KYIV/NEW YORK, March 23, 2023—Medical services have been severely disrupted in war-torn areas of southern and eastern Ukraine due to the destruction of medical facilities, restrictions on civilian movements and the unpredictable behavior of Russian forces, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today, sharing a summary of accounts from health workers and patients, Between enemy lines: the destruction of health care in Ukraine.
Despite making requests to work on both sides of the war's front line, MSF medical teams have only been able to operate in areas once they come under Ukrainian control. After the front shifted to the southeast in late 2022, MSF assessed the needs of people in 161 towns and villages in the Donetsk and Kherson regions that had been caught in the fighting.
“Our teams directly witnessed homes, stores, playgrounds, schools, and hospitals reduced to rubble," said Christopher Stokes, MSF head of programs in Ukraine. "In some of the towns and villages where we work, the destruction was absolute."
Between November 15, 2022, and February 19, 2023, MSF teams conducted about 11,000 medical consultations for patients who had remained in communities under Russian military occupation, most of whom were older adults with reduced mobility or chronic diseases, including hypertension, cardiovascular disease and diabetes.
Health care under occupation
MSF found that chronic diseases had gone untreated for several months while communities were occupied by Russian forces, and food shortages had prevented patients from controlling their diets, leading to problems with mobility, eyesight and muscle function, and increasing their dependence on others.
Attacks on health care infrastructure
MSF medical workers witnessed numerous attacks on health care infrastructure in 2022. In two separate instances, in Mykolaiv in April and in Apostolove in June, they witnessed the apparent effects of cluster munitions on hospitals, forcing the suspension of medical activities for several days and effectively depriving patients of access to care. On October 8, 11 and 15, MSF teams discovered the presence of antipersonnel landmines inside functioning hospitals, in areas previously under Russian occupation in the Kherson and Donetsk regions and in Izium.
“The use of landmines is widespread in frontline areas, but to see them placed in medical facilities is shocking: a remarkable act of inhumanity," said Vincenzo Porpiglia, MSF project coordinator in the Donetsk region. "It sends a clear message to those who come in search of medicines or treatments: hospitals are not a safe place."
MSF medical teams also discovered that several medical facilities in formerly Russian-occupied areas of the Kherson and Donetsk regions were looted, while medical vehicles including ambulances were destroyed.
Respect for international humanitarian law
The difficulties of obtaining medicines and accessing medical care have been corroborated by messages sent to MSF medical teams from Ukrainian doctors and nurses working in Russian-occupied areas of Kherson and Zaporizhzhia regions who made repeated requests to be supplied with essential medicines.
From May to September 2022, MSF was able to fulfill a limited number of these requests with the support of Ukrainian volunteer organizations, who worked to move essential medicines and supplies from Ukrainian-held territory to areas under Russian military control. The only officially authorized crossing point at the front line was in Vasylivka, a town in Zaporizhzhia region. However, since September 2022, the flow of supplies entering Russian-occupied areas from Ukraine has been impeded, and MSF teams had no option but to stop sending medical supplies.
MSF urges all warring parties to uphold international humanitarian law and their obligations to protect civilians and civilian infrastructure. Hospitals and other health care facilities must never be targets. Warring parties must allow the unobstructed supply of life-saving medicines and medical supplies and provide safe and unhindered access to independent humanitarian assistance for those in need.
MSF first worked in Ukraine in 1999. Since February 24, 2022, we have significantly scaled up and reoriented our activities to respond to the needs created by the war in Ukraine. Today MSF is working in Apostolove, Dnipro, Fastiv, Ivano-Frankivsk, Kharkiv, Kostiantynivka, Kropyvnytskyi, Kryvyi Rih, Kyiv, Lviv, Lyman, Mykolaiv, Odesa, Pokrovsk, Sloviansk, Ternopil, Uzhhorod, Zaporizhzhia, and Zhytomyr. Our medical services include treatment for tuberculosis, emergency surgery, treatment for sexual violence, physiotherapy and mental health. We also run a fleet of ambulances and specialized medical evacuation trains that evacuated 2,558 patients in 2022, including 700 people with traumatic injuries.