Ukraine's healthcare system must endure the strain of three-year-long full-scale war – Jarno Habicht
In an interview with Interfax-Ukraine, WHO Representative in Ukraine and Head of the WHO Country Office, Jarno Habicht, speaks about the biggest challenges faced by the country's healthcare system, the ways to address them amid the suspension of USAID projects, and the ongoing support provided by WHO
By Hanna Levchenko
What are the 2024 results for the healthcare system: main achievements and challenges
Currently, the health system needs to cope with the pressures generated by almost three years of full-scale invasion and it has been under pressure during last 11 years of war. This includes demographic shift and population movements, disruption of health services and attacks on health facilities, challenges to social cohesion and increasing inequalities. The system also needs to continue to reform and improve access to quality health services for the population, putting more efforts to quality rehabilitation and mental health. Furthermore, all this is taking place in a challenging economic context caused by invasion and constant overall situation changes.
Besides the war challenges, we were able to reach 4.7 million people directly and indirectly in 2024 through a variety of implemented emergency activities and support of 920 health institutions, distributing 780 metric tonnes of medical supplies and equipment to ensure uninterrupted health care. Moreover, we continued installation of modular primary healthcare facilities, established 11 units and one emergency medical care basepoints.
WHO emphasizes capacity development by conducting internationally accredited training programmes nationwide. In 2024, over 8,700 healthcare professionals in Ukraine participated in medical training programmes, strengthening the nation’s emergency response and advanced care capacities.
Rehabilitation is one of important highlights for our efforts in capacity building of professionals. WHO conduct training for multidisciplinary rehabilitation teams from 28 non-specialized in-patient rehabilitation departments from 11 oblasts and by the end of 2024, we had trained 696 professionals in rehabilitation-related skills.
Additionally, WHO worked with the National Health Service of Ukraine (NHSU) to update reimbursement packages and introduced assessment tools to standardize rehabilitation care for all persons in need nationwide.
Talking about mental health of Ukrainians, another vital health aspect, we noted that in 2023 index of health national study, almost half of respondents experienced some form of mental health problems. At the same time, this indicator differs significantly in the regional aspect. The greatest pressure on mental health was reported in Kherson (78.7%), Zaporizhzhia (77.1%), Kharkiv (73.7%) regions.
Nowadays, Ukraine shows significant progress toward ensuring that all people in Ukraine receive high level of mental health and well-being services. WHO helped establish a comprehensive framework to guide mental health system reforms. Key achievements included developing the Target Model of the Mental Health and Psychosocial Support System of Ukraine and the 2024–2026 National Mental Health Action Plan, along with 24 oblast-level plans. All these is crucial when we talk about establishing reliable nationwide system and ensure its accurate and most productive operation.
Another important area related to the spread of Antimicrobial Resistance (AMR) and the delivery of safe healthcare. A significant milestone was the approval of the National Action Plan on AMR. This strategic document outlines essential actions to combat antimicrobial resistance, emphasizing the promotion of antimicrobial stewardship and the responsible use of antimicrobials. WHO conducted numerous capacity-building activities to strengthen these practices among healthcare professionals nationwide.
Besides the mentioned above, our worked closely with the Ukrainian government to strengthen governance, transparency, and accountability within the health sector, aligning reforms with European Union (EU) standards and taking into account WHO Country Cooperation Strategy 2030, signed with the Minister of Health of Ukraine in 2024.
Implementation of the recovery programs. Please comment on the opinion that currently the recovery of damaged medical facilities in frontline areas is risky and impractical
The ongoing humanitarian crisis has displaced millions, including 3.6 million internally displaced persons (IDPs) and 6.7 million refugees globally as of late 2024. This displacement, combined with damage to healthcare infrastructure and interruptions in access to essential medications, has left vulnerable populations with unmet health needs.
Since 24 of February 2022 WHO has verified more than 2200 attacks on health, many of which damaged or destroyed health facilities. In such areas, mainly frontline, we continue the project of installing modular primary healthcare clinics (PHC) to guarantee access to essential healthcare services and bridge emergency response with early recovery. Such modular units can be moved to another place if the situation changes which was done already ones. Last year, thanks to financial support of the European Union, another 12 modular PHC centers were established, supporting the temporary restoration of health infrastructure.
Mobile medical teams have also been essential in extending healthcare services to remote and conflict-affected regions. In the past 12 months these 20 teams of healthcare workers provided over 24,000 consultations to populations in 8 contact line oblasts otherwise cut off from regular healthcare services. Mobile teams received essential equipment, consumables, and medications from WHO to provide medical care in remote locations. This response intervention was organized in line with the organization`s experience in response to other emergencies.
In this context, we can also mention mental health and rehabilitation development to support the people of Ukraine affected by war to recover and return to normality.
Implementation of mobile (modular) pharmacy/clinic projects. How effective are they? Do you plan to somehow adjust such programs based on the experience of 2023-2024? What are the main challenges of such projects?
The initiative of installation modular healthcare units started in 2023 and provides a temporary yet adaptable solution to maintain essential health services during the reconstruction of permanent facilities. Designed with a lifespan of up to 10 years, these prefabricated facilities are integrated into Ukraine’s health system, ensuring service continuity and supporting broader recovery efforts. During previous two years WHO has installed 29 modular health facilities of two types which are modular primary care clinics and a modular station for emergency medical teams (EMS) teams. In total all the modular facilities provide services for around 250,000 patients in 8 regions.
This was also a pilot project for WHO with such systematic approach on the use of temporary primary healthcare facilities in emergencies, so Ukraine is the first to implement and evaluate to then share as guidance for others.
This year we plan to continue installation of modular units with the financial support of our donors.
One of key aspect of the WHO’s work has been organizing and coordinating interagency convoys to deliver essential medicines, basic equipment, and supplies to healthcare facilities located near the front lines, ensuring that humanitarian aid reached the most affected communities
How do you assess the current situation with provision of medicines? How do you assess the provision of foreign-made medicines?
Access to medicines is a long-standing issue in Ukraine - about half of all funds that people spend on health from their own budgets are spend on medicines. Consequently, medicine expenditures are one of two main drivers (together with inpatient care) of financial hardship for families.
According to Health needs assessment WHO conducts regularly, high price of medicines was main issue in obtaining medicines for 84% of households in September 2022 and for 73% in October 2024, with 8% of households who were unable to obtain necessary medications. In this light we have noticed some positive tendence of rising awareness of the Affordable Medicines Programme that has increased significantly, reaching 62%.
However, gaps remain in access, with unavailability of some medicines which has worsened, rising from 16% in April to 21% in October 2024.
Our team in the field facilitated the distribution of over-the-counter (OTC) health kits to hard-to-reach regions. These kits provide essential medicines and supplies, enabling individuals in remote areas to manage their health needs when access to healthcare facilities is limited.
To add a bit more about technical side of our work, WHO provided guidance to the Medical Procurement of Ukraine (MPU) as it worked towards Good Distribution Practice (GDP) certification which is a critical milestone for ensuring high-quality medicines and healthcare products throughout the supply chain. The GDP standards, established by WHO and the European Union (EU), apply to organizations involved in the storage, transportation, distribution, and trade of healthcare products, including medicines, vaccines, and diagnostics. Compliance with these standards ensures that healthcare products are handled and distributed safely, reducing risks to patients and reinforcing trust in the supply chain.
How do you assess the work of healthcare facilities in the third year of war? Are there enough facilities that can provide inpatient services? How is the geography of the location of healthcare facilities changing due to the war? Is there a shortage/surplus of beds?
Access to health care is increasingly unequal. Most damaged and dysfunctional health facilities are along the front line, where the remaining population often faces multiple vulnerabilities, such as being elderly or having disabilities. These facilities experience more disruptions in medical supplies, a shortage of health workers, and various barriers to receiving care.
According to the results of the Health Needs Assessment in 10 oblasts near the frontline, in terms of health, after two and a half years of the Russian Federation invasion, 68% of the adult population indicates their health has worsened compared to the pre-war period. Most of the deterioration was related to mental health issues. So we have a lot of work ahead and it is important to build it under reliable systematic approach what the health authorities and WHO stress on.
However, the healthcare system is adopting to the existing reality and moving to health facilities be an autonomous islands of stability to continue deliver during electricity cuts with support of WHO and other partners where we provide generators, water stations, modular heating units.
Workforce shortage is an issue especially in rural areas, with only 17% of doctors and 7% of nurses serving 30% of the population. Elderly populations are predominantly affected and face significant barriers to health-care access.
We put efforts to addresses issues such as the quality of education for nurses that meets today's requirements, supportive work environment, the development of leadership in nursing, and the improvement of the quality-of-service delivery. Approved Framework of Nursing Strategic development aims to contribute to the professional growth of nurses, improvement of the quality of medical services and integration of international standards. Nursing educators from the medical college have already participated in WHO-supported initiatives, including Basic Emergency Care training, mental health programs, infection prevention and control initiatives, and related rehabilitation discussions
What changes do you anticipate in demand for certain types of medical services due to the war?
With the current situation in Ukraine, the primary goal of WHO is to reduce mortality and morbidity rates. Strengthening the health system to restore and develop essential services such as rehabilitation, primary healthcare and public health surveillance is critical for national recovery.
The health system has shown resilience and continued reforms since 2017. However, technical expertise, capacity-building and coordination support are still needed for the successful recovery and strengthening of health-care services in Ukraine.
Continuous missile strikes on energy infrastructure may lead to power outages lasting up to 20 hours per day, especially during winter and summer. During these seasons, the demand for electricity increases due to heating and cooling needs.
As a result, power is prioritized for critical infrastructure like hospitals and emergency services, leaving civilian infrastructure without basic services. Due to these challenges, several oblasts, including Chernihivska, Dnipropetrovska, Donetska, Kharkivska, Sumska and Zaporizhka are at high risk for the 2024–2025 winter period.
Nearly one in three households has a member with a disability, facing physical barriers due to the lack of inclusive design in urban settings and health facilities. Households with disabilities in eastern and southern oblasts are 10–20% less likely to access health-care services than households without persons with disabilities. Assistive technology and rehabilitation services remain expensive and unaffordable for the most vulnerable households. The injury rate continues to increase, indicating a higher risk of disability.
Older people and people with disabilities are disproportionately affected by protection risks, including aerial attacks, artillery shelling, exposure to mines, loss of livelihood and access to basic goods and services. Persons with disabilities report health care as a top priority (59%) compared to households without members with disabilities (19%).
The ageing health workforce impacts the sustainability of human capital in health care. Over 50% of PHC doctors are over 50, and 29% are over 60. The workforce is highly feminized, with women representing 98% of nurses and 81% of PHC doctors.
Exposure to war increases risks for post-traumatic stress disorder and other mental health issues, which can lead to long-term mental health conditions and disabilities. Over half of individuals seeking mental health and psychosocial support show psychological distress symptoms. Negative coping mechanisms – which people are more likely to turn to – may lead to long-term public health issues.
NCDs contribute to 84% of all deaths in Ukraine. The main barriers to health care for NCD patients are the unavailability of services and the cost of medicines, exposing people living with chronic conditions to disruption of care and irreversible deterioration of their health status.
Taking into account the war-related needs there is also permanent request on skills update among healthcare workers. WHO support to train health professionals in the whole country during 2024 to strengthen their practices in essential primary healthcare and emergency care management, for example, Basic Emergency Care (BEC), Hostile Environment Surgical Training (HEST), European Trauma Course (ETC) and other.
The termination of USIAD projects, which influenced the development of the health system in Ukraine, in particular the reform, etc.
Thanks to USAID support for many years it was possible to improve health infrastructure in Ukraine, increase personnel capacity of healthcare facilities in the areas of immunization, emergency response and many other training programs, strengthen the public health system, strengthen laboratory capacity throughout the establishments of country and the epidemiological surveillance system, delivering medical supplies to health facilities in frontline areas, and also contribute to the work of field primary health care teams to provide outpatient consultations in the most affected regions.
WHO in Ukraine remains committed to delivering critical support, focusing on health response needs during the ongoing war, rapid recovery, and health system reform. In light of the recent suspension of US funding, WHO is conducting assessments to fully understand and mitigate its impact to ensure continuous support to Ukraine.
WHO, like other organizations relying on financial contributions from Member States including the US government, is still awaiting further clarity on future financial commitments. Meanwhile, we are conducting the necessary scenario planning and programme reviews to ensure resources are allocated effectively. WHO Ukraine has already started to implement cost efficiency measures, including consolidation of operational costs and international travel expenses. However, we will continue to deliver to the country ensuring support to operation of the healthcare system of Ukraine during the war and recovery.