Ukraine

As of November 15, 2022, there are approximately 116 international Doctors Without Borders/Médecins Sans Frontières (MSF) staff and 685 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 Apostolove, Dnipro, Ivano-Frankivsk, Kharkiv, Kyiv, Lyman, 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 77 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 2,607 hospital patients have been medically evacuated to date, along with their family members, in addition to 78 orphans. About 28 percent of the patients have been violence-related 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.

Kropyvnytskyi 

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 (with bedding kits, hygiene kits, and food) and doing rehabilitation work in more than 10 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 briquettes and firewood, at amounts estimated to get people through the winter.

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.

In addition, we are now aiming to verticalize the project on mental health by addressing the needs of specific populations in secondary health facilities (including the war wounded, veterans, and people with PTSD) as well as centralizing the mental health activities toward 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 mental health support to staff and patients and develop a PTSD victims of war program. 

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.

Kherson

On November 15, 2022 MSF became the first medical INGO to arrive in Kherson city since it was retaken by Ukrainian forces. After arriving, our medical teams carried out 818 medical consultations in six days, mainly for patients living with non-communicable diseases. Given that Kherson city’s psychiatric hospital lost power due to strikes on energy infrastructure, it was decided to evacuate the 400 patients to other medical facilities further from the frontlines, which MSF did in four stages, using buses and trains.

Mykolaiv 

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 and water and sanitation services. We also run mobile clinics in the areas recently retaken by the Ukrainian forces in the Mykolaiv and Kherson oblast, providing primary health care services and psychological counseling. We have visited several villages and observed a gaping hole in access to health care. 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.

Kharkiv

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 drop, working conditions are getting more difficult and patients are facing increased barriers to access health care. 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 health care. We are seeing an increase in acute diseases including upper respiratory tract infections and exacerbation of asthma.

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.

In coordination with local authorities, MSF developed an emergency response plan that aims to provide access to comprehensive health care for the civilians when the frontline is moving. This includes:

• An advanced medical post in accessible areas close to the moving frontline.
• A modular bridge facility in newly retaken areas.

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 

Support for 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 in human resources, supply provision, monitoring SRH, mental health, emergency care, medical and surgical needs, pediatrics, maternity,  and neonatology.

We also send donations to primary, secondary, and tertiary health care places. And we provide training support on specialized emergency response like MCP training, MHGap, and peritonial dialysis.

Support for people left behind

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 cannot afford to remain displaced, 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.

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 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 (including bedding kits, hygiene kits, and food) for displaced people, particularly in nearby rural areas, as well as doing rehabilitation works at 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.

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. 

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 the 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.

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 17,2000 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).

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. 

November 27, 2022 marked one year of MSF’s medical activity serving people on the move stranded between Belarus and the EU countries.