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 five million people have fled to neighbouring countries since the war began, with an additional seven 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. 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.
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.
MSF teams remain in Ukraine, and we are currently seeking ways to adapt our response as the conflict situation evolves.
We currently work with approximately 120 international staff in Ukraine and employ more than 200 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 225 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, Uzhhorod, Vinnytsia and Zhytomyr.
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.
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. Six further referrals by this train have been completed, mostly taking patients from hospitals close to frontlines of the war in Donetsk and Luhansk regions, but also one evacuation of seriously wounded patients from Kharkiv and one evacuation of babies and young infants from an orphanage in Zaporizhzhia. More than 270 patients have been medically evacuated to date, with their family members. 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.
In Kyiv, we have established a telephone hotline for people with non-communicable diseases, which can be used by elderly and vulnerable individuals to get their medication delivered at home and started mobile clinics for non-communicable diseases.
MSF has also a new project providing primary health care and mental health care to people in Hostomel, near Bucha and Kyiv, which was occupied by Russian forces for 35 days.
MSF teams are running mobile clinics providing outpatient consultations in locations around Kyiv (Ivanivka, Yahidne, Velyka Vis, Siberezh).
In the early days of the war an MSF surgical team conducted mass casualty training and hands-on war-surgery training in a paediatric hospital and provided brief mass casualty training for five other hospitals. 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.
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 Odesa an MSF anaesthetist/resuscitator trained general practitioners and nurses who may be called upon to take immediate charge of the oblast's inhabitants.
In Odesa and Mykolaiv, we were able to donate medical supplies to hospitals preparing to accept wounded. Consultations for IPD and vulnerable people will be provided soon.
In and around Zhytomyr, we donated trauma-related supplies and conducted mass casualty training in nine hospitals during the phase when frontlines of fighting were close. We were also able to move a considerable part of our TB (tuberculosis) supplies from Kyiv to Zhytomyr, where we were previously running a TB program. The focus in Zhytomyr is gradually returning to a resumption of our former activities supporting the treatment of drug-resistant tuberculosis.
MSF is expanding 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.
In and around Dnipro, we are providing support to people who have managed to flee parts of Donetsk and Luhansk oblasts where the conflict has intensified and who are now staying temporarily or longer term in dozens of shelters and accommodation. Our support is being expanded to include providing essential relief items, ensuring continuation of care for people with chronic illnesses, administering psychological first aid and linking people with essential health and social services.
In Zaporizhzhia MSF is providing psychological first aid to people who have recently arrived from Mariupol and the surrounding areas at reception centres and shelters. We have also donated medical supplies and carried out mass casualty training for staff at the main referral hospital in Zaporizhzhia.
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 remains an important hub for organising the medical train evacuations from hospitals further east and closer to active frontlines of conflict. Most of the patients are referred to Lviv, in the far west of Ukraine.
In Lviv, our teams provided mass casualty training and assisted hospitals to prepare for mass influx of wounded. 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. MSF donated a large supply of cold weather items (sleeping bags, thermal blankets, warm clothes, tents) to civil society organisations supporting displaced people and refugees. A new project has started to support one of the larger hospitals in Lviv to run its burns unit.
In Vinnytsia 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. A destigmatisation and psychological approach to mental health care in a context which was previously held an institutional and pharmacological (biomedical) approach to mental health has been started in Nemyriv district.
We helped the main referral hospitals in Berehove and Mukachevo, in the southwest near to the Hungarian border, with a mass casualty training in case they receive large influxes or referrals of wounded patients. A team has started mobile clinics along the border with Hungary, where there are significant numbers of people gathered, centred for the moment on Berehove. The team is seeing early signs that mental health support will be a high priority, and the work will focus more in this direction, and also on the continuity of care for patients who were previously following medical treatment that risks being interrupted by their rapid departure to a place of safety.
In Chernihiv, we provided a substantial donation of medical supplies to one of the hospitals in the city. We have also set up mobile clinics in neighbouring villages and in the city to respond to health needs and are providing outpatient consultations for non-communicable diseases as well as mental health support.
In Kharkiv, we are running mobile clinics for thousands of people sheltering in metro stations (more than half the total stations in the city), many of whom are suffering stress and psychological trauma due to the war. More than 500 consultations have been performed.
A specific attention has been paid to elderly people as well to internal displaced people who suffer from chronic diseases. Psychosocial et medical support have started on 5 April and around 60 medical consultations have been dispensed for elderly people in the surroundings of Makariv. The plan is to continue assessing the situation for this people living in the countryside and cut from health care for the whole month. Training and donation have also been done to health facilities. Last week the Fastiv team started consultations in Borodianka, another newly accessible area that was occupied by Russian troops and reported similar experiences to those seen in Bucha.
We have set up bases in these locations, where we have assessed the health facilities and are establishing a network for support in terms of medical donations to hospitals here and in frontline areas. We have carried out trainings with local health professionals, including on mental health for psychologists and first responders, and in the case of Ivano-Frankivsk our teams have started group therapy sessions with internally displaced people. We have also distributed around 1,000 non-food item (NFI) kits for displaced people in these locations and the nearby rural areas.
An MSF team based now here is assessing the health facilities in the town and peripheral areas and has started doing trainings for para-medics and first responders.
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.
According to UNHCR, more than 2.8 million people have fled Ukraine to Poland. Poland has so far been a primary route to bring staff and supplies into Ukraine, and MSF has teams to facilitate these movements. In the first few days of the response. In the first few days of the response, MSF donated some essential relief items to Red Cross Lublin and to a reception point in Horodlo, near Zosin border crossing.
The UN refugee agency has reported more than 470,000 people having crossed as refugees into Hungary. While initial assessments indicated that many of the immediate needs of refugees are being adequately met, we have started working in partnership with local organisations and with the support of Hungarian doctors to be able to provide primary healthcare and psychological first aid. We need to see how the situation develops and whether there are vulnerable individuals or groups that are missing out on essential services and support.
As of 19 April, nearly 426,000 people have crossed into Moldova from Ukraine, many in transit. Moldova, which has a population of only 2.6 million people, hosts the largest concentration of Ukrainian refugees per capita (UNHCR).
MSF has sent teams to border points in the north (Otaci) and southeast (Palanca). On March 12th, in Palanca, MSF started providing primary health care consultations and Psychological First Aid (PFA) sessions for refugees, as well as basic need support for families fleeing from Mikolayiv and Odesa region – this activity has now closed and has been handed over to other humanitarian players. Similar activities started in Otaci, where MSF has opened a medical point. We have already started training local volunteers in psychological first aid.
MSF’s mental health team has also provided psychological first aid to people in reception facilities in the capital, Chișinău. Assessments in different hospitals of the city are also ongoing to evaluate how to improve access to health care for refugees.
According to UNHCR, over 340,34239,813 people have crossed to Slovakia from Ukraine, as of 19 April. We have signed a Memorandum of Understanding with the Ministry of Health to be able to import medical supplies and we are now framing the scope of our collaboration with the authorities, which will likely focus on the areas of mental health, SGBV and TB for arriving refugees. For the moment, the critical humanitarian and medical needs are covered by the local authorities and civil society.
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.
According to UNHCR nearly 550,000 people have crossed to Russia from Ukraine as of 19 April. MSF is currently exploring whether new medical humanitarian needs have emerged in the regions of Russia bordering Ukraine. The team has visited Rostov, Voronezh and Belgorod. In Rostov, we have made some donations such as food, hygiene kits, essential relief items and medicines to be distributed among displaced people. 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.
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 also assisted people on the move stranded between Belarus and the EU countries. MSF has carried out an initial assessment of the situation on the Belarus - Ukraine border and continues to be ready to assist emerging medical and humanitarian needs. Over 23,000 people have crossed into Belarus from Ukraine.
