Conf
lict and war
After weeks of speculation, Russian forces launched attacks on multiple cities in late February 2022. Millions of Ukrainians are now at risk.
R
efugees and displaced persons
More than nine million people have fled to neighbouring countries since the war began, with an additional six million currently displaced within Ukraine.
Following continuous low-level conflict in eastern Ukraine, in Donetsk and Luhansk oblasts (provinces) since 2014, in late February 2022, Russian forces attacked multiple cities across all of Ukraine, leading to full-scale war.
The intense fighting and shelling have led to over five million people leaving Ukraine and becoming refugees, with seven million displaced within the country. Médecins Sans Frontières (MSF) teams had been working in eastern Ukraine and have now suspended our usual medical activities, including our HIV and tuberculosis programmes, in order to address the current crisis.
We have been in contact with hospitals that are receiving patients wounded as a result of the fighting. The conflict is putting a huge amount of pressure on health facilities that have limited staff and supplies; many hospitals are facing shortages. It is difficult to find medical and other crucial supplies in the country, as these are in high demand to meet the needs of so many patients.
MSF first worked in Ukraine in 1999, supporting the Ministry of Health to treat HIV. From 2011 to 2014, MSF ran a drug-resistant tuberculosis programme within the regional penitentiary system in Donetsk.
MSF responded to the conflict in eastern Ukraine from 2014 onwards and has also continued to provide specialised programmes to treat infectious diseases, such as hepatitis C.
When the current war broke out in February 2022, MSF was running a drug-resistant tuberculosis project in Zhytomyr, an HIV project in Sievierodonetsk and working to improve access to primary healthcare for people affected by conflict in eastern Ukraine. These projects were temporarily suspended as we reoriented our activities to respond to the needs created by the war.
MSF teams remain in Ukraine, and we are currently seeking ways to adapt our response as the conflict situation evolves.
Many displaced people are now sheltering in Lviv and other towns in western Ukraine. Often, they have left their homes with only what they can carry. Local volunteers and civil society organisations are working hard to help them, but conditions are harsh, with available accommodation already full to overflowing and temperatures as low as -10 at night. MSF is donating a large supply of cold weather items (sleeping bags, warm clothes, tents) to civil society organisations supporting displaced people and refugees.
So far, the focus has been on surgical, trauma, ER (Emergency Room) and ICU (Intensive Care Unit) equipment and drugs. But a broader picture of other key medical items is starting to emerge insulin for diabetes patients, medicines for patients with other chronic diseases such as asthma, hypertension, or HIV.
The medicalised train run by MSF takes patients from overburdened Ukrainian hospitals close to active warzones to Ukrainian hospitals with more capacity that are further from active warzones.
The train began operating on 28 March 2022. In 2022, the medical train completed 79 trips, referring 2,558 patients; 700 of these patients were trauma cases, and 136 were admitted to the ICU carriage.
So far in 2023, the train has referred 216 patients on 11 trips. On all the train referrals, there are family members and caretakers of some patients too.
In Hostomel on the outskirts of Kyiv, MSF is running a project to treat survivors of torture. The project has mental health and physiotherapy rehabilitation components, as well as a general medical practitioner. Our teams also provide mental health care in 10 different locations outside of Kyiv, in 2022, our mental health teams provided almost 1,000 individual mental health consultations, and 184 group therapy sessions).
In Kyiv city, we provide physiotherapy and psychological counselling services for war-wounded people in a hospital managed by the Ministry of Interior. We treat patients and provide training to local health staff, to respond to a major need and bridge a significant gap in the Ukrainian healthcare system. The rehabilitation and mental health services were not particularly developed in the healthcare system prior to the war, but now there are a huge number of people with major injuries and the need for post-operative care is enormous; the trauma patients we see are at risk of developing long-term issues without proper care.
We also provide self-care and psychological first aid training for railway staff, who often end up acting as psychological first responders, as they serve people who are evacuating from areas heavily affected by the war.
MSF has provided medical donations to 23 health facilities in Kirovohrad oblast, where Kropyvnytskyi is located, and the northern part of neighbouring Mykolaiv oblast. Between April and December, we provided 146 training sessions for health professionals, psychologists and first responders on things like managing a high influx of war wounded, decontamination, trauma and mental health. A total of 2,301 people participated in these training sessions. Since April our mental health team has seen 299 patients in individual sessions and 9,463 patients in group psychoeducation sessions. MSF is also distributing relief items (bedding kits, hygiene kits, food, firewood, electrical materials…) and doing rehabilitation work in IDP shelters, particularly in the area of water and sanitation.
Our rehabilitation project at the ministry of Health hospital in Vinnytsia continue. Our teams provide physiotherapy and psychological counselling to war-wounded people, following a similar approach to the project we operate in Kyiv. Our approach focuses on providing hands-on treatment to patients and capacity-building through training to local staff.
In Vinnytsia, we run mobile clinics, particularly in the southern part of the oblast and rural areas where IDPs have settled and are not able to access primary health care. We also have mental health/health promotion-dedicated mobile teams. We are aiming to verticalize the project on MH by addressing the needs of specific populations in secondary health facilities (war wounded, veterans, PTSD) as well as centralizing the MH activity towards a stable structure as opposed to a mobile model. Hence, we plan to reorient the activity into fixed and mobile clinics inside the oblast and start targeting secondary health institutions for specialized MH support to staff and patients & develop a PTSD/ victims of war program to target specific populations.
In Apostolove hospital, MSF provides emergency room and direct, hands-on surgical support. This includes assisting with, and working on, triage and surgical interventions. In the hospital our teams provided 972 consultations in 2022 and admitted 403 patients for violent trauma injuries.
From a base in Kryvyi Rih medical teams have been running mobile clinics predominantly in Kherson and Mykolaiv oblasts (areas heavily affected by fighting), in 2022, these mobile clinics visited 144 towns and villages in the vicinity providing a total of 8,307 medical consultations in total. The services include primary healthcare consultations, sexual and reproductive health services and mental health care, as well as health promotion. Medical teams in these areas have provided 1,848 primary health care consultations.
MSF ambulances also transfer patients to hospitals and between medical facilities around Kryvyi Rih and areas in Kherson oblast. This includes one regular ambulance, one ambulance able to transport up to four patients and one ambulance able to support patients requiring ICU-level care. In 2022, 973 patients were referred using this ambulance service.
In the Mykolaiv oblast and in areas recently retaken by the Ukrainian forces in the Kherson oblast, MSF mobile clinics provide primary healthcare services, psychological counselling and social services, and contribute to the rehabilitation of healthcare facilities damaged during the fighting. The main health issues we see, after months of extremely limited access to healthcare when the area was controlled by Russian forces, are chronic diseases such as hypertension and diabetes. Important mental health needs are also emerging; the impact of the war has overcome the stigma associated with mental health care, pushing people to come forward and seek the help of MSF counsellors in the villages we visited.
In Kochubeivka and Svobodny, we run stabilisation points where patients are treated before being referred to hospitals.
We run mobile clinics in rural villages and towns in the Kharkiv region, providing primary health care, including sexual and reproductive health, and mental health support. Most of MSF’s patients are women over the age of 60, the major medical needs are chronic illnesses, such as hypertension and diabetes. We provide non-food items such as hygiene kits and medical donations to health facilities. Many communities in the region still have destroyed or damaged health facilities and have been living without electricity and heating for months. The weather and lack of public transportation is making it more difficult for patients to travel to locations with healthcare. We are seeing an increase in acute diseases including upper respiratory tract infections and exacerbation of asthma.
The teams also provide medical and psychiatric care in 2 care houses hosting patients with severe psychiatric and neuropsychologic conditions, most of the patients didn't receive any or proper psychiatric or medical care for almost 7 months since February 2022, besides we provided group and individual psychological support for the staff of these facilities. In January 2023, we briefly supported 3 more of such facilities inside the region.
The teams are continuing to provide Care for Carers for the local health care professionals who experience burn out and stress. The activities
MSF teams continue to provide social support (food parcels and hygiene kits) and psychological support to all active TB patients to help them to keep taking their medication correctly and complete treatment. In collaboration with health authorities, MSF has recently started doing contact-tracing for children who have been in close contact with TB patients. MSF also transports samples to the TB hospital for testing so that patients’ progress can be monitored. At the same time, we continue to support the regional TB Hospital by providing them with TB and other drugs as well as laboratory consumables and food for patients.
In and around Dnipro, we are supporting vulnerable people who have fled parts of Donetsk and Luhansk oblasts where the conflict is particularly intense in more than 40 shelters. In Zaporizhzhia, we provide support to thousands of people who were displaced from Mariupol.
Our teams have been running mobile clinics to provide medical consultations and medicines for people with chronic illnesses such as hypertension, asthma, diabetes, heart disease, epilepsy. We also do referrals to hospitals for severely unwell patients, provide psychological first aid and mental health consultations, and distribute basic relief items. These mobile clinics are being scaled down as people can access these services through the national health system.
Our teams have also started working with boarding houses which provide care for the most vulnerable people (elderly, people with disabilities, abandoned children, etc). We are providing nursing care trainings to the staff who are looking after patients at these boarding houses. We are also supporting specifically around infection prevention and control, logistics and regular patient care..
We developed an agile emergency response capacity in coordination with the authorities that aims at providing access to comprehensive health care for civilians when the frontline is moving. That includes a medical mobile team which will visit areas close to the frontline and provide urgent medical services based on the needs including evacuation of patients and primary healthcare in both Dnipro and Zaporizhzhia.
In Zaporizhzhia, continued support to hospitals close to the front line is ongoing through donations. Mental health activities are also being increased and including workers close to the frontline as the burden of mental health trauma of the continued conflict gets heavier.
MSF also runs a clinic providing sexual and reproductive health services, including contraceptives and care for people who have experienced sexual violence, as well as health promotion, information and linking to services via social media. In 2022, MSF teams provided 372 consultations for sexual and reproductive health in Dnipro.
Kostiantynivka
Support to hospitals: We send donations to primary, secondary and tertiary health care services and provide training support on specialized emergency response (MCP training, MH Gap, Peritonial Dialysis). After months of disruption or decreased activities, the health care delivery system is slowly trying to recover while the needs are increasing with the partial return of a population that cannot afford to remain IDP. Therefore, we have started providing agile emergency response through an ambulance in Sloviansk and Pokrovsk.
In Ivano-Frankivsk we are supporting a fixed outpatient department point and a mobile clinic focusing on IDP patients run by doctors who are themselves displaced by the war. Since the beginning of the collaboration until December, 3,017 medical consultations were done, mainly for hypertension, cardiovascular issues, chronic diabetes and upper respiratory tract infections. In Uzhhorod and other peripheral areas we are running mobile clinics at IDP public shelters. Between July and December, MSF carried out 3,925 medical consultations through mobile clinics visiting various locations in Zakarpattia Oblast, including Uzhhorod, Mukachevo or Perechyn, among others. The main medical conditions seen were hypertension, cardiovascular issues and respiratory infections. In Uzhhorod we also support a fixed interfamily volunteer clinic, where 663 medical consultations were done between November and December.
We have carried out training sessions on decontamination, mass casualty, sexual and gender-based violence and mental health with local health professionals, psychologists and first responders. Between March and December, we provided 41 training sessions attended by 764 people in the oblast of Zakarpattia, to which Uzhhorod belongs, and 69 sessions in Ivano-Frankivsk oblast, with the participation of 1,146 people.
We continue to donate medical supplies on a regular basis. We have donated 84 donations of kits in about 20 facilities in these two oblasts. We also distribute relief items (bedding kits, hygiene kits, food…) for displaced people, particularly in nearby rural areas, as well as do rehabilitation works at IDP shelters. Throughout the past year, our mental health teams in both locations have seen 797 patients in individual sessions and 4,593 patients in group psychoeducation sessions.
MSF is working to rapidly scale up our medical and humanitarian response in various parts of the country, based on where we see the greatest need and the best opportunity for our assistance to have a significant impact.
Context: As of 24 January 2023, the UNHCR has recorded 19,673 refugees from Ukraine in Belarus. According to the Belarus State Border Guards public reporting, 5,655 Ukrainians entered Belarus between 1 January 2023 and 3 February 2023.
In Belarus, MSF continues to respond to the medical needs of people on the move stranded between Belarus and the EU countries. While the winter conditions in Belarus seem to have caused a decrease in the number of crossing attempts into Europe, the MSF team is still responding to people suffering from frostbites, injuries including violence-related, and chronic diseases. Since November 2021, we have assisted more than 1200 patients from various countries of origin, few of them from Ukraine. MSF has not provided any direct support to patients from Ukraine since early December 2022. According to a government decree from mid-September 2022, Ukrainian citizens and stateless persons from Ukraine, regardless of their status in Belarus, have the right to affordable medical care on an equal basis with citizens of the Republic of Belarus.
In Belarus, MSF continues to support the delivery of person-centred care and treatment for people with drug-resistant tuberculosis via the National Tuberculosis Programme, and provide care and treatment for incarcerated people with TB, HIV and Hep C.
Context: More than 9.4 million people have crossed from Ukraine into Poland since 24 February 2022 (UNHCR). More than 1.5 million people have registered for temporary protection.
MSF is actively working to support the Ministry of Health to ensure that patients are able to access treatment for drug-resistant tuberculosis, including patients previously supported by MSF in Ukraine.
Context: Over 2,800,000 people have crossed to Russia from Ukraine as of 3 October 2022 (UNHCR).
MSF has been present in Russia for 30 years. Currently, MSF’s teams in Russia work with health authorities in Arkhangelsk and Vladimir regions to support crucial, life-saving treatment for patients with drug-resistant tuberculosis. In the last few months, MSF scaled up its assistance to partner organisations in St Petersburg and Moscow ensuring continuation of HIV treatment for people from Ukraine and other people in need. We have seen an increase in the number of people from Ukraine living with HIV and hepatitis C in need of refills for their antiretroviral medicines.
Alongside this, in order to respond to the needs resulting from the international armed conflict in Ukraine, MSF has started to support people displaced to Voronezh, Belgorod and Rostov-on-Don regions. Through regional non-governmental organisations, MSF has organized a team of local social workers, medical doctors, psychologists, and legal counsellors that are making efforts to ensure that people from Ukraine, mostly newly arrived ones, receive all the necessary qualified medical services in licensed medical clinics and have access to other state social services. When necessary, we have been covering any medical care gaps and paying for the necessary medications and medical consultations.
Since the beginning of activities, MSF has provided medical support to around 4,800 migrants which also included nearly 1020 mental health support sessions.
MSF is regularly supporting organisations in Voronezh, Belgorod and Rostov-on-Don regions with urgently needed items such as food, hygiene kits, and small household items that have supported more than 20,925 newly arrived migrants.
As in any country, our work in Russia is focused on providing medical care where we can, based on medical needs alone.
