Ukraine

As of November 15, 2022, there are approximately 133 international Doctors Without Borders/Médecins Sans Frontières (MSF) staff and 580 Ukrainian staff working across Ukraine, with more joining the team every day. They work as medical staff (surgeons, doctors, nurses); psychologists; logistics and administration; and management. We currently have teams based in Dnipro, Ivano-Frankivsk, Kharkiv, Kyiv, Lviv, Mykolaiv, Odesa, Poltava, Pokrovsk, Kochubeivka, Kostiantynivka, Kryvyi Rih, Uzhhorod, Kropyvnytskyi, Vinnytsia, Zaporizhzhia and Zhytomyr.

Since February 24, MSF has brought more than 800 metric tons of medical and relief supplies into Ukraine to support hospitals, health centers, and displaced people.

Medical evacuation trains

On April 1, 2022, MSF completed its first medical train referral, taking nine patients who had been wounded in or near the besieged city of Mariupol from hospitals in Zaporizhzhia to hospitals in Lviv. They were transported on a two-carriage train equipped as a basic hospital ward, accompanied by a team of nine MSF medical staff. 

We are now using a larger and more highly medicalized train. So far, we have completed 65 referral trips, mostly taking patients from overburdened Ukrainian hospitals close to active warzones to Ukrainian hospitals with more capacity that are further from active warzones. Among the people we've evacuated are seriously wounded patients from Kharkiv and babies and children from an orphanage in Zaporizhzhia. A total of 2,010 hospital patients have been medically evacuated to date, along with their family members, in addition to 78 orphans. About 33 percent of the patients have been trauma cases. Further medical referrals are planned as urgent requests from hospitals in the east continue.

Kyiv

In Kyiv we are running a telephone hotline for survivors of sexual violence and domestic violence, offering confidential consultations and delivery of medications to prevent HIV, sexually transmitted infections, and unwanted pregnancy in Kyiv and Chernihiv oblasts.

In Hostomel, on the outskirts of Kyiv, an MSF team continues to support basic health care alongside Ukrainian doctors, following intense fighting in the area in March and April. We are increasing our support for mental health care to address the psychological consequences of the war.

In the city of Kyiv, this July we began providing physiotherapy services in a hospital managed by the Ministry of Interior where 70 beds (out of a total of 200 trauma beds) are dedicated to physiotherapy for war-wounded people. Our teams are both treating patients and providing bedside training to local health staff, in order to respond to a major need and bridge a significant gap in the Ukrainian health care system. The brutality of this war is leaving many people with major injuries and the need for post-operative care is enormous. However, rehabilitation and physiotherapy were not particularly developed in the local health care system prior to the war. The high number of trauma patients are at risk of developing long-term mobility 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.

Vinnytsia

In Vinnytsia, we are continuing with our mobile clinics especially 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.

Since July, we have been providing physiotherapy with 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 provide post-operative care for war-wounded patients and bedside training to increase the local capacity.

Sumy

We are running mobile clinics in villages in the Sumy region, offering general outpatient care, including family planning and treatment for chronic diseases or sexual and gender-based violence, as well as mental health services.

Kropyvnytskyi

The MSF team here has provided medical donations to 17 health facilities in Kirovohrad oblast, where Kropyvnytskyi is located. Between March 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. In the same period, our mental health team has seen 149 patients in individual sessions and 2,605 in group psychoeducation sessions. MSF is also distributing relief items and doing rehabilitation work in IDP shelters, as well as supporting a maternity hospital to make more accessible services for survivors of sexual and gender-based violence.

Chernihiv

We are shifting from running mobile clinics in several villages in Chernihiv oblast to a more specific focus on mental health needs, women's health, and caring for survivors of sexual and gender-based violence. We are working to reach patients through our hotline and are continuing to donate medical supplies to health facilities.

Apostolove and Kryvyi Rih

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 activities and have treated over 1,000 patients in recent months.

In the broader area of Kryvyi Rih, mobile clinics provide sexual and reproductive health and mental health services and health promotion. Mobile clinics also visit areas that have been affected by fighting for many months and been under the control of different military forces, where many people have not accessed health care during that time. MSF teams continue to assess new areas as the frontlines shift and territory is retaken by the Ukrainian forces.

In Kochubeivka, we run a stabilization point 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 in the areas of the Kherson oblast that are under Ukrainian control. 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.

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.

In Mykolaiv, we support several hospitals in the city with medical and logistic donations, along with 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 stigmatized in the country and there aren’t enough psychologists and psychiatrists, especially with experience of war-related trauma.

In Bashtanka, north of Mykolaiv, we made a large donation of medications and emergency supplies to the local hospital after an airstrike caused many casualties on June 6. 

Kharkiv

In Kharkiv we have phased out our mobile clinics in metro stations now that many people are no longer sheltering there. The counteroffensive launched in early September by the Ukrainian Armed Forces in the Kharkiv oblast resulted in the retreat of the Russian Armed Forces from the northern and eastern areas. Since then, the teams have been able to reach villages, towns, and people that were previously inaccessible. The majority of those who had remained in the region are elderly people living with chronic health issues and people with disabilities, including mobility issues. Many have experienced isolation, fear and panic, depression or stress; and the lack of access to medical care has left people without proper treatment and treatment interruptions of chronic diseases.

The need for medical care and mental health support is high—especially in the rural communities. Our teams run mobiles clinics—focusing on areas with damaged or destroyed health facilities or no healthcare presence—providing primary care, including sexual and reproductive health, and psychological first aid and mental health consultations.

Due to the high medical needs and increase in regional accessibility, the teams doubled the average rate of monthly medical consultations in September as opposed to previous months. The teams are also providing non-food items such as hygiene kits, medical donations to health facilities, and water treatment systems to IDP shelters.

We also operate a phone hotline for Kharkiv city and oblast to respond to ongoing needs for medications and online medical and psychological consultations. The number of patients increased significantly in the last two weeks of October, as the population in the rural areas were reconnected to the mobile network.

Zhytomyr

In Zhytomyr, MSF teams continue to provide social support (food parcels and hygiene kits) and psychological support to all active tuberculosis (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.

Dnipro and Zaporizhzhia

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 especially vulnerable people (including the elderly, people with disabilities, abandoned children, and others) 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.

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 center 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 center mental health and health promotion team is still there. As in Dnipro, the project is now transitioning into support of strategic primary healthcare centers. Continued support to hospitals close to the front line is ongoing with donations for set up of a bunker operating theater as contingency planning. 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.

Daily shelling incidents in Zaporizhzhia city continued during the month of September. In September our teams assessed water and sanitation needs in the frontline communities and received requests from local groups and hospitals, such as one maternity hospital in Zaporizhzhia city and primary health care centers, that were provided with the first donations.

Kostiantynivka and Lyman

MSF has supported the emergency department, and surgical and intensive care units with medical care at the Kostiantynivka Hospital since late July. The MSF teams work alongside and in partnership with Ukrainian Ministry of Health staff. Most of the cases they see are trauma cases.

Lyman is in an area recently retaken by the Ukrainian forces. MSF teams have visited the area, donated medical supplies and mobile clinic consultations in the past few weeks. They will continue to intervene in this area and to further explore how MSF can best respond to needs.

Donetsk oblast 

Ambulance referrals

MSF ambulances refer patients between health care facilities, serving 16 different facilities in the Donetsk region, often to move patients from facilities close to the frontline to hospitals further away from the fighting, where they can continue their care. Most of these patients have suffered severe trauma. Around 31 patients are transferred every week.

Support to hospitals

We are finalizing the setup of pediatric inpatient and outpatient departments in Sloviansk hospital and supporting the hospital in the emergency room. Once the pediatric inpatient department opens, Sloviansk hospital will be the only hospital to provide this service in the oblast, including those of newly retaken areas. Mental health services in Kramatorsk city primary health care center is also being set up. Primary health care and network set up are being connected to other organizations able to provide medications.

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.

Care for Carers Program 

As the conflict has put pressure on the local health care professionals, the teams are providing mental health support to medical and mental health care professionals, who experience burn out and stress. The activities include psychological group support and stress management trainings, focusing on providing coping mechanisms. The teams have also provided training in some other locations such as Odesa.

Uzhhorod and Ivano-Frankivsk

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 have 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 to 12 health facilities in these two locations and distribute non-food item (NFI) kits for displaced people, particularly in nearby rural areas, as well as doing rehabilitation works at IDP shelters.

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. Over 17 weeks of collaboration until the end of August, a total of 1,274 medical consultations took place. In Uzhhorod and other peripheral areas we are running mobile clinics at IDP public shelters. Since August, our teams have conducted an average of 200 medical consultations per week and the main conditions seen are chronic diseases and acute respiratory tract infections. We are also carrying out between 25-30 individual consultations of mental health and arranging group activities with an average of 170 people every week.

According to the UN Refugee Agency, more than 7.7 million people have fled Ukraine since the war began, over 6 million of whom have since crossed back into Ukraine. MSF is responding to the needs of Ukrainian refugees in neighboring countries. Within Ukraine, over 6.2 million people remain displaced by the war, according to the International Organization for Migration.

Slovakia

More than 540,000 people have crossed to Slovakia from Ukraine, and more than 270,000 have cross back into Ukraine, as of June 28. We have signed a memorandum of understanding with the Ministry of Health to import medical supplies, and we have trained health staff on providing care for people with tuberculosis, including multidrug-resistant tuberculosis, and people who have suffered sexual and gender-based violence. For the moment, critical humanitarian and medical needs are being covered by local authorities and civil society. 

Poland

More than 6.9 million people have crossed from Ukraine into Poland as of October 18, 2022. More than 1.45 million have registered for temporary protection. We are supporting the Ministry of Health to provide treatment for patients with drug-resistant tuberculosis, including patients previously treated by our teams in Ukraine. 

Russia

More than 2.8 million people have crossed to Russia from Ukraine as of October 3, 2022. Our teams have worked in Russia for 30 years. Currently, our teams work with health authorities in the Arkhangelsk and Vladimir regions to support crucial, life-saving treatment for patients with drug-resistant tuberculosis. In the last few months, we scaled up our assistance to partner organizations in St. Petersburg and Moscow to ensure the 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 who need refills of their medications. 

We have also recently started to support displaced people in Rostov and Voronezh, in coordination with local authorities. In May 2022, a dedicated MSF hotline was launched with an aim to provide referral services to medical and social support for refugees and displaced people from Ukraine. As of mid-October, MSF, with the support of local specialists, responded to the medical needs of more than 1,000 people on a case-by-case basis in Voronezh, Rostov-on-Don, and Belgorod. In collaboration with local organizations, we delivered essential relief items including food, glucometers, and supplies to diabetic patients from Ukraine in Voronezh.

Through local organizations, social workers, and health providers, we aim to link people in need to existing medical and humanitarian services and improve their ability to receive medical and humanitarian support. Our work is focused on providing medical care where we can, based on medical need alone.

Belarus

According to the Belarus State Border Committee, more than 60,000 Ukrainians have arrived since February 24, including some 16,000 via the Ukrainian-Belarusian border, 35,800 via Poland and some arrivals via Lithuania (7300) and Latvia (1300). UNHCR has recorded more than 16,705 people crossing from Ukraine into Belarus as of October 18 (UNHCR).

Our team has seen an increasing number of people forcibly displaced from Ukraine in need of medical assistance and social support. 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 children and people with non-communicable and chronic diseases including diabetes and hypertension. A majority of them is in need of urgent psychological support.

MSF continues to run its regular programs. We support the national TB program in the civil and penitentiary sectors and hepatitis C treatment in prisons. Since 2021, we have also been assisting people on the move stranded between Belarus and the EU countries.