these training sessions. In the same period, our mental health team has seen 149 patients in individual sessions and 2,605 in group psychoeducation sessions. MSF is also distributing relief items and doing rehabilitation work in IDP shelters, as well as supporting a maternity hospital to make more accessible services for survivors of sexual and gender-based violence.

Vinnytsia

  • In Vinnytsia, we are continuing with our mobile clinics and going more in the southern part of the oblast, in the rural areas where IDPs have chosen to settle, and are not able to access primary health care. We have also started strengthening our mental health activities in the form of mental health/health promotion-dedicated mobile teams.

  • Since July, we have been providing physiotherapy with a similar approach to the project we operate in Kyiv. In Vinnytsia, we work in a hospital belonging to the Ministry of Health featuring 60 beds dedicated to physiotherapy. Our teams provide post-operative care for war-wounded patients and bedside training to increase the local capacity.

Southern Ukraine

Apostolove and Kryvyi Rih 

  • In Apostolove hospital, MSF provides emergency room and direct, hands-on surgical support. This includes assisting with, and working on, triage and surgical interventions. We also support outpatient activities in four activities and have treated over 1,000 patients in recent months.
     
  • In the broader Kryvyi Rih area, mobile clinics provide sexual and reproductive health and mental health services and health promotion. Mobile clinics also visit areas that have been affected by fighting for many months and been under the control of different military forces, where many people have not accessed healthcare during that time. Teams continue to assess new areas as the frontlines shift and territory is retaken by the Ukrainian forces.
     
  • In Kochubeivka, we run a stabilisation point where patients are provided with initial treatment before being referred to hospitals. Many of the patients in this particular area have injuries as a result of landmine explosions.
     
  • MSF ambulances also transfer patients to hospitals and between medical facilities around Kryvyi Rih and in the areas of the Kherson oblast that are under Ukrainian control. This includes one regular ambulance, one ambulance able to transport up to four patients and one ambulance able to support patients requiring ICU-level care.
     

Mykolaiv 

  • In Mykolaiv, we support several hospitals in the city with medical and logistic donations and water and sanitation services.  We provide mental health services in three sites in the rural areas around the city, where we witness the extremely severe impact of war on the psyche of the people. This is an area that needs attention as mental health issues are still frequently stigmatised in the country and there aren’t enough psychologists and psychiatrists, especially with experience of war-related trauma.

Northern Ukraine

Kharkiv region

  • The counteroffensive launched in early September by the Ukrainian Armed Forces in the Kharkiv oblast resulted in the retreat of the Russian Armed Forces from the northern and eastern areas. Since then, the teams have been able to reach villages, towns and people that were previously inaccessible. The majority of those who had remained in the region are elderly people living with chronic health issues or and people with disabilities, including mobility issues. Many have experienced isolation, fear and panic, depression or stress; and the lack of access to medical care has left people without proper treatment and treatment interruptions of chronic diseases. 

  • The need for medical care and mental health support is high – especially in the rural communities. Our teams run mobiles clinics – focusing on areas with damaged or destroyed health facilities or no healthcare presence – providing primary care, including sexual and reproductive health, and psychological first aid and mental health consultations. Due to the high medical needs and increase in regional accessibility, the teams doubled the average rate of monthly medical consultations in September as opposed to previous months.

  • The teams are also providing non-food items such as hygiene kits, medical donations to health facilities and water treatment systems to IDP shelters. As the hotline team continued to provide medical and psychological consultations and medicine deliveries for the city and the oblast, the number of patients increased significantly in the last two weeks of October, as the population in the rural areas were reconnected to the mobile network.

Zhytomyr

  • In Zhytomyr, MSF teams continue to provide social support (food parcels and hygiene kits) and psychological support to all active TB patients to help them to keep taking their medication correctly and complete treatment. In collaboration with health authorities, MSF has recently started doing contact-tracing for children who have been in close contact with TB patients.

  • MSF also transports samples to the TB hospital for testing so that patients’ progress can be monitored. 
    At the same time, we continue to support the regional TB Hospital by providing them with TB and other drugs as well as laboratory consumables and food for patients.

Eastern Ukraine

Dnipro

  • In and around Dnipro, we are supporting vulnerable people who have fled parts of Donetsk and Luhansk oblasts where the conflict is particularly intense, and who are now staying temporarily or longer-term in more than 40 shelters. 

  • In the shelters our teams run mobile clinics, providing medical consultations; continuation of care and medications for people with chronic illnesses such as hypertension, asthma, diabetes, heart disease, epilepsy; referrals to hospital for severely unwell patients; psychological first aid and mental health consultations; and basic relief items. MSF also provides consultations and referrals for people who have experienced sexual violence.

  • The mobile clinic activity in the shelters is slowly transitioning into support to strategic primary health structures as people are choosing to stay and settle in the oblast. Rural areas are also being looked at to ensure that both IDPs and host community have equal access to health care. Teams have also started looking at facilities providing care for the more vulnerable of the population (elderly, people with disabilities, abandoned children, etc) and giving them support specifically around infection prevention and control, logistics and preparing for winter.

  • MSF also runs a clinic providing sexual and reproductive health services, including contraceptives and care for people who have experienced sexual violence, as well as health promotion, information and linking to services via social media. 

Zaporizhzhia

  • In Zaporizhzhia, we are providing support to displaced people, thousands of whom were displaced from Mariupol, and other areas where fighting is intense. 

  • Our teams run mobile clinics in the main reception centre and support more than 30 shelters throughout Zaporizhzhia, providing medical consultations; medicines for people with chronic illnesses such as hypertension, asthma, diabetes, heart disease, epilepsy; and referrals to hospital for severely unwell patients; psychological first aid and mental health consultations; and basic relief items.

  • The reception centre mental health and health promotion team is still there. As in Dnipro, the project is now transitioning into support of strategic primary healthcare centres. Continued support to hospitals close to the front line is ongoing with donation for set up of a bunker operating theatres as contingency planning. Mental health activities are also being increased and including workers close to the frontline as the burden of mental health trauma of the continued conflict gets heavier.

  • Daily shelling incidents in Zaporizhzhia city continued during the month of September. In September our teams assessed water and sanitation needs in the frontline communities and received requests from local groups and hospitals, such as one maternity hospital in Zaporizhzhia city and primary health care centres, that were provided with the first donations.

Kostiantynivka

  • MSF has supported the emergency department, and surgical and intensive care units  with medical care at the Kostiantynivka Hospital since late July. The MSF teams work alongside and in partnership with Ukrainian Ministry of Health staff. Most of the cases they see are trauma cases. 

Lyman

  • Lyman is in an area recently retaken by the Ukrainian forces. MSF teams have visited the area, donated medical supplies and mobile clinic consultations in the past few weeks. They will continue to intervene in this area and to further explore how MSF can best respond to needs. 

Donetsk region

  • Ambulance referrals: MSF ambulances refer patients between healthcare facilities, serving 16 different facilities in the Donetsk region, often to move patients from facilities close to the frontline to hospitals further away from the fighting, where they can continue their care. Most of these patients have suffered severe trauma. Around 31 patients are transferred every week. 
  • Support to hospitals: We are finalizing the setup of paediatric inpatient and outpatient departments in Sloviansk hospital and supporting the hospital in the emergency room. Once the paediatric inpatient department opens, Sloviansk hospital will be the only hospital to provide this service in the oblast, including those of newly retaken areas. Mental health services in Kramatorsk city primary healthcare centre is also being set up. Primary health care and network set up are being connected to other organizations able to provide medications.

  • Support for people left behind: We are working with volunteers and civil society to identify gaps and support needs to be able to provide warmth and contingency planning this winter.

Care for Carers Program

  • As the conflict has put pressure on the local health care professionals, the teams are providing mental health support to medical and mental health care professionals, who experience burn out and stress. The activities include psychological group support and stress management trainings, focusing on providing coping mechanisms. The teams have also provided training in some other locations such as Odesa.
Western Ukraine

Uzhhorod and Ivano-Frankivsk

  • We have carried out training sessions on decontamination, mass casualty, sexual and gender-based violence and mental health with local health professionals, psychologists and first responders. Between March and August, we have provided 36 training sessions attended by 707 people in the oblast of Zakarpattia, to which Uzhhorod belongs, and 62 sessions in Ivano-Frankivsk oblast, with the participation of 1,069 people. We keep doing donations to 12 health facilities in these two locations and distributing non-food item (NFI) kits for displaced people, particularly in nearby rural areas, as well as doing rehabilitation works at IDP shelters. 

  • In Ivano-Frankivsk we are supporting a fixed outpatient department point and a mobile clinic focusing on IDP patients run by doctors who are themselves displaced by the war. In 17 weeks of collaboration until the end of August, 1,274 medical consultations were done. In Uzhhorod and other peripheral areas we are running mobile clinics at IDP public shelters. Since August, our teams have done an average of 200 medical consultations per week and the main conditions seen are chronic diseases and acute respiratory tract infections. We are also carrying out between 25-30 individual consultations of mental health and arranging group activities with an average of 170 people every week.

MSF is working to rapidly scale up our medical and humanitarian response in various parts of the country, based on where we see the greatest need and the best opportunity for our assistance to have a significant impact.

Responding in neighbouring countries

Belarus
  • Context: According to the Belarus State Border Committee, more than 60,000 Ukrainians have arrived since February 24, including some 16,000 via the Ukrainian-Belarusian border, 35,800 via Poland and some arrivals via Lithuania (7300) and Latvia (1300).  UNHCR has recorded more than 16,705 people crossing from Ukraine into Belarus as of 18 October (UNHCR).
     
  • In Belarus, an MSF assessment team has moved to areas of the Belarus-Ukraine border to assess potential medical and humanitarian needs. In Belarus, our team has seen an increasing number of people forcibly displaced from Ukraine in need of medical assistance and social support. We are responding to the needs of patients from Ukraine, as well as other countries of origin, in Minsk, Grodno, Brest, Gomel, Mogilev and Vitebsk regions. Among our patients, there are many children and people with non-communicable and chronic diseases including diabetes and hypertension. A majority of them is in need of urgent psychological support. In Belarus, MSF continues to run its regular programmes. We support the national tuberculosis (TB) programme in the civil and penitentiary sectors and hepatitis C treatment in prisons.
     
  • Since 2021, we have also been assisting people on the move stranded between Belarus and the EU countries. 
Poland
  • Context: More than 6.9 million people have crossed from Ukraine into Poland as of 18 October 2022 (UNHCR). More than 1.45 million people have registered for temporary protection.
     
  • MSF is actively working to support the Ministry of Health to ensure that  patients are able to access treatment for drug-resistant tuberculosis, including patients previously supported by MSF in Ukraine. 

 

Russia
  • Context: Over 2,800,000 people have crossed to Russia from Ukraine as of 3 October 2022 (UNHCR).
     
  • MSF has been present in Russia for 30 years. Currently, MSF’s teams in Russia work with health authorities in Arkhangelsk and Vladimir regions to support crucial, life-saving treatment for patients with drug-resistant tuberculosis. In the last few months, MSF scaled up its assistance to partner organisations in St Petersburg and Moscow ensuring continuation of HIV treatment for people from Ukraine and other people in need. We have seen an increase in the number of people from Ukraine living with HIV and hepatitis C in need of refills for their antiretroviral medicines.
     
  • Alongside this, MSF has recently started to support people displaced to Rostov and Voronezh (since February 2022), in coordination with local authorities. In May 2022, a dedicated MSF hotline was launched with an aim to provide referral services to medico-social support to the refugees and from Ukraine.  As of mid-October, MSF, with the support of local specialists, responded to the medical needs of more than 1,000 people on a case-by-case basis in Voronezh, Rostov-on-Don and Belgorod.
     
  • For several months now, we are regularly supporting organizations in Voronezh, Rostov-on-Don and Belgorod with urgently needed items such as food, hygiene kits, small household items to support some of thousands of refugees who have crossed into Russia and help them to access medical services and medications as needed.
     
  • MSF through local organisations, social workers and local health providers, aims to link populations in need to existing medical and humanitarian services and improve their ability to receive the needed medical and humanitarian support. As in any country, our work in Russia is focused on providing medical care where we can, based on medical needs alone.

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