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.
Between 31 March and 19 December, 77 referral journeys have transported a total of 2,607 patients with their family members and caretakers. Of the patients transported, 28.19% have been violence-related trauma cases.
MSF continues to support outpatient medical care services in Hostomel on the outskirts of Kyiv, for example by supplying medication. We also provide mental healthcare in nine different locations outside of Kyiv, and to date our teams have provided more than 850 individual mental health consultations and 184 group consultations with 1,179 participants.
In the city of Kyiv, in July we began to provide physiotherapy and psychological counselling services for war-wounded people in a hospital managed by the Ministry of Interior. Our teams have now access to a total of 200 trauma beds, i.e. the total number of beds available for war-wounded patients. We treat patients and provide bedside training to local health staff, in order to respond to a major need and bridge a significant gap in the Ukrainian healthcare system. The brutality of this war is generating a huge number of people with major injuries and the need for post-operative care is enormous. However, rehabilitation and mental health services were not particularly developed in the local healthcare system prior to the war. The high number of trauma patients 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 and who have suffered particularly difficult experiences.
The MSF team here has provided medical donations to 17 health facilities in Kirovohrad oblast, where Kropyvnytskyi is located. Between April and August, we provided 97 training sessions for health professionals, psychologists and first responders on aspects such as managing a high influx of war wounded, decontamination, trauma and mental health. A total of 1,495 people participated in these training sessions. Since April our mental health team has seen 212 patients in individual sessions and 6,434 patients in 795 group psychoeducation sessions.
MSF is also distributing relief items (bedding kits, hygiene kits, food…) and doing rehabilitation work in more than 10 IDP shelters, as well as supporting a maternity hospital to make more accessible services for survivors of sexual and gender-based violence. With the start of the winter, more than 400 vulnerable families residing in the urban areas of Haivoron, Novyi Buh, Ustynivka, Znamianka and Kropyvnytskyi were supported with heaters and kettles. Other 175 vulnerable families residing in the rural areas of Haivoron, Blahovitchsenke, Holovanisk and Ustynivka were supported with a total of 200 tons of briquettes and 375m3 of firewood, an amount of solid fuel estimated enough to go throughout the winter.
In Vinnytsia, we are continuing with our mobile clinics and going more in the southern part of the oblast, in the rural areas where IDPs have chosen to settle, and are not able to access primary health care. We have also started strengthening our mental health activities in the form of mental health/health promotion-dedicated mobile teams. In addition, we are now 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 that can be used to target a particular population.
Since July, we have been providing physiotherapy and psychological counselling to war-wounded people, following a similar approach to the project we operate in Kyiv. In Vinnytsia, we work in a hospital belonging to the Ministry of Health featuring 60 beds dedicated to physiotherapy. Our teams treat patients and provide bedside training to local staff, to increase the local capacity.
In Apostolove hospital, MSF provides emergency room and direct, hands-on surgical support. This includes assisting with, and working on, triage and surgical interventions. We also support outpatient activities in four areas and have treated over 1,100 patients for trauma injuries, and 1,029 gynaecology consultations in recent months.
From a base in Kryvyi Rih medical teams have been running mobile clinics predominantly in areas of Kherson and Mykolaiv oblasts, which have recently been retaken by Ukrainian forces. This service is comprised of three mobile clinics in 40 towns and villages and has been providing consultations, sexual and reproductive health services and mental health care, as well as health promotion. Many of the areas where our teams our working have been heavily affected by fighting for many months with extremely limited access to healthcare. Teams continue to assess and work in new areas as the frontlines shift. Medical teams in these areas have provided 1,848 primary health care consultations.
In Kochubeivka and Svobodne, we run stabilisation points where patients are provided with initial treatment before being referred to hospitals. Many of the patients in this particular area have injuries as a result of landmine explosions.
MSF ambulances also transfer patients to hospitals and between medical facilities around Kryvyi Rih and certain 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. The ambulance service in Apostolove has referred 772 patients, and in Svobodne 354.
In Mykolaiv, we support several hospitals in the city with medical and logistic donations and water and sanitation services. We provide mental health services in three sites in the rural areas around the city, where we witness the extremely severe impact of war on the psyche of the people. This is an area that needs attention as mental health issues are still frequently stigmatised in the country and there aren’t enough psychologists and psychiatrists, especially with experience of war-related trauma.
The Mykolaiv team also runs mobile clinics in the areas recently retaken by the Ukrainian forces in the Mykolaiv and Kherson oblast, providing primary healthcare services and psychological counselling. We have visited several villages and observed a gaping hole in access to healthcare. In many cases, local health staff has left when Russian forces advanced in the region and hasn’t returned. This added to the extremely harsh living conditions that people say they experienced during the eight months of Russian presence. Recently, the extended blackouts and lack of access to water have compounded their problems. The main health issues we see are chronic diseases such as hypertension and diabetes. Important mental health needs are also emerging, as the impact of the war has been so strong as to overcome the stigma associated with mental health care, pushing people to come forward and actively seek the help of MSF counsellors in the villages we visited.
Our teams are continuing their mobile clinic activities for the 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, with the medical needs being predominantly chronic illnesses, such as hypertension and diabetes. The teams continue to provide non-food items such as hygiene kits and medical donations to health facilities. The teams also provide medical, psychological, and psychiatric care in two psychiatric long-term facilities. Many of the patients have not received any or proper psychiatric or medical care since February.
Many of the communities in the region have destroyed or damaged health facilities and have been living without electricity and heating for months. As the temperatures are dropping, working conditions are getting more difficult and patients are facing increased barriers to access healthcare. In some communities, in the health facilities without heating patients – of whom many are elderly - have to wait in the cold halls for consultations. 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 are continuing to provide Care for Carers for the local health care professionals who experience burn out and stress. The activities include psychological group support and stress management trainings, focusing on providing coping mechanisms.
In Zhytomyr, 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, and who are now staying temporarily or longer-term in more than 40 shelters.
In the shelters our teams run mobile clinics, providing medical consultations; continuation of care and medications for people with chronic illnesses such as hypertension, asthma, diabetes, heart disease, epilepsy; referrals to hospital for severely unwell patients; psychological first aid and mental health consultations; and basic relief items. MSF also provides consultations and referrals for people who have experienced sexual violence.
The mobile clinic activity in the shelters is slowly transitioning into support to strategic primary health structures as people are choosing to stay and settle in the oblast. Rural areas are also being looked at to ensure that both IDPs and host community have equal access to health care. Teams have also started looking at facilities providing care for the more vulnerable of the population (elderly, people with disabilities, abandoned children, etc) and giving them support specifically around infection prevention and control, logistics and preparing for winter.
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.
Shelling continues on a regular basis in Zaporizhzhia. We are providing support to displaced people, thousands of whom were displaced from Mariupol, and other areas where fighting is intense.
Our teams run mobile clinics in the main reception centre and support more than 30 shelters throughout Zaporizhzhia, providing medical consultations; medicines for people with chronic illnesses such as hypertension, asthma, diabetes, heart disease, epilepsy; and referrals to hospital for severely unwell patients; psychological first aid and mental health consultations; and basic relief items.
The reception centre mental health and health promotion team is still there. As in Dnipro, the project is now transitioning into support of strategic primary healthcare centres. 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.
In addition we’ve developed in coordination with the authorities an Emergency response capacity that aims at providing access to comprehensive health care for the civilians when the frontline is moving. That includes;
- An Advanced Medical Post in accessible areas close to the moving frontline.
- A Modular bridge facility in newly retaken areas.
Kostiantynivka
Support to hospitals: We are focusing on supporting the emergency room in Sloviansk hospital. Once the department opens, Sloviansk hospital will be the only hospital to provide this service in the oblast, including those of newly retaken areas. Primary health care and network set up are being connected to other organizations able to provide medications.
We provide support to primary and secondary health care facilities we support in HR, supply, monitoring SRH, MH, Emergency, Medical and Surgical IPD, Paediatrics, Maternity, Neonatology.
We also send donations to primary, secondary and tertiary health care. And we provide training support on specialized emergency response eg MCP training, MHGap, Peritonial Dialysis
Support for people left behind: We are working with volunteers and civil society to identify gaps and support needs to be able to provide warmth and contingency planning this winter. 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 can not afford to remain IDP, like in the case of Sloviansk.
We are working with volunteers and civil society to identify gaps and support needs to be able to provide warmth and contingency planning this winter.
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 August, we provided 36 training sessions attended by 707 people in the oblast of Zakarpattia, to which Uzhhorod belongs, and 62 sessions in Ivano-Frankivsk oblast, with the participation of 1,069 people. We continue to donate medical supplies to more than 10 health facilities in these two locations and distributing relief items (bedding kits, hygiene kits, food…) for displaced people, particularly in nearby rural areas, as well as doing rehabilitation works at IDP shelters. Throughout the past 5 months, our mental health teams in both locations have seen 330 patients in individual sessions and 4,557 patients in 488 group psychoeducation sessions.
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. In 25 weeks of collaboration until the end of November, 2,541 medical consultations were done. In Uzhhorod and other peripheral areas we are running mobile clinics at IDP public shelters. Between July and November, MSF carried out 3,643 medical consultations through mobile clinics visiting 12 locations in Zakarpattia Oblast. The main medical conditions were chronic diseases and respiratory infections.
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 29 November, the UNHCR has recorded more than 17,200 people crossing from Ukraine into Belarus since 24 February.
In Belarus, we are responding to the needs of patients from Ukraine, as well as other countries of origin, in Minsk, Grodno, Brest, Gomel, Mogilev and Vitebsk regions. Among our patients, there are many people with non-communicable and chronic diseases including diabetes and hypertension. In Belarus, MSF continues to run its regular programmes. We support the national tuberculosis programme in the civil and penitentiary sectors and hepatitis C treatment in prisons.
On 27 November MSF marked one year of our medical activity serving people on the move stranded between Belarus and the EU countries.
Context: More than 6.9 million people have crossed from Ukraine into Poland as of 18 October 2022 (UNHCR). More than 1.45 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, MSF has started to support people displaced to Voronezh and Rostov regions (since February 2022), in coordination with local authorities. In May 2022, a dedicated MSF hotline was launched with an aim to provide referral services to medico-social support to the refugees and from Ukraine. As of end of November, MSF supported medical referrals of more than 2 370 people on a case-by-case basis in Voronezh, Belgorod and – lately - Rostov-on-Don.
For several months now, we are regularly supporting organizations in Voronezh, Belgorod and Rostov-on-Don with urgently needed items such as food, hygiene kits, small household items to support more than 15,550 refugees who have crossed into Russia and help them to access medical services and medications as needed.
MSF through local organisations, social workers and local health providers, aims to link populations in need to existing medical and humanitarian services and improve their ability to receive the needed medical and humanitarian support. As in any country, our work in Russia is focused on providing medical care where we can, based on medical needs alone.
