Medicine during the war: What challenges did the medical system face?

The full-scale war waged by russia over the last year has had a significant, devastating impact on the lives and health of people in Ukraine, and has caused significant damage to the healthcare system. The attack on medical facilities was part of the strategy and tactics of the russian invaders. The destruction of medical infrastructure, lack of staff, and disruption of logistical chains have all impeded the timely and full provision of medical resources to the population. Despite the many challenges, the healthcare system managed to survive and provide help when it was needed most. Doc.ua CEO Garry Andreasyan told Mind what damage the war caused to the Ukrainian healthcare system, what changes took place, and how the healthcare system is developing now.

The Ukrainian healthcare system was not exemplary even in peacetime. The war had every chance of completely destroying the medical system, but instead, it pushed us to find effective solutions that not only helped the country's healthcare to survive but also to continue developing. However, before discussing the positive changes, let's look at the most negative consequences of the war on the Ukrainian medical front.

Huge losses

According to Health Minister Viktor Liashko, as of February 2023, since the beginning of the invasion, russians have completely destroyed almost 200 medical facilities in Ukraine, and 1218 facilities have been damaged. In particular, 540 hospitals have been partially destroyed, 173 – completely, and 593 pharmacies have been damaged. At least 98 people have been killed and 134 injured, including approximately 18 medical workers and 56 seriously injured.

According to the latest estimates by the Ministry of Economy and the KSE Institute, as of December 2022, the amount of direct documented damage to Ukraine's infrastructure caused by the full-scale invasion reached $137.8 billion (replacement cost), with direct losses from the destruction or damage to healthcare facilities amounting to $1.7 billion. The Ministry of Health estimates that Ukraine will need between €14.6 and €20 billion to rebuild the healthcare system.

Read also: Medicine at war: How the healthcare system has changed

Patient Migration 

Many people have been forced to relocate. According to the International Organisation for Migration (IOM), as of August 2022, more than 10 million people were internally displaced: about 6.5 million became internally displaced persons (IDPs), and about 4 million left the territory of Ukraine. This means that people who have moved to other regions of Ukraine are now looking for opportunities to receive medical services there, which has affected the healthcare system. Some of them refused to receive treatment or postponed it for later.

For example, at Doc.ua, the demand for medical services fell by almost 70% at the beginning of the war. And it is not surprising. At that time, it was "not the right time" for people. At the same time, a lot of free medical platforms, chatbots, and other services where doctors provided free consultations appeared. However, we are already seeing positive dynamics, with indicators starting to level off as people try to return to their normal routines and continue devoting time to their health. According to the latest IOM data, as of 23 January, the number of IDPs in Ukraine was 5.4 million. It is slightly lower than in previous reports, and it means that the estimated number of IDPs in Ukraine is steadily decreasing.

Staff issues

Not only patients but also doctors moved to other oblasts or went abroad because of the war, which also affected the medical system. Foremost, it led to the redistribution of professionals within the country, with many internally displaced healthcare workers finding jobs in other cities. According to Doc.ua, in the first three months of the war (compared to the previous three), there was a sharp demand for doctors in Lviv, Ivano-Frankivsk and Dnipro, the oblasts where people migrated the most. At the beginning of the war, the west of Ukraine was oversaturated with specialists, while in the east and south, along the frontline, there was, and still is, a shortage of medical professionals.

However, according to the Ministry of Health, there is currently no critical shortage of doctors in Ukraine, as there has been no large outflow of specialists, with only 1% of doctors leaving the country. Moreover, there is now a potential opportunity to attract foreign healthcare workers who are willing to work in Ukraine voluntarily.

Disruption of logistics and availability of medicines

Since the beginning of the war, due to the large-scale destruction of Ukraine's medical infrastructure and disruption of logistics, medical institutions have faced shortages of a large number of medicines and equipment. According to a WHO survey, every fifth patient (22%) was unable to purchase the medicines they needed, and every third – in the temporarily occupied territories and territories with active hostilities. The situation with internally displaced persons is similar.

Most often, respondents mentioned the following types of medicines that were difficult to obtain due to increased prices (84%) or lack of medicines in the pharmacy (46%):

• Medicines for high blood pressure – 49%.
• Medicines for heart disease – 49%.
• Painkillers – 41%.
• Sedatives – 33%.
• Antibiotics – 32%.

However, thanks to Ukraine's international partners – governments and ministries, international and Ukrainian businesses – Ukraine has received more than 8,500 tonnes of medical humanitarian aid totalling more than UAH 12 billion in almost a year and continues receiving regular assistance in the form of medicines, medical equipment and other necessary medical supplies.

Read also: Egg fever: The outbreak of salmonellosis in Kyiv is a logical consequence of wartime realities. To what extent is the state control system to blame and how can citizens protect themselves?

Adequate bomb shelters shortage in medical facilities

The war revealed weaknesses in all areas of public administration, and healthcare was no exception. One of the most painful lessons learned was the lack of proper bomb shelters in medical facilities. Doctors had to work in field conditions, replacing sterile operating theatres with basements and bomb shelters. The lack of an autonomous ventilation system, water supply and solid ceilings make them unsuitable even as shelters for healthy people.

Many hospitals located in cities where there are no hostilities are now equipped with shelters. In emergency cases, doctors can even perform operations there, but it is not the level required for full-fledged work. We will definitely need to work on it after the war is over.

How medicine has changed and is changing now

The Ukrainian healthcare system has not only survived the war but continues developing. Today, hospitals continue performing the most complex emergency surgeries and planned transplants, and the blood service is actively working. Furthermore, it has led to the following positive developments:

Accelerating the introduction of new treatment approaches

People across Ukraine report that the main barriers to accessing healthcare are cost and time constraints. People living in the temporarily occupied territories and in the areas of active hostilities remain the most vulnerable, as the fear of coming under fire, limited transport accessibility and an insufficient number of doctors add to the previous reasons.

Fortunately, since the beginning of the war, many IT initiatives have begun to create services to provide online medical care to Ukrainians, some of them on a volunteer basis. These are mostly telemedicine services – consultations with a doctor via chat, phone, or video. Our company also continues to develop a user-friendly telemedicine product. It was available on the website in a test version before the war started. Now, the number of users of such services has increased significantly, in particular, due to the need for consultations for Ukrainians from abroad.

Focusing on mental health

The war has undoubtedly affected the psyche of every Ukrainian, prompting patients to seek psychological help and doctors to provide it in various ways. In the first months of the war, Doc.ua saw a significant increase in demand for the services of doctors of such specialities as: psychologists, psychotherapists, psychiatrists, and neurologists.

Many platforms offering psychological support for Ukrainians appeared: Mindly, Tell Me, Resilience Hub, and others, which continue to provide psychological support. More than 12,000 psychosocial counselling sessions have been conducted since the beginning of the war. The Minister of Health said that at least 15 million people will need psychological help after the war is over, and the Ministry of Health is already working on certain rehabilitation programmes for the Ministry of Defence and the Ministry of Veterans.

Free medical services and programmes

The medical guarantee programme not only continues operating during the war, but also introduces new service packages. The Government has already approved the Procedure for Implementing the Medical Guarantee Programme for 2023. The planned budget for the MGP-2023 is over UAH 142 billion. It includes UAH 4.7 million for reimbursement of medicines. As previously, the Medical Guarantee Programme 2023 will cover all major types of medical care: primary, specialised and highly specialised care, emergency, palliative care and medical rehabilitation. It will also include medical care for children under 16 and maternity care. In total, the Medical Guarantee Programme for the next year provides 39 service packages, including:

• Affordable Medicine – immunosuppressive drugs, test strips for insulin-dependent patients and painkillers for palliative care patients are added;
• medical rehabilitation of infants born prematurely and/or sick during the first three years of life;
• oncological disease treatment;
• a package of psychological support at the primary level;
• special packages are provided for medical institutions in the occupied territories and in the combat zone.

International support for Ukraine's healthcare system

According to the European Commission, the EU has successfully coordinated more than 1,000 medical evacuations of Ukrainian patients through its civil protection mechanism to provide them with specialised medical care in hospitals across Europe. Several European countries have also announced a partnership to strengthen Ukraine's public health system, for which $45 million has already been allocated. Since the beginning of the full-scale war, more than UAH 4 billion has been transferred to the healthcare system of Ukraine.

Thus, despite the war in Ukraine and the heavy losses, the healthcare system has survived and continues to develop. One of the proofs is the healthcare reform. It began in 2017, and now it is helping to effectively transform Ukraine's healthcare system. I believe that the reform should continue, and the work of the entire system should be continued along with it. In addition, the state should support the introduction of new technologies and convenient tools from medical IT initiatives, which are also driving forces for positive change. People's health, after all, both physical and mental, has always been a priority and will remain so after the war is over. It is also important to provide Ukrainians with convenient access to medical services. We have not only the need to do this, but also effective projects that have already been implemented.