On February 24, 2022, Russia commenced a full-scale military invasion of Ukraine. The targeting of healthcare facilities has become part of the strategy and tactics of Russian invaders.
The Ukrainian healthcare system was not exemplary even in peacetime. People suffering from chronic diseases often faced interruptions in the supply of medicines, doctors complained about low salaries, and extortions in hospitals have long ceased to be surprising. The war had every chance of completely destroying the system, but instead it pushed the government and local specialists to find effective solutions, thanks to which medicine in the country not only survived, but also continued to develop.
Doctors have to work in the field, replacing sterile operating rooms with basements and bomb shelters. In some cities, the medical staff does not leave the hospital around the clock, which has become their second home.
There is an outflow of medical personnel from areas of active hostilities. Most of the doctors in Ukraine, as well as all over the world, are women, many of them have children. Fleeing from shelling, they were forced to evacuate to the western regions of the country or abroad. Among those who remained, many mobilized to help the fighters on the front lines.
As a result, we have a number of settlements that are regularly bombed, without properly functioning hospitals and the necessary number of doctors. At the same time, most of the population living there today are people of retirement age who need medical control of chronic diseases.
When the military administration calls on residents to evacuate, it is important to understand that this is not only done because of the direct threat to life due to shelling. Such decisions are made, among other things, on the basis of an assessment of the health situation in the region. By staying, people run the risk of being unable to obtain necessary medicines or medical care.
A big problem today is the access of citizens to medical care in the occupied territories. Having captured a settlement, the occupiers are unable to meet the basic needs of the population, neither in terms of food, nor in terms of health care.
Ukrainian military doctors have extensive experience in complex operations and treatment of seriously wounded soldiers since 2014-2015. Knowing about their success, over the past 8 years, foreign doctors have come to Ukraine to exchange experience.
Under the conditions of the war, the Ukrainian healthcare system not only survived, it continues to develop. To date, our hospitals continue to perform the most complex emergency operations, planned transplantations, and the blood service is actively working.
The war exposed weaknesses in all areas of government, and medicine was no exception. One of the most painful lessons was the lack of full-fledged bomb shelters at medical facilities. The cellars, which were rather arrogantly called shelters, were often turned into mass graves during massive shelling. The lack of an autonomous ventilation system, water supply and solid ceilings make them unsuitable even as a shelter for healthy people. There is no need to talk about the long stay of seriously ill patients in need of therapy.
Now in many hospitals located in cities where hostilities are not ongoing, basements have already been equipped. In emergency cases, doctors will even be able to perform operations there, but this is not the level that is necessary for full-fledged work. This will definitely need to be worked on after the end of the war.
Also in the future, it is necessary to start creating and constantly updating a reserve of medicines and other necessary funds, which at a critical moment were not in Ukrainian hospitals. And in connection with the threat of the use of chemical weapons, the issue of providing means of protection not only for the military, but also for civilians has become actual.
The main challenge for the system after the end of the war will be the issue of personnel. It will require new managerial decisions regarding the organization of work in the field. The matter is not limited to the search for specialists alone. Against the backdrop of a shortage of personnel, it will be necessary to introduce the latest technologies into work in order to compensate for the shortage of personnel.
Traditional approach to protection of civilians in war was based on the assumption that civilian persons and items can be distinguished from military targets. During the war in Ukraine, the world understood that all civilians were at major risk and that work of human rights, humanitarian organizations should be significantly strengthened. This effort should become a major goal of contemporary and future public health.
We must immediately start a global dialogue on war control as a major public health responsibility. The fight against hatred and tolerance are the main means of strengthening peace. Moreover, we must oppose and abolish the right to war as a right of the state.
About the author: Oleksii Korzh – Professor, MD, PhD, Doctor of Medical Science, a member of WONCA, RCGP, AAFP
I continue working as Head of Department of General Practice – Family Medicine at Kharkiv Medical Academy of Postgraduate Education and Professor of Department of General Practice – Family Medicine at V.N. Karazin Kharkiv National University, Kharkiv, Ukraine.
Competing interests: None
Handling Editor: Neha Faruqui