Crisis in Ukraine

Conf Medical 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 Medical efugees and displaced persons
More than five million people have fled to neighbouring countries since the war began, with an additional seven million currently displaced within Ukraine.

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The current situation

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. 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.

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Our history in Ukraine

We have run a range of activities in Ukraine, including tuberculosis (TB) and HIV programmes. In 2020, we started new projects in Donetsk and Luhansk, while also supporting the national COVID-19 response. Access to healthcare remains limited for people living along the contact line of the conflict in eastern Ukraine, which has been ongoing since 2014.

In Donetsk region, we work with local volunteers, organisations, and healthcare professionals and authorities to help people travel to healthcare facilities, access prescribed medications and to raise awareness about common health challenges.

Our teams also train and support family doctors and community nurses to offer basic mental healthcare to their patients. In Luhansk region, we run a project focusing on HIV.

Elsewhere in Ukraine, we work to show that it is possible to successfully treat patients with drug-resistant tuberculosis through a combination of a short-course of newer medications, psychological counselling and social support.

At the time of writing these activities were on hold as we adapt our response to the current crisis.

Elena and her son Kirill (6) are examined by Kelly and Kirill, an MSF doctor and medical student respectively, in the Kharkiv metro, Ukraine, on April 11, 2022. © Adrienne Surprenant/MYOP

How MSF is responding

MSF teams remain in Ukraine, and we are currently seeking ways to adapt our response as the conflict situation evolves.

Our current emergency response

We currently work with approximately 140 international staff in Ukraine and employ more than 470 Ukrainian staff. More are joining the team every day. They work as medical staff (surgeons, doctors, nurses); psychologists; logistics and administration; and management.

Since the 24th of February MSF has brought more than 800 metric tonnes of medical and relief supplies into Ukraine. Much of it has already been dispatched to hospitals and health centres, or to the Ministry of Health for onward transport to the places where it is most needed. Our teams are currently present in Berehove, Bila Tserkva, Dnipro, Ivano-Frankivsk, Kharkiv, Kyiv, Lviv, Mukachevo, Odesa, Poltava, Pokrovsk, Uzhhorod, Kropyvnytskyi, Vinnytsia and Zhytomyr.

Assisting displaced people

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.

Overlapping medical needs

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.

Medical train

On 1 April we completed our first medical train referral, taking nine patients who had been wounded in or near Mariupol from hospitals in Zaporizhzhia to hospitals in Lviv. We transported them on a two-carriage train kitted out as a basic hospital ward, with a team of nine MSF medical staff on board.

More than 594 patients have been medically evacuated to date, with their family members—including 78 orphans evacuated from an orphanage. Further medical referrals by train are planned as the urgent requests from hospitals in the east continue to grow, while a larger and more highly medicalised train is being got ready for use. We have completed 18 referral journeys to date.

Regional responses

Central Ukraine

Kyiv

Hostomel, on the outskirts of Kyiv, experienced very severe fighting and was under the control of Russian forces for several weeks in March and April. An MSF team came in to work alongside Ukrainian doctors and nurses to restart medical care once the Russian forces had left. As well as primary healthcare, we have seen extensive trauma and are working to provide mental healthcare to address the psychological consequences of the war.
In Kyiv, we are winding down a hotline for NCDs, but are we are following up with more than 1,000 patients with non-communicable diseases, mainly elderly and vulnerable individuals. Volunteers help us deliver medication at patients’ homes. Within the next few weeks, we will end this project.
We are running a telephone hotline for survivors of sexual violence and domestic violence, offering confidential consultations and delivery of medications to prevent HIV, STIs and unwanted pregnancy in both Kyiv and Chernihiv Oblasts. [We also have a hotline in Kharkiv].
We support shelters for survivors of sexual violence around Kyiv with training and mental health consultations.
We continue to provide medical donations to hospitals and polyclinics in Kyiv and Chernihiv oblasts.
In Bila Tserkva, 80 kms south of Kyiv, a hospital that specializes on surgery has been identified. An MSF team is leading a 2-day training on managing a mass influx of casualties and donations have been made to health facilities in the Oblast.
In Fastiv, Makariv and Borodianka, we work to support elderly people and internally displaced persons who suffer from chronic disease through mobile clinics and home-based care. Psychosocial support is offered as well as medical consultations, while trainings are offered to local health facilities.

Kropyvnytskyi

An MSF team is doing medical donations, trainings for health workers and first responders, distributing relief items in IDP shelters and carrying out psychoeducation sessions with groups of displaced people and individual mental health consultations both in the town and peripheral areas. We are also supporting from this week a maternity hospital to make more accessible services for survivors of sexual and gender-based violence (SGBV), and helping with the payment of medication and transportation for the patients.

Southern Ukraine

Kryvyi Rih

An MSF team based in Kryvyi Rih has been working with a hospital near to the southern frontline to help them develop their emergency room and mass casualty response capacity. The team also delivered donations to areas of the Kherson region that was recently retaken by the Ukrainian armed forces.

Mykolaiv and Odesa

To help Ukrainian health facilities cope with a potential influx of injured people, MSF teams have trained hundreds of medical doctors and nurses to triage patients according to the severity of their injuries. This step is essential to ensure that patients are treated appropriately in an emergency situation.
In Mykolaiv, MSF is also funding the work of local volunteers who bring medical and logistic equipment in and out of the besieged city.

Northern Ukraine

Chernihiv

We are running mobile clinics in villages in Chernihiv oblast, providing outpatient consultations, NCD continuation of care, and MH consultations. Further explos have been conducted in the area.
We’ve been providing medical and NFI donations to health posts in Chernihiv oblast and we continue to provide medical donations to hospitals and polyclinics in Kyiv and Chernihiv oblasts.
We are also working to reach patients in Chernihiv oblast with our SGBV hotline, based in Kyiv.

Kharkiv

Most of the thousands of people sheltering in metro stations have been evacuated and the metro system started functioning on 24 May, so the majority of MSF activities in the metro have ended. According to our findings most of the evacuated people have found a place to stay, but others still don’t have a solution. We are following up with the most vulnerable people. In spite of the city’s efforts at normalization, conflict activity picked up in the city last week. The unstable security situation has made it more difficult to move, however we have new mobile clinic sites in the city.
We donated a portable ultrasound and two blood warmers to Chuhuiv General Hospital, and we visited and donated NFIs at a dormitory and sanitorium that are hosting displaced people.
Outside the city, we are continuing movements to remote villages in Kharkiv oblast, focusing initially on the Derhachi, Chuhuiv and Ruska Lozova axes, to conduct explos and mobile clinics, to build connections and provide donations. Last week we had to postpone some movements due to the security situation. We continue to work with volunteer networks to reach people in need, including donations of food and NFIs to selected groups with a focus on those that are supplying to villages outside the city. We are also continuing to make donations of medical supplies to small health posts and facilities in remote villages.
Last week, we launched a new hotline for Kharkiv city and oblast to respond to ongoing needs for medications and online medical and psychological consultations. We have agreed to collaborate with a volunteer network for pick-up from our warehouse and distribution to people’s homes. The hotline is based on learnings from our NCDs hotline in Kyiv and it got a good response in its first week.

Zhytomyr

In Zhytomyr, MSF teams are providing 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.
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.

Eastern Ukraine

MSF has expanded its activities in eastern Ukraine in response to the growing humanitarian needs in areas close to the frontline and in places hosting people who have fled their homes.

Since February 2022 we have donated medical supplies and/or provided in person or remote mass casualty training to Ukrainian medical staff working in numerous hospitals throughout eastern Ukraine. This includes hospitals in Bakhmut, Dnipro, Kramatorsk, Mariupol, Myrnohrad, Orikhiv, Pokrovsk and Zaporizhzhia.

Dnipro

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.
Many of the people living in the shelters are highly vulnerable, including the elderly, people with disabilities, unaccompanied children and people who cannot afford to make the journey further west in Ukraine or abroad.
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.

Zaporizhzhia

In Zaporizhzhia, we are providing support to people who are arriving from Mariupol and other areas where fighting is intense.
Our teams run mobile clinics in the main reception centre and more than 30 shelters throughout Zaporizhzhia, 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.
We have also donated medical supplies and carried out mass casualty training for staff at the main referral hospital in Zaporizhzhia.

Donetsk and Luhansk regions

We are working with health facilities close to the frontline in Donetsk oblast to make sure they have enough of the right supplies and training to be able to keep treating patients even if they get cut off from supply lines by intense fighting.
For some facilities we are also providing logistical support so they can have their own autonomous supply of electricity through generators and solar power, and clean water to continue functioning for up to a week.
The hospitals that MSF has visited in the Dontesk and Luhansk regions all have surgical capacity, but at varying levels. MSF has a team based in the region to provide guidance, coaching and on-going training for hospitals to improve and expand their surgical capacity, and also potentially available to step in as surge capacity in case of an overwhelming influx of mass casualty patients.
MSF also runs an ambulance referral service. Run out of Dnipro and Pokrovsk towns, this hospital-to-hospital referral service has seen been very active as fighting in the region has intensified in the last few weeks and continues to transfer patients from hospitals near the frontlines to health facilities further away in places like Dnipro. These ambulances also bring patients from hospitals to the medical referral train.

Western Ukraine

Vinnytsia

In Vinnytsia, we provide support to people who have fled from other parts of the country and taken refuge in temporary and longer-term accommodation and 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.
We are working with local hospitals to help them prepare for mass casualty events and exploring how we can provide water and sanitation support. Our teams have also made donations to health facilities in the Oblast.
We have rehabilitated part of a medical facility to host elderly people who are evacuated from the eastern frontline regions and require medical follow-up for chronic disease. We are now coordinating with the authorities to begin the referrals.

Lviv

In Lviv, our team continues to support the burns unit of one of the big referral hospitals.

Uzhhorod and Ivano-Frankivsk

We have carried out trainings with local health professionals, including on mental health for psychologists and first responders, and have started group therapy sessions and individual mental health consultations with internally displaced people.
In Ivano-Frankivsk we are supporting a clinic focusing on IDP patients run by doctors who are displaced from the conflict themselves.
We keep doing donations to health facilities in these two locations and distributing non-food item (NFI) kits for displaced people, particularly in nearby rural areas.

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.

MSF activities in Ukraine as of June 2022.

Responding in neighbouring countries

Slovakia

More than 461,000 people have crossed to Slovakia from Ukraine as of 29 May (UNHCR).

We have signed a Memorandum of Understanding with the Ministry of Health to be able to import medical supplies and we have trained health staff on TB and MDR-TB, and SGBV.

For the moment, the critical humanitarian and medical needs are covered by the local authorities and civil society.

Russia

More than 971,000 people have crossed to Russia from Ukraine as of 26 May (UNHCR).

MSF works with the health authorities in Arkhangelsk and Vladimir regions to reduce the burden of drug-resistant tuberculosis (DR-TB) and improve treatment for the disease.

In our project in Moscow and Saint Petersburg where we are partnering with local NGOs to support vulnerable groups, we’ve seen an increase of cohort for HIV and HCV care, among them -Ukrainians who are stranded in Russia and cannot get refill for their ARVs.

Belarus

More than 27,000 people have crossed into Belarus from Ukraine as of 12 May (UNHCR).

In Belarus, MSF continues to run its regular programmes. We support the national tuberculosis (TB) programme and hepatitis C treatment in prisons.

Since 2021, we have also been assisting people on the move stranded between Belarus and the EU countries.

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Crisis in Ukraine