Crisis in Ukraine

Crisis in Ukraine

ConfMedicallict and war
Russian forces launched attacks on multiple cities in late February 2022, damaging key infrastructure and civilian areas. Millions of Ukrainians are at risk.
 

MedicalRefugees and displaced persons
More than nine million people have been displaced by the conflict, with an estimated 6.3 million refugees seeking protection outside of the country.

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 millions of people leaving Ukraine and becoming refugees. Médecins Sans Frontières (MSF) teams had been working in eastern Ukraine and have suspended our usual medical activities, including our HIV and tuberculosis programmes, in order to address the current crisis.

The conflict continues to put 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.

 

How MSF is responding

MSF teams remain in Ukraine, and we are currently seeking ways to adapt our response as the conflict situation evolves. We are working predominantly in the south and east, providing assistance to Ukrainian populations by filling gaps in the healthcare system caused by the war.

  • Mobile clinics teams are providing primary healthcare, mental health counselling and psychoeducation services, as well as sexual and reproductive healthcare, particularly in areas close to the frontlines.
  • Medical donations, including medical kits, equipment and medicine to hospitals and medical facilities with shortages.
  • Trainings about secondary healthcare, including psychiatric care training, mass casualty trainings and mental health to healthcare staff. 
  • Physiotherapy and post-surgery care, and psychological support for war-wounded and injured patients, as well as physiotherapy trainings for staff in rehabilitation wards at hospitals supported by MSF teams.
  • Supporting the emergency care and intensive care unit as well as supporting the surgical capacity of hospitals near the frontlines in Donetsk and Kherson regions.
  • Medical referrals and evacuation from ambulances and mobile clinics.

 

Regional responses

Evacuations and referrals: train and ambulance

We have 15 ambulances and we were running a medically equipped train to transfer patients, both capable of transporting those in critical condition. Given the continued strain on the healthcare system in Ukraine, and with a continued flow of patients needing referrals due to trauma injuries related to violence, especially in the Donetsk, Kherson, Dnipropetrovsk, Zaporizhzhia regions, MSF ambulance teams refer patients to other hospitals where patients can receive the appropriate care. Near the frontlines in the east and south, the healthcare system is struggling to cope with both the old and new emerging medical needs caused by the fighting. 

The medical 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. The train began operating on 28 March 2022. In 2022, the medical train completed 79 trips, referring 2,558 patients; 700 of these patients were trauma cases, and 136 were admitted to the ICU carriage. Due to a shift in the war's dynamic, whereby patients stay in eastern Ukraine, rather than being referred to the west, our activities using the train have wound down during 2024.

Mobile clinics: primary healthcare, mental health support, reproductive health

The war has had a devastating impact on the continuity of care for those with pre-existing conditions, such as diabetes and hypertension, and the mental health of people after experiencing fear, isolation and fighting – both for internally displaced people and those still living near the frontlines. With thousands of internally displaced people living across Ukraine in shelters and lack of healthcare staff and destroyed healthcare facilities near the frontlines, people’s access to healthcare has been severely disrupted.

To ensure continuity of care and respond to the emerging mental health needs, MSF mobile clinic teams of psychologists, doctors and health promoters are supporting patients and communities with medical consultations, psychological consultations, medical and non-medical donations, and supporting the capacity of the healthcare system by reconstruction of health facilities and training healthcare staff. 

In regions heavily affected by the fighting, such as in the Donetsk, Kherson, and Mykolaiv, especially in the areas that are near the frontlines most of MSF’s mobile clinic patients are elderly people, who are either unwilling or unable to leave their homes. MSF doctors have consistently seen a high prevalence of chronic illnesses such as hypertension, diabetes, heart disease and epilepsy – many of which are diseases that if uncontrolled can have long-term consequences on health and require continuous care. Through our mobile clinics in the Kherson and Mykolaiv regions, we have also begun screening for tuberculosis.

Emergency department, intensive care unit and surgical interventions

Near the eastern and southern frontline areas, people are experiencing incredible hardship as daily shelling and fighting persists. MSF is seeing patients with traumatic injuries from shelling, bomb and shrapnel blasts. At the same time, as health facilities are coping with emerging and increased needs, patients injured in car accidents or those with non-communicable diseases (for example, cardiovascular emergencies), are still prevalent. 

In Kherson city, an MSF medical team supports surgical and trauma activities. From July 2022 until December 2023, MSF was supporting Kostiantynivka hospital, where our teams set up an Emergency Department, two beds in the ICU and one operating room on the ground floor of the hospital to run a contingency trauma facility. However, given the continued shelling of Kostiantynivka, there is no longer a constant MSF presence there. A mobile emergency response team for mass casualty incidents remains ready to respond in both Kostiantynivka and Selydove. 

Most of the patient admissions have been related to violent trauma. 17 per cent of patients coming into the emergency departments where MSF worked in 2023 (in Kostiantynivka and Kherson) were deemed to be “red cases”, meaning that there is an immediate life threat to the patient and that the treatment window should be within 30-60 minutes of first medical contact. The MSF staff aim at alleviating the burden on the healthcare system and specifically on the trauma centres, by triaging and stabilising patients. The staff assess the needs, determine the urgency, and depending on the needs, stabilise them and refer to in-hospital department, to emergency damage-control surgery or refer them to other Ministry of Health hospitals. 

Rehabilitation: Physiotherapy and psychological care

A huge number of people have suffered severe injuries caused by the war. Without adequate, early post-surgical treatment, their recovery may remain incomplete or take much longer than necessary, affecting their lives and weighing on an overwhelmed system. 

MSF teams are supporting the Ukrainian healthcare system with specialisation and training in physiotherapy and post-operative care, as well as psychological consultations. Rehabilitation and mental health services were not particularly developed in the healthcare system prior to the war, but now there are a huge number of people with major injuries and the need for post-operative care is enormous; the trauma patients we see are at risk of developing long-term medical problems or permanent disabilities without proper care.

MSF teams have provided both theoretical and on-the-job physiotherapist training to the staff involved in physical rehabilitation of war-wounded patients in different areas until recently, but now it only continues with a training programme at a hospital in Kharkiv city.

MSF also runs an early rehabilitation project for war wounded in Cherkasy and Zhytomyr regions. In the Ministry of Health hospital in Cherkasy, the team supports incoming war wounded patients. Using a multidisciplinary approach with physiotherapy, psychological and nursing care. In addition, trainings and technical support is given to hospitals in Zhytomyr. 

Psychological care for PTSD

In 2023, MSF started providing specialised psychotherapeutic services for people experiencing war-related post-traumatic stress disorder (PTSD) symptoms in Vinnytsia. A newly custom designed mental health centre was opened in September this year. MSF offers psychological sessions for both individuals and members of the patient’s support network. Our specialists provide them with techniques to help reduce and prevent worsening of symptoms, increase coping skills, improve interpersonal functionality, and decrease consequences of traumatic stress.

A specially trained mental health promotion team is responsible for community engagement and mobilisation through partnerships with key organisations and other health providers in Vinnytsia city. In addition, we train relevant staff (medical doctors, psychologists, social workers, etc) in partner organisations, and medical staff in primary healthcare centres in referral criteria to MSF services. 

Other MSF activities across Ukraine

In the northwest of Ukraine, the MSF tuberculosis (TB) project in Zhytomyr that ran for five years has closed. At the end of 2023, the Biosafety Level 3 Lab was be handed over to the Ministry of Health. However, in Kherson and Mykolaiv regions, MSF is continuing some TB activities, providing screening of suspected TB cases through mobile clinics.

Since the beginning of 2023, MSF has made more than 624 donations (amounting more than two million EUR) of medicines, medical consumables and equipment, hygiene kits and blankets.

In the same period MSF made 197 medical donations (amounting for around 900,000 EUR) to 100 health facilities (hospital and primary healthcare centres) in the oblasts of Poltava, Sumy and Kharkiv (northeast), Ivano-Frankivsk and Zakarpattia (west), Kirovohrad, Zhytomyr, Kyiv (centre) and Mykolaiv and Kherson (south).

Also in 2023, MSF made donations in Lviv and the eastern and southern regions on the frontline amounting to a total of 574 260 Euros. MSF made 45,304 Euros in donations and spent 68,173 Euros in construction costs on health care structures.

Also between the start of 2023 and January 2024, MSF carried out mental health trainings with 189 groups and a total of 2,785 people; as well as trainings on physiotherapy with 82 groups and a total of 192 people in the oblasts of Poltava, Kharkiv, Kirovohrad and Mykolaiv. These trainings were addressed to medical professionals and specialists.

Map Feb 2022

Responding in neighbouring countries

Poland

Context: 
More than 11.7 million people have crossed from Ukraine into Poland since 24 February 2022 (UNHCR, updated 22 May 2023). More than 1.6 million people have registered for temporary protection.

  • MSF is actively working to support the Ministry of Health to ensure that patients can access treatment for drug-resistant tuberculosis, including patients previously supported by MSF in Ukraine. 
Russia

Context: Over 2,850,000 people have crossed into Russia from Ukraine as of 30 July 2023 (UNHCR).

  • MSF has been present in Russia for more than 30 years. Currently, MSF’s teams in Russia work with regional health authorities to support crucial, life-saving treatment for patients with drug-resistant tuberculosis (DR-TB). MSF together with its partner organisations in Moscow and St Petersburg provides assistance to people living with HIV and hepatitis C, including those who crossed from Ukraine into Russia.
  • Since the start of the international armed conflict, MSF has been supporting people displaced to the southern regions of Russia and found themselves in Voronezh, Belgorod and Rostov regions. In close collaboration and partnership with local NGOs, MSF organized teams of local social workers, medical consultants and psychologists, to ensure that people displaced from their homes, mostly newly arrived ones, receive all the necessary qualified medical services in licensed medical clinics and have access to other state healthcare and social services. When necessary, MSF covers any medical care gaps and pays for the necessary medications and medical consultations. 
  • In August 2023, our team concluded the support to the Voronezh-based NGO and started a new partnership with the Taganrog-based NGO that provides assistance to people in transit temporary accommodation centres (TACs) in Taganrog, the Rostov region. In many cases, people displaced by the conflict arrive at TACs without anything; thus, essential food, clothing, and personal hygiene items are provided to them.
  • Our partner NGOs' support those in need of medical and mental healthcare. Social workers from partner NGOs support people displaced by the conflict in acquiring the necessary documents for their registration within the Russian system.
  • Since the beginning of the activities, MSF has provided support to more than 23,600 displaced people, including more than 3,200 people who received mental health support.
  • MSF regularly supports local organisations who provide support to the displaced population in Belgorod, Taganrog and Rostov-on-Don with urgently needed items, e.g. food, hygiene kits and small household items. Since the beginning of the activities, more than 45,000 displaced people received essentials with the support of our partner NGOs.
  • MSF continues to seek access in order to provide assistance to people in Russian-controlled areas of Donetsk and Luhansk regions, where the fighting is intense and humanitarian needs are understood to be significant.

 

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.

Lubov

Lubov Mykolaina, 64 years old, is a patient at the health centre in Chornobaivka supported by MSF. "I have a lot of problems right now. I feel bad. I am afraid of the shelling. I don't feel well. Since the occupation I am afraid. I feel scared, nervous, and that gives me health problems." | October 2023 © Nuria Lopez Torres 

 

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