Ukraine’s health system is a symbol of resilience

Dr. Hans Henri P. Kluge is the World Health Organization’s regional director for Europe.

At the Okhmatdyt pediatric hospital in Kyiv, a little boy was learning how to walk again. At this center of excellence for rehabilitation, serving children wounded in the war in Ukraine, he had been fitted with prosthetics. And with the support of a dedicated physiotherapist and his mother, he slowly yet methodically traversed the length of the hospital corridor, face determined, eyes fixed on the floor.

As I witnessed this scene, both poignant and inspiring, I marveled, yet again, at the resilience of Ukraine’s health system, battered by war and yet still standing.

And today, as we approach the two-year mark of this conflict that seems without end, what continues to astonish me is just how far the country has come — despite all odds — in striving to achieve health for all.

Even before Feb. 24, 2022, Ukraine had embarked on ambitious health reforms — an essential requirement in the EU accession process. But when war hit, critical infrastructure across the country was destroyed. Hospitals, ambulances, generators, cold chain units, pharmacies . . . It was difficult, if not impossible, to deliver health services at or near the front lines.

And massive internal displacement only compounded the crisis.

However, after reeling from the initial impact, Ukraine’s health system began to rebound under the leadership of its Ministry of Health.

The World Health Organization (WHO) and other partners brought in essential supplies, including generators, ambulances, prefabricated emergency care units, trauma kits and medicines, all generously funded by a range of donors public and private.

The government was determined to not only build back the health system but to build back better. And reform was put back on track with renewed commitment.

Ukraine now has a significant national mental health program — championed by First Lady Olena Zelenska — which is scaling up rapidly. Critical, for as it stands, there are nearly 10 million people estimated to be at risk of, or living with, a mental health condition, and almost 4 million people suffering from moderate to severe symptoms in Ukraine.

Physical rehabilitation services incorporating assistive technology are also being strengthened.

Digital health technology is enabling greater access to diagnostics and consultations for those living near front lines and in regained territories too, including for the elderly and those with chronic conditions.

Fleets of specially equipped buses now traverse the country, laden with essential vaccines for mumps, measles and rubella to Covid-19, getting through to those hardest to reach.

And remarkably, in 2023, Ukraine managed to close an outbreak of Poliovirus, which was initially detected in October 2021 — a commendable milestone in the face of war.

But we also need to admit that Ukraine’s health ecosystem remains challenged on multiple fronts.

As of today, WHO has confirmed over 1,500 attacks on health facilities, infrastructure or personnel — an average of two a day since the war began — with renewed strikes in recent weeks adding to the tally.

The number of internally displaced persons is currently estimated at 3.5 million; over 6 million refugees have been recorded, mostly in neighboring countries; and almost 8 million people are in need of health assistance within government-controlled territory.

Currently, two-thirds of those seeking care encounter barriers that are primarily related to cost, time and transportation. In areas close to the front lines, 22 percent of households delay seeking medical care, with 7 percent struggling to acquire essential medications. Family doctor access is also significantly reduced in these regions where financial constraints are more acute, and almost 25 percent cannot afford medicines, while 51 percent are unable to pay for medical services.

Moreover, noncommunicable diseases (NCDs) — like cardiovascular disease, diabetes, cancer — these don’t simply disappear in a conflict zone. On the contrary, in Ukraine, NCDs cause 84 percent of all deaths, often exacerbated by factors stemming from the war.

Ukraine also continues to experience one of the highest burdens of HIV, tuberculosis and maternal mortality ratios in the WHO European Region. And the risk of infectious disease and outbreaks of food and water-borne disease is constant.

This applies to the unprecedented threat of a chemical, biological, radiological and nuclear emergency as well.

All formidable hurdles, to be sure.

But when it comes to the future of health in Ukraine, I’m an optimist. Because what I’ve seen firsthand, during many visits to Ukraine, is true commitment.

So, to Ukraine’s committed government and Minister of Health Viktor Liashko, to its committed health and care workforce — operating 24/7, exhausted by the double whammy of Covid-19 and war but still going strong — to all of them I say, WHO has and will continue to stand with you, no matter what.

To Ukraine’s committed neighbors who have welcomed refugees — mostly women, children and the elderly — to all of them I say, WHO thanks you for demonstrating our shared humanity, for underscoring that health is a human right.

To the country’s committed  donors — from the EU to entities further afield in the U.S., Middle East and Asia — to all of them I say, WHO is grateful for your continued solidarity. But your generous support for health in Ukraine must remain unwavering.

At this crucial juncture, when the country has striven so hard to achieve health for all — and that goal is well within reach — taking our foot off the pedal now would undermine, and likely even reverse, all the gains made these past two years.

We owe it to the resilient people of Ukraine, like that little boy I met in Kyiv — as well as the remarkable health system that serves them — to ensure this won’t happen and that they can count on us, now and always.