More than 3 years of full-scale war has had a profound impact on the health system in Ukraine. The damage to critical infrastructure and disruptions to service availability have been particularly significant in areas close to the front line.
A new WHO report, “Community perspectives on health system responses and recovery efforts in the war-affected areas of Ukraine: voices from the front line”, provides evidence of local communities' perceptions of the war's impacts on health-care availability and access, and their experiences of, and aspirations for, recovery.
Recovery and reconstruction efforts are already underway in the country. WHO in Ukraine has been playing a key role in installing 29 modular primary care clinics, supporting Emergency Medical Teams and helping the Government of Ukraine define longer-term recovery plans.
“Incorporating communities' views in recovery helps ensure the relevance, effectiveness and sustainability of all recovery efforts,” said Dr Jarno Habicht, WHO Representative in Ukraine. “These insights will guide WHO's continued support to build health systems that can inspire confidence and meet the aspirations that communities have expressed for their future.”
Impact of war on health system resources and access
The study found that many health facilities have been damaged or destroyed by Russian military activity. Areas that experienced occupation in 2022 face additional challenges from looting of medical equipment. The legacy of occupation has contributed to health worker departures and undermined local health system functionality.
“All hospitals lack equipment. When we were under occupation, everything was stolen, everything – yes, even the old ambulances. They took them,” said a participant from Mykolaiv Oblast.
Workforce shortages have emerged as the main reason for reduced availability of primary care and specialist services, with security threats, trauma and relocation decisions contributing to staff departures. This has led to increased workloads and service burnout in many areas. Security threats continue to pose major barriers to access, with travel to health facilities often dangerous.
The populations of many areas near the front line are now primarily comprised of older and vulnerable people with complex health needs.
“It is a problem to get to a medical facility because, in fact, the entire service area is under constant shelling,” said a participant from Kherson Oblast.
The war has led to an estimated 3.6 million internally displaced people as of October 2024, of whom 2.2 million need humanitarian health assistance. The study found that health systems have generally responded effectively to displacement challenges, though administrative barriers and limited capacity for primary care in high-demand areas continue to present obstacles.
Positive impact of ongoing health reform
Despite challenges, the study shows that Ukraine's Programme of Medical Guarantees and Affordable Medicines Programme have reduced financial barriers to health-care access. The universal nature of coverage has supported access for internally displaced people in particular, as they are entitled to receive care in their host communities.
“The reform has had a lot of impact [on patients],” shared a lead doctor at a primary care facility in Zaporizhzhia Oblast. “The easiest example I can tell you about is asthma. Before the reform, people were not receiving proper care because combined inhalers were too expensive for them. Now that combined inhalers have been added to the [Affordable Medicines] Programme, a lot of patients finally have a way to treat their disease, to treat their symptoms, because they can receive those inhalers for free.”
The report presents findings from interviews and focus group discussions, conducted from June to December 2024, with local government officials; facility managers; health workers; residents in areas within 50 kilometres of the front line in Kherson, Mykolaiv and Zaporizhzhia oblasts; and internally displaced people in Dnipro, Poltava and Mykolaiv oblasts, which host large numbers.
Communities hope for comprehensive recovery
Communities expressed expectations for health system recovery that go beyond infrastructure reconstruction. While rapid rebuilding efforts after de-occupation were well regarded, respondents highlighted workforce shortages as the central challenge for meaningful recovery.
“The material base is improving already – it’s clear that more equipment is coming. But I don’t know about the doctors, how to lure them back – that’s the key. [ . . . ] A piece of iron alone won’t cure anything, right? There has to be a person who knows how to use it,” said a participant from Kherson Oblast.
There were calls for financial and in-kind incentives to support recruitment and retention, particularly for primary care, and ambitious long-term recovery approaches focused on inspiring hope, encouraging the return of those who have been internally displaced, and motivating others to establish careers in local health facilities.
The WHO Country Office in Ukraine conducted this research in collaboration with the Ukrainian Institute for Social Research and with the financial support of the Government of Canada and the WHO Universal Health Coverage Partnership.