Ukraine's health system limps on into a third year of war, but its focus is changing, says WHO

Two years  since the conflict started in Ukraine, and the toll on the country's infrastructure has been astronomical - an estimated $155 billion, according to rough estimates from Kyiv. But one of the country's most under-pressure industries appears to have coped seemingly well considering the massive demands on it - Ukraine's health sector. 

"It's amazing that the Ukrainian health system is still standing," WHO Regional Director for Europe Hans Kluge tells CGTN Europe. "It has been very, very resilient and what I call agile to adapt almost on a daily basis; be it using solar panels and generators so that hospitals, maternity wards still can function despite the attacks on civil energy infrastructure, be it by mobile mental health teams, or digital technologies to provide medical service to the frontline." 

However, the top WHO official stresses that this resilience is "very fragile". Indeed, direct damages to Ukraine's healthcare infrastructure -  Kluge says there are about two attacks on hospitals and medical sites everyday - now total around $3.1 billion, according to the Kyiv School of Economics. 

Its staying power in the face of such duress, according to the WHO official, has been down to strong international support from a variety of countries, "so it is very important that this support continues," he stresses. "What is needed is a very strong budget support from the West, from the global South, from other countries to continue at least the salaries and the basic medicines for the health system."

Focus on first aid shifts to chronic disease

Yet the funds that already exist are not necessarily being focused where outside observers might expect. 

In terms of those most at risk, and where the healthcare services are now honing their energies, Kluge says there's been a notable change. "At the beginning [of the conflict], the focus was on immediate response, the life-saving interventions, trauma kits, surgery, which is all still necessary," he says.

"But there is now a shift under the guidance of the Ministry of Health and the WHO towards what we call chronic diseases cardiovascular, diabetes, cancer, lung diseases."

He says that eight out of ten Ukrainians who die are now losing their lives to such chronic diseases: "This has huge implications also on the health system, the procurement and supply chain. So now there's a bit of a shift from acute response to reform and recovery through a very strong primary health care." 

Another key issue for Ukraine's health service, Kluge says, is gender based violence. "A lot of girls, women are prone to violence at home or due to the conflict situation," explains Kluge.

Mental health a 'major challenge' 

This is closely tied to what he calls the "major challenge" in tackling a decline in mental health throughout the country amid the conflict's impact.  

Last year, Ukraine's Ministry of Health said the conflict had led to an estimated 15 million Ukrainians needing psychological support. Among children alone, Unicef reports there are about 25,000 minors with serious mental health needs in Ukraine, a country where mental health intervention is still widely mistrusted. 

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In a bid to take on such a massive task, Kluge, alongside Ukraine's First Lady Olena Zelenska, recently launched a nationwide mental health program under the motto 'Every person should see a psychologist', "because ultimately everyone is prone to depression, anxiety, post-traumatic stress syndrome," he says. 

Praising Ukraine's innovation in treating mental health issues, promoting digital tools like self-training to manage anxiety and insomnia, Kluge remains positive about the country's quick response to such a massive healthcare crisis. 

Fighting back

"It's amazing. When I go to Ukraine, I make it a point to go to the frontline to encourage the doctors, the nurses, some of them who have not been home for two years," he says.

But despite its sterling adaptations, the country's health system is still creaking under the weight of conflict, and other conflicts are now foreshadowing the effects of the fighting in Ukraine. 

"Indeed, there are about 14 what we call Grade Three emergencies within the European region," says Kluge. "There is the Ukraine-Russia war, but there's also Israel-Gaza, there are other emergencies as well. There are challenges for everyone."

And he says that sadly, such challenges aren't going away. "We are living in a perma-crisis. We're going to have this crisis globally, unfortunately, most likely for a while." 

His answer to such constant turmoil is a dual track attack: one track to tackle the emergency and prepare better for other ones, on a second parallel track, to provide daily essential health kit. The best way to combine those two tracks, he says "is through a strong, community based primary health care system to bring the care close to where the people live and thrive."

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