As the war in Ukraine escalates, our teams are responding to a deepening humanitarian crisis.
Ukraine: MSF teams witness attacks on two hospitals
KYIV/NEW YORK, November 27, 2023—Doctors Without Borders/Médecins Sans Frontières (MSF) staff directly witnessed two deadly attacks on Ukrainian hospitals this month, underlining the unacceptable violence against health care workers, patients and medical facilities in areas close to the front lines of the ongoing war with Russia.
Our work in Ukraine
As full-scale war erupted in Ukraine, Doctors Without Borders/Médecins Sans Frontières (MSF) scaled up activities to meet the many health needs—supporting health facilities, running mobile clinics, and operating a specially designed medical train.
What's happening in Ukraine?
After eight years of low-intensity conflict in eastern Ukraine, Russian forces launched an all-out military assault in 2022, causing thousands of civilian casualties and extensive damage to energy and other key infrastructure, particularly in the country’s eastern regions. Many homes were destroyed and public services were severely disrupted, including health care, water and power supplies.
By the end of 2022, 6.5 million people were internally displaced within Ukraine, and about eight million had fled the country.
How we're helping in Ukraine
Before the war escalated, MSF’s regular programs in Ukraine included providing health care and mental health services to people affected by hostilities in Donetsk and Luhansk regions. Based in Bakhmut and Mariupol, our teams ran mobile clinics and supplied facilities with drugs and equipment. We also offered lifesaving care for tuberculosis (TB) patients and supported the implementation of an innovative TB treatment regimen in Zhytomyr. OnFebruary 24, 2022, these regular programs were suspended and/or reoriented to meet emerging needs in Ukraine and nearby countries.
In the early days following the escalation of the war, hospitals were in crucial need of medical supplies. We established supply lines to health facilities and displaced people in Severodonetsk, Luhansk region, Mariupol, Donetsk region, Dnipro, and the capital city of Kyiv for the delivery of drugs, medical materials and other essential items.
As of November 15, 2022, there are approximately 116 international 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, 2022, 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. We have made over 80 referral trips, mostly taking patients from overburdened Ukrainian hospitals close to active war zones to Ukrainian hospitals with more capacity that are further from active war zones. Among the people we've evacuated are seriously wounded patients from Kharkiv and babies and children from an orphanage in Zaporizhzhia. Over 2,500 hospital patients have been medically evacuated, 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.
How we are helping in Kyiv
In Hostomel, on the outskirts of Kyiv, MSF runs a project to treat survivors of torture. The project has mental health and physiotherapy rehabilitation components, as well as a general medical practitioner. Our teams also provide mental health care in 10 different locations outside Kyiv. In 2022, these teams provided almost 1,000 individual mental health consultations, and 184 group therapy sessions.
In Kyiv city, we provide physiotherapy and psychological counseling services for war-wounded people in a hospital managed by the Ministry of Interior. We also treat patients and train local health staff to respond to major needs, including rehabilitation and mental health care, which are major gaps in the Ukrainian health care system. Since the escalation of the war there are a huge number of people with major injuries and the need for post-operative care is enormous. The trauma patients we see are at risk of developing long-term 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 areas heavily affected by the war.
Rehabilitation, mobile clinics, and mental health care in Vinnytsia
Our rehabilitation project at the Ministry of Health hospital in Vinnytsia continues. MSF teams provide physiotherapy and psychological counseling to war-wounded people, following a similar approach to the project we operate in Kyiv. This approach focuses on providing hands-on treatment to patients and capacity-building through training for local staff.
In Vinnytsia, we run mobile clinics, particularly in the southern part of the oblast and rural areas where IDPs have settled without access to primary health care. Other mobile teams focus on mental health and health promotion.
Donations and training in Kirovohrad
MSF has made donations of medical supplies to 23 health facilities Kirovohrad oblast, where the city of Kropyvnytskyi is located, and the northern part of neighboring Mykolaiv oblast. From April to December we provided 146 training sessions for health professionals, psychologists, and first responders on things like managing influxes of war wounded people, decontamination, trauma, and mental health. A total of 2,301 people participated in these training sessions. Since April, our mental health team has seen 299 patients in individual sessions and 9,463 patients in group psychoeducation sessions. MSF is also distributing relief items (bedding kits, hygiene kits, food, firewood, electrical materials, and more) and doing rehabilitation work in IDP shelters, particularly in the area of water and sanitation.
Support for internally displaced people (IDPs) in Dnipro
In and around Dnipro, MSF supports vulnerable people in more than 40 shelters who fled parts of Donetsk and Luhansk oblasts, where the conflict is particularly intense. In Zaporizhzhia we provide support to thousands of people who were displaced from Mariupol.
Our mobile clinics provide medical consultations and medications for people with chronic illnesses such as hypertension, asthma, diabetes, heart disease, and epilepsy. We also refer severely ill patients to hospitals, provide psychological first aid and mental health consultations, and distribute basic relief items. These mobile clinics are being scaled down as many people can once again access these services through Ukraine’s national health system.
According to the UN Refugee Agency, more than 8 million people have fled Ukraine since the war began. MSF is responding to the needs of Ukrainian refugees in neighboring countries. Within Ukraine, over 6.5 million people remain displaced by the war, according to the International Organization for Migration.
As of January 24, 2023, UNHCR had recorded 19,673 Ukrainian refugees in Belarus. According to public reporting by the Belarus State Border Guards, 5,655 Ukrainians entered the country between January 1, 2023, and February 3.
In Belarus, MSF continues to respond to the medical needs of people on the move stranded between Belarus and the European Union. While the winter conditions in Belarus seem to have caused a drop in the number of crossing attempts into Europe, the MSF team is still caring for people suffering from frostbite, injuries— including violence-related injuries—and chronic diseases.
Since November 2021, we have assisted more than 1,200 patients from various countries of origin, few of them from Ukraine. MSF has not provided any direct support to patients from Ukraine since early December 2022. According to a government decree from mid-September 2022, Ukrainian citizens and stateless persons from Ukraine, regardless of their status in Belarus, have the right to affordable medical care on an equal basis with citizens of the Republic of Belarus.
In Belarus, we continue to support the delivery of person-centered care and treatment for people with drug-resistant tuberculosis via the National Tuberculosis Program and provide care and treatment for incarcerated people living with TB, HIV, and hepatitis C.
More than 9.4 million people have crossed from Ukraine into Poland since February 24, 2022, according to UNHCR. More than 1.5 million people have registered for temporary protection. MSF is actively working to support the Ministry of Health to ensure that patients are able to access treatment for drug-resistant tuberculosis, including displaced patients previously supported by MSF in Ukraine.
More than 2,800,000 people have crossed to Russia from Ukraine as of October 3, 2022, according to UNHCR.
MSF has been present in Russia for 30 years. Currently, our teams in Russia work with health authorities in Arkhangelsk and Vladimir regions to support lifesaving treatment for patients with drug-resistant TB. In the last few months, MSF scaled up its 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 in need of refills for their antiretroviral medicines.
An emergency department in Kostiantynivka
MSF has supported the emergency department and surgical and intensive care units at the Kostiantynivka hospital since late July. In 2022, MSF teams treated 752 patients in the emergency room (ER) with 168 surgical interventions performed in the operating theater. These teams work alongside and in partnership with staff from the Ukrainian Ministry of Health. Most of the patients they see are trauma cases.
Supply donations and a mobile clinic in Lyman
The Lyman area was retaken by Ukrainian forces in late 2022. In the last quarter of the year, MSF teams conducted 3,152 primary health care consultations in Lyman and the surrounding areas and donated medical supplies. We will continue to work in this area and will further explore how MSF can best respond to the evolving needs.
Supporting hospitals in Donetsk oblast
MSF sends donations to primary, secondary, and tertiary health care services and supports training for specialized emergency response. After months of disruption and decreased activities, the health care system is slowly recovering. Meanwhile, medical needs are increasing as some people who fled the fighting return to their homes. In response, MSF has launched an agile emergency response, running an ambulance in Sloviansk and Pokrovsk.
MSF ambulances refer patients between health care facilities, serving 16 different facilities in the Donetsk region. Many of these patients require transport from facilities close to the front line to hospitals further away from the fighting where they can continue their care. Of the 1,180 people transferred by this service, most suffered severe trauma. Some ambulances are also equipped for intensive care unit (ICU) support. In 2022, 41 patients who were intubated or needed specific medical monitoring were transported.
Care for Carers Program
MSF teams continue to support local health care professionals experiencing burnout and stress. Activities include psychological group support and stress management trainings focused on providing coping mechanisms.
Uzhhorod and Ivano-Frankivsk
Supporting an outpatient department and mobile clinic
In Ivano-FrankivskMSF supports a fixed outpatient department point and a mobile clinic focusing on care for IDP patients run by doctors who are themselves displaced by the war. At least 3,017 medical consultations have been carried out, mainly for hypertension, cardiovascular issues, chronic diabetes, and upper respiratory tract infections. In Uzhhorod and other peripheral areas we run mobile clinics at public IDP shelters. From July to December, MSF carried out 3,925 medical consultations through mobile clinics, visiting various locations in Zakarpattia oblast, including Uzhhorod, Mukachevo, and Perechyn, among others. The main medical conditions seen were hypertension, cardiovascular issues, and respiratory infections. In Uzhhorod, we also support a fixed interfamily volunteer clinic, where 663 medical consultations were done between November and December.
We have carried out training sessions on decontamination, mass casualties, sexual and gender-based violence, and mental health with local health professionals, psychologists, and first responders. From March to December 2022, we provided 41 training sessions attended by 764 people in Zakarpattia oblast and 69 sessions in Ivano-Frankivskoblast, with the participation of 1,146 people.
MSF continues to donate medical supplies on a regular basis. We have made 84 donations of kits in about 20 facilities in these two oblasts. We also distribute relief items (bedding kits, hygiene kits, food, and more)for displaced people, particularly in nearby rural areas. We also offer rehabilitation work at IDP shelters. In 2022 our mental health teams in both locations saw 797 patients in individual sessions and 4,593 patients in group psycho-education sessions.
Support to boarding houses
We have started working with boarding houses that care for vulnerable people including the elderly, people with disabilities, and unaccompanied children. We provide nursing care training to the staff, especially on infection prevention and control, logistics, and regular patient care.
Emergency mobile medical team
MSF has developed an agile emergency response capacity in coordination with authorities that aims to provide access to comprehensive health care for civilians when the front line of the conflict moves. Services include a medical mobile team that will visit areas close to the fighting to provide urgent medical services based on the needs, including evacuation of patients and primary health care in both Dnipro and Zaporizhzhia.
Support to hospitals
In Zaporizhzhia, MSF continues to support hospitals near the front line through supply donations. Mental health activities are also being scaled up to include workers close to the front line as the burden of mental health trauma related to the continuing conflict grows.
Sexual and reproductive health care
MSF also runs a clinic providing sexual and reproductive health services, including contraceptives and care for people who have experienced sexual violence. The team also provides health promotion and information and connects people to health services via social media. In 2022, MSF teams provided 372 consultations for sexual and reproductive health in Dnipro.
Supporting psychiatric patients
MSF teams also provide medical and psychiatric care in two “care houses” that host people with severe psychiatric and neuropsychologic conditions. Most of these patients hadn’t received proper psychiatric or medical care since February 2022. We also provided group and individual psychological sessions for the staff of these facilities. In January 2023 we briefly supported three more such facilities in the region.
Social support in Zhytomyr
MSF teams continue to provide social support (including food parcels and hygiene kits) and psychological support to tuberculosis (TB) patients to help them keep taking their medication and complete treatment. In collaboration with health authorities, we recently began contact-tracing for children who have been in close contact with TB patients. MSF also transports samples to the TB hospital for testing to monitor treatment progress. At the same time, we continue to support the regional TB hospital with drugs, laboratory consumables, and food for patients.
Mobile clinics and mental health care in Kharkiv
We run mobile clinics in 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. The major medical needs are chronic illnesses, such as hypertension and diabetes. For some time, MSF also ran mobile clinics in the Kharkiv metro stations.
We also provide non-food items such as hygiene kits and medical supplies to health facilities. Many health facilities in the region have been damaged or destroyed, and communities have been living without electricity and heating for months. The weather and lack of public transportation makes it difficult for people to reach health care. We are seeing an increase in acute diseases, including upper respiratory tract infections and exacerbation of asthma.
Emergency support in 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. In the hospital, our teams provided 972 consultations in 2022 and admitted 403 patients suffering from violent trauma injuries.
From a base in Kryvyi Rih, MSF has been running mobile clinics predominantly in Kherson and Mykolaiv oblasts. In 2022, these teams visited 144 towns and villages in the region, providing a total of 8,307 medical consultations. Services offered include primary health care consultations, sexual and reproductive health services, and mental health care, in addition to health promotion. Medical teams in these areas have provided 1,848 primary health care consultations.
Three MSF ambulances transfer patients to hospitals and between medical facilities around Kryvyi Rih and areas in Kherson oblast. In 2022, 973 patients were referred through this service.
How we are helping in Kherson
In Mykolaiv oblast and in parts of Kherson oblast recently retaken by Ukrainian forces, MSF mobile clinics provide primary health care services and psychological counseling and social services. We also support the rehabilitation of health care facilities damaged during the fighting. After months of control by Russian forces and extremely limited access to health care, the main health issues we see are chronic diseases such as hypertension and diabetes. Important mental health needs are also emerging as people come forward to seek the help of MSF counselors in the villages we visit.
Noncommunicable diseases and evacuation of psychiatric patients
MSF is one of the only nongovernmental organizations working in Kherson city. Our teams provide medical consultations, mainly for patients living with noncommunicable diseases. When strikes on energy infrastructure caused Kherson city’s psychiatric hospital to lose power, MSF evacuated the facility’s 400 patients to other medical structures further from the front lines via buses and trains.
In Kochubeivka and Svobodny, we run stabilization points where patients are treated before being referred to hospitals.
To respond to the needs resulting from the conflict in Ukraine, MSF has started to support displaced people in the Voronezh, Belgorod, and Rostov-on-Don regions. Through regional nongovernmental organizations, MSF has organized a team of local social workers, medical doctors, psychologists, and legal counselors that are working to ensure that people from Ukraine—mostly newly arrived ones—receive all the necessary qualified medical services in licensed medical clinics and have access to other state social services. When necessary, we have been covering any medical care gaps and paying for the necessary medications and medical consultations. We also regularly support organizations working in these regions with essential supplies like food, hygiene items, and more.
So far, we have provided medical support to around 4,800 migrants, which also included nearly 1,020 mental health support sessions.
As in any country, our work in Russia is focused on providing medical care where we can, based on medical needs alone.
MSF first worked in Ukraine in 1999, supporting the Ministry of Health to treat HIV. From 2011 to 2014, MSF ran a drug-resistant TB program within the regional penitentiary system in Donetsk. We have been responding to the war in eastern Ukraine since 2014 and have continued to run specialized programs to treat infectious diseases like hepatitis C. When the conflict escalated in February 2022, MSF was running a drug-resistant tuberculosis project in Zhytomyr and an HIV project in Sievierodonetsk and was working to improve access to primary health care for people affected by years of fighting in the east. These projects were suspended as were oriented our activities to respond to the urgent needs stemming from the escalation of the war.
How we're helping
individual mental health consultations
patients evacuated by medical train