Health systems under siege

The healthcare crises in Ukraine, Russia, and Cuba reveal the human cost of war and political choices

It’s natural to be concerned about the healthcare system in Ukraine when one thinks of the war between the country and Russia.

In fact, the healthcare in Ukraine has largely managed to withstand the upheaval that began in 2022.

This is largely because it had developed a comprehensive primary care programme prior to the Russian invasion.

However, hospital services near the war’s frontline have migrated underground to hospital basements and cellars.

The protracted war has put particular unprecedented pressure on vulnerable populations, such as ageing patients and those with chronic disease.

Healthcare reforms, which were introduced almost 10 years ago in 2017, are now facing considerable strain due to financial and human-resource constraints.

In contrast, Russia’s healthcare system receives considerably less attention. I was therefore struck by a recent feature in the British Medical Journal (BMJ), titled ‘Russia’s healthcare crumbles amid Putin’s war with Ukraine’.

The article explains that the need to reform Russia’s healthcare sector has been recognised and debated since the early 2000s, yet little meaningful progress has followed. The system was already experiencing serious difficulties as oil revenues started to fall in 2014, and the war that began in 2022 has placed further pressure on an already struggling service.

A particularly serious effect of these problems has been the loss of experienced healthcare professionals. Many skilled workers have left the medical profession, with excessive workloads and administrative bureaucracy among the factors contributing to their departure.

Figures from Russia’s Ministry of Health indicate that the country’s medical workforce has fallen from approximately 750,000–800,000 in 2014 to fewer than 600,000 by May 2026. A government spokesperson told the BMJ that around 496,000 additional medical workers are required to address the current shortages.

Pay is another significant factor behind the workforce decline. Doctors in Russia are paid substantially less than their colleagues in Poland, for example. The departure of experienced medical staff has placed additional demands on those who remain, with many working extra hours without receiving overtime pay.

In an attempt to address staffing shortages, the Putin government introduced a compulsory service requirement for newly qualified doctors. This took effect in March 2026. Under the new policy, all Russian nationals graduating from medical school must complete a minimum three-year placement in a state-run Russian hospital, with their location of service determined by the federal authorities.

For many years, while under the leadership of Fidel Castro, Cuba had a close relationship with Russia (the USSR at the time). But that relationship withered on the vine and now Cuba’s health system is in dire straits, according to a recent feature in The Lancet.

It’s a catastrophic fall from the days when Cuba was seen as a leader of health services among low-income countries. The reason for the health crisis? A US oil blockade that seeks to increase pressure on the island’s revolutionary government.

In May, UN officials warned that hospitals across Cuba were suspending surgeries, struggling to keep lifesaving equipment running, and facing severe medicine shortages.

The blackouts and fuel shortages were pushing the country’s healthcare system deeper into crisis.

Later in the summer, the Cuban government eased longstanding restrictions on private importers in an effort to increase the supply of medicines in the country.

But the situation remains perilous. What was once seen as a model public health system is now unable to diagnose common viral illnesses, stock essential medicines, guarantee running water, or electricity in hospitals.

As is the case in Ukraine and Russia, the crisis is driving emigration. Medical workers were among the quarter of a million people to leave Cuba last year.

The negative health consequences of the policies undertaken by the current US and Russian regimes are enormous. It begs the question of how much more harm will be experienced by the ordinary people of Cuba, the Ukraine, and Russia.