Healthcare during wartime

Despite significant pressures, the Ukrainian healthcare system has somehow continued to function since the beginning of the war

Four years after Russia’s full-scale invasion of Ukraine, there have been more than 47,000 Ukrainian civilian casualties. Some 5.6 million people have fled abroad and 3.8 million have been internally displaced. And in the midst of all the conflict, Ukraine’s healthcare system has come under enormous pressure.

It has been directly targeted by Russian forces with more than 2,800 attacks on healthcare, leaving over a thousand facilities destroyed or damaged and hundreds of healthcare workers dead. As a result, there has been significant harm to population health. Since the start of the war, 68 per cent of Ukrainians say there has been a decline in their health. A mental health crisis and interruptions to immunisation are just some of the effects of the protracted conflict.

The situation would be a lot worse if it wasn’t for the bravery and determination of the country’s healthcare professionals. As part of a world report feature to mark the war’s fourth anniversary, The Lancet spoke to a range of medical staff across Ukraine. Unsurprisingly, almost all identified the ever-present threat of Russian attacks on their facilities as a major challenge to their work. Constant interruptions to electricity and water supplies, as well as ongoing shortages of medicine, equipment, and staff pose significant additional obstacles.

As a result of doctors joining the military, and others leaving the country, there is an estimated 4,000 shortfall in the medical workforce. Even with additional pay and anticipated better retention of doctors, shortages in specialist areas are likely to continue. There is a need for rehabilitation specialists to deal with combat injuries, as well as psychologists to treat mental health conditions, especially post-traumatic stress disorder.

The number of people in Ukraine with disabilities has increased by nearly 390,000 since February 2022, yet access to rehabilitation remains severely limited.

Almost all the healthcare workers who spoke to The Lancet complained of being overworked and underpaid.

“A critical and widely shared concern is remuneration. Most healthcare workers report extremely low salaries that are insufficient to meet basic living needs, often equivalent to approximately €300 per month. This level of income creates persistent financial insecurity and makes it difficult for medical professionals to support their families, contributing to workforce attrition and burnout,” Dr Oleh Sobko, a psychiatrist with the Prykarpattia Regional Mental Health Centre in Ivano-Frankivsk, Ukraine, told The Lancet.

There has been recognition of this challenge in the 2026 health budget. Additional resources have been put in place to provide for a rise in doctors’ salaries. And a new national health system development strategy recognises that the protection and morale of health workers is essential to Ukraine’s present and future.

The reality of war is that while most of the fighting is in eastern Ukraine, nowhere is safe. Emergency workers have been deliberately targeted in drone attacks. Maternity wards have been moved underground. There is constant upheaval in the health system which is taking its toll on staff. Most report burnout (81 per cent), anxiety (69 per cent), and depression (61 per cent), alongside sleep problems and emotional distress. Only 17 per cent have access to psychosocial support.

Dr Anzhela Sainchuk, an infectious diseases specialist at the LV Hromashevsky Institute of Epidemiology and Infectious Diseases in Kyiv, told The Lancet that the repeated aerial attacks have affected her mental health. “I work away from the frontlines, [but] constant shelling, night attacks, lack of sleep, and power outages mean I experience increased anxiety, which affects my psycho-emotional state,” she said.

Despite these pressures, the healthcare system has continued to function. This reflects the resilience of those working within it and their capacity to adapt to the most difficult of circumstances.

In a particularly vivid description, one Ukrainian doctor told The Lancet how he performed emergency surgery on patients in the basement of their hospital while it was being bombed. The hospital had no water and no power. As a result, the doctor and his team used the light from mobile phones in order to continue to work.

I’m sure Medical Independent readers will want to join me in expressing our solidarity and support for our colleagues in Ukraine. Their fortitude and professionalism is truly impressive.