The invasion of Ukraine, which began on February 24, had a strong impact on the country’s health system, which was already deficient before the war. According to the WHO (World Health Organization), more than 269 attacks hit hospitals, clinics and other structures, but this number is likely to be much higher.
The situation poses a serious threat to millions of Ukrainians. In the east of the country, it is estimated that only 15% of health professionals still work in the region.
Faced with the precariousness and lack of perspective on the end of the conflict, associations and NGOs organize themselves to transfer war wounded and patients with chronic diseases to other regions, in addition to ensuring basic care, which includes vaccination and monitoring of pregnant women, for example.
The coordinator of the Médecins Sans Frontières in Ukraine, Gustavo Fernandez, told RFI’s Priorité Santé program that the living conditions of the population, under constant threat of attacks and living underground, are increasingly difficult. The removal of the wounded is always a complex operation, he describes, depending on the city in which it takes place.
“We try to keep in touch with local volunteers and people who know the internal situation well. We also seek to stay close to the doctors and nurses who have remained in the cities and who know the population well to provide, on a daily basis, the material to guarantee the continuity of medical care”, he declared.
The team must also be ready to act immediately in urgent situations, which include, for example, the transfer of patients during bombings. “It’s very risky, but we have to try to put in place a system that allows this kind of medical evacuation of the civilian population,” he points out.
A firefighter tries to control a fire in a hospital in Ukraine after a Russian attack (Photo: REUTERS/Stanislav Kozliuk)
The impression, says the doctor, is that today there are “two Ukraines”: there are regions close to the front, which experience the war more closely, and others where life is relatively normal. Hospitals there, however, are overwhelmed.
“The further we get away from the front, we come across more people who have left everything behind and now live in big cities, where the system is still functional, and where international aid arrives, which precisely supports local systems. But it is clear that the displaced suffer from severe psychological sequelae,” she notes.
Many elderly Ukrainians, who live close to the fighting areas, are also unable to physically leave their villages, where they have spent their entire lives. This situation, recalls the coordinator of the NGO, increases the possibility of the emergence of diseases that will spread among patients.
“In one of the visits we made, we found 50 elderly people living in the basement of a hospital, in total darkness. It was a narrow, humid place, with no medicine, water or food, and they only had the support of a few members of the hospital administration who remained in the region, and volunteers who kept coming and going to help them”, he describes.
RFI correspondent in Ukraine, Stéphane Siohan, says that the health system, even before the war, already had several problems. One of them, he says, is corruption. As wages are low, some practices have become normal. He says, for example, that when his son was born five years ago, he had to distribute money to the maternity team.
“In reality, it is the patients who finance the health system, not the state. There have been attempts at reforms in recent years, with the creation of a Social Security, but we are still in a transitional system, post-Soviet era, exhausted, but which tries to be inspired by the European experience. Now the war has arrived, hampering this process,” he analyzes.
French anesthetist Raphaël Pitti, specializing in War Medicine, told RFI that the gravity of the situation in Ukraine can be compared to the war in Syria, with intense bombings against the civilian population.
That’s why, he says, he and his team created a training center for Ukrainian professionals in Metz, in the east of the country. Courses started in July.
“In general, what is important is learning to manage and logistically organize the flow of patients. When there is an attack, 50% of victims will die of suffocation or hemorrhage. It is important to train urgent care workers in damage control, that is, damage control: removing the victim and providing emergency care so that the chances of survival increase, before taking him to the hospital”, he explains.
In hospitals, doctors trained in France will also be able to apply methods of war surgery, known in Ukraine only in military hospitals.
At the same time, it is also important to emphasize the important role of volunteers, explains the RFI correspondent in Ukraine. Many civilians engage in Ukrainian forces, and during combat, they provide first aid to wounded at the front.
In any case, at least in the next few months, the war should be at the center of the daily lives of many Ukrainians who stayed in the country: there is no prediction, for now, that the conflict will come to an end.
Ukrainian President Volodymyr Zelensky visits a hospital in Odessa on July 29, 2022 – Photo: Ukraine Presidency/Handout via Reuters