After eight years of low-intensity conflict in eastern Ukraine, Russian forces launched an all-out military assault on 24 February 2022, causing thousands of civilian casualties and extensive damage to energy and other key infrastructure, particularly in the country’s east, southeast and northeast. Many homes were destroyed, and public services, including healthcare, water and power supplies, were severely disrupted.

By the end of 2022, 6.5 million people were internally displaced within Ukraine, and about eight million had fled abroad.

Since 2014, MSF had been providing healthcare, including mental health services, to people affected by the 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. On 24 February, these regular programmes 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, the capital, Kyiv, and Dnipro for the delivery of drugs, medical materials and other essential items.

Our teams offered emergency and surgical care for patients during mass casualty and trauma events, particularly in Apostolove and Konstiantynivka. We also supported hospitals across the country with donations and training on mass casualty management, decontamination response in case of chemical or biological attack, mental health care, and treatment for sexual and gender-based violence.

In addition, we launched mobile clinics to respond to the needs of displaced people in Ukraine and in neighbouring countries such as Poland, Moldova, Hungary, Romania, Russia and Belarus, providing medical and mental healthcare at border crossings. While activities in other countries were eventually closed, those in Russia and Belarus continued throughout the year.

Supporting people in war-torn areas

In March, Mariupol was besieged and thousands of people, including MSF staff, were cut off from the world, with no access to water or food. We called for the safe passage of civilians and donated some of our remaining medical supplies to an emergency room in the first few days. As the electricity and phone networks ceased to function, we were unable to maintain our activities.

In April, we started running a specially designed medical train to evacuate patients from areas near the eastern frontlines to the west of the country. The first medical train referral transported nine patients injured, in or near Mariupol from hospitals in Zaporizhzhia to Lviv. Over 80 referrals were conducted, including the evacuation of nearly 80 children from an orphanage in Zaporizhzhia and over 200 neurological and psychiatric patients from Kharkiv. We also operated an ambulance referral system in the east and south of the country.

When Ukraine retook rural Kharkiv in September, and Kherson in November, MSF was the first international medical organisation to reach these areas. Near the frontlines and retaken areas, our mobile clinics ensured continuity of care, particularly for elderly people and people with disabilities who had been deprived of healthcare for months. Our teams worked with local volunteers to re-establish access to basic healthcare and psychological counselling, and helped rehabilitate health facilities, repairing damage and reconnecting them to water and electricity.

Responding to the health needs of war-wounded and displaced people

Throughout the year, we worked to ensure continuity of care for displaced people through mobile clinics in Dnipro, Zaporizhzhia and Vinnytsia, with a particular focus on mental health support and treatment for chronic diseases. In more stable areas, such as the western regions of Ivano-Frankivsk and Zakarpattia, and in the central region of Kirovohrad, in addition to running mobile clinics, our teams helped rehabilitate medical facilities and shelters, and restore their water and sanitation systems. They also organised the distribution of firewood and other alternative means of energy for displaced people living in rural areas.

Mental health was a major concern, especially among vulnerable groups such as children and elderly people, as well as healthcare workers. We provided mental health care in shelters for displaced people and villages, and in the aftermath of the battle for Hostomel in April, conducted individual and group counselling sessions for people traumatised by the fighting. MSF also assisted people who had been victims of torture or sexual and gender-based violence.

The war created an increased need for physiotherapy and rehabilitation for war-wounded people, many of whom have life-altering injuries. In coordination with the Ukrainian Interior Ministry and the Ministry of Health in Kyiv and Vinnytsia, MSF offered specialised physiotherapy, as well as psychological and psychiatric treatment, in two hospitals.

In 2022, Ukraine was an extremely dangerous place for civilians and healthcare workers. MSF staff witnessed directly the damage wreaked by bombs on the oncology hospital in Mykolaiv on 4 April, and the devastating consequences of attacks on multiple health facilities near the frontlines and retaken areas of Kherson, Kharkiv, Mykolaiv and Donetsk regions