1. Assessment of the needs in healthcare

Currently, there is not much known about the condition of Ukrainian healthcare. A medical reform, which started in 2016, impacted the surveillance tools for many diseases. The transition to the new tools for the biggest part of the diseases has not happened yet. Additionally, the COVID-19 pandemic dragged away the focus from the completion of the reform and disrupted the proper functioning of multiple levels of healthcare. Therefore, it is difficult to assess the dynamics of the pre-invasion morbidity structure and what has changed afterward. Attempts to evaluate the current situation are being performed, but they are not as numerous as they could be in a peaceful time. Despite the ongoing war leading to the prioritization of more urgent needs, planning for the further development of the system should remain in focus.

2. Healthcare services coverage

As of 24th July 2022, more than 900 healthcare facilities in Ukraine were damaged, and 127 hospitals were destroyed. As of April 2023, large territories of Ukraine were de-occupied. But, nevertheless, continuous shelling and rocket strikes continue to damage Ukrainian infrastructure, including healthcare facilities. Inner migration of the population and increased demand for medical care of wounded in combat militaries and civilians cause a strong strain on the preserved part of the healthcare system. In rural areas, especially in regions that have spent some time under Russian occupation, there is a severe lack of healthcare personnel and medical goods supply. Multiple non-governmental organizations with their humanitarian missions make a huge difference. However, a systematic approach and careful planning are needed to address the current situation.

3. Cancer care

Pre-invasion cancer epidemiology in Ukraine was quite comparable to the world’s data. Despite the comparison with the data from European Region revealing the need for improvement in cancer care (Semenov et al.), implementation of nationwide programs would be likely to improve the situation. However, the priority of cancer care was pushed back during the COVID-19 pandemic, as well as during the war. It is natural to expect a surge of cancer cases, especially in advanced stages, given that the information about these cases will be accumulated.

4. Mental health

Mental health problems were under-recognized in Ukraine before the full-scale invasion. The comprehensive epidemiological data about mental health problems in the Ukrainian population was quite scarce. On the one hand, the stigma of mental health and the cultural perception that mental health issues are not serious problems (unlike somatic pathologies) could be an important cause of neglecting mental health by people. On the other hand, treatment of mental health conditions is usually prolonged and costly (like antidepressants, which are not reimbursed in Ukraine, or psychotherapy). It is quite natural to expect a drastic surge in the number of people who require psychological support during the war.

It is expected that around 15 million Ukrainians will require psychological support, among them around 3-4 million will require pharmacological treatment due to mental health problems. Importantly, mental disorders often aggravate pre-existing pathology or could be a risk factor for the development of new diseases, which for sure will influence the population’s health.

5. Rehabilitation

Last but not least, are the consequences of the direct influence of combat and artillery/rocket strikes. It is expected that the number of people who need rehabilitation and prosthetics will increase in the nearest time because of the war. The official information about the number of wounded and killed in combat (both military and civilians) is scarce, and contradictory, and usually comes with a delay. However, given the intensity of combat, the area involved, and the numbers that appear in the media, it can be assumed that the genuine number of wounded people is huge.

It is very likely that Ukrainian rehabilitation centers will face a need for restructuring and an increase in their capabilities. A lot of Ukrainian soldiers and civilians receive medical help in other countries and it makes a huge difference. But the increase of resources in Ukrainian own rehabilitation centers might become a pressing question in Ukrainian healthcare.

The presented list is not exhaustive. There are other aspects of Ukrainian healthcare that require attention, such as the shift from emergency care to planned healthcare programs, dealing with an energy shortage due to Russian attacks on the Ukrainian energy systems, training of medical staff to face the challenges related to the war, and many others.

The text was prepared by Viktor V. Semenov and Lilia V. Kriachkova in cooperation with the Centre for Innovation in Medicine.

Dnipro region is the area that is located near the frontline and Dnipro itself has become an eastern fortress of Ukraine. Despite no active military actions taking place in the region, its southern parts suffer from constant shelling from the occupied part of Ukraine – from the other side of the river Dnipro. The additional danger always in the minds of locals is Zaporizhia Nuclear Power Plant, which is currently occupied by Russian troops. Only mentioned problems would be enough to paralyze an average Ukrainian in spring 2022. But not in spring 2023.

Science keeps developing in Ukraine, despite being usually associated with a quiet university environment. And problems that were bothering scientists in peaceful times are being considered again. One of the latest studies, conducted by a team composed of scientists from Dnipro State Medical University (including myself) and the Cancer Registry of Dnipropetrovsk region investigates the epidemiology of gastric cancer in the region.

Significant efforts have been made to decrease the prevalence of risk factors of gastric cancer. But even despite a gradual decrease in incidence and prevalence, gastric cancer remains one of the top killers in oncology worldwide. Especially for the male population. The study I coordinated (Semenov et. al) represents an extended version of the routine cancer surveillance performed by the National Cancer Registry of Ukraine. The study presents the data of isolated gastric cancer cases collected in the Dnipro region from 2009 to 2019.

Investigation of isolated gastric cancer is important and in this study, we attempted to eliminate the influence of coexisting cancers that could impact the prognosis of patients. Standardized incidence and prevalence allow comparing the results of the study to European and World data. On top of that, we provide the anonymized research data, making possible additional insights from other researchers.

The results of the study show that the epidemiological situation with gastric cancer (incidence, prevalence, mortality rate, and survival of patients) in Ukraine is comparable to the situation in the World. However, the incidence and mortality of gastric cancer in Ukraine are around 1.5 times higher than in the European Region. Generally, gastric cancer in Ukraine follows the same pattern as in other countries – males and older persons suffer more often and have a greater risk of death. Sub-analysis by the area of residence has revealed some differences between the parts of the Dnipro region, but the underlying basis for such differences is to be investigated.

The study demonstrates trends in gastric cancer epidemiology in the Dnipro region over 11 years of observation. The results of the study indicate the need for the development and implementation of a nationwide program targeted at the systematic prevention of gastric cancer in Ukraine. The experience from the neighboring countries might be of use during the development and implementation of the program.

It seems very optimistic that in this anxious time, such very fine things as science keep existing. Thanks to the bravery of Ukrainian soldiers supported by the Allies, the whole of Europe, together with a large part of Ukraine can lead a relatively peaceful life. But let’s not forget what the price of our quiet lives is…

The link to the full-text version of the study:
Viktor V. Semenov, Lilia V. Kriachkova, Natalia Shestakova, Viktor Khanov, Halyna Donchenko, Olga Balashova, Yulia I. Viklienko. Gastric cancer epidemiology from 2009 to 2019 in Dnipro Region, Ukraine. Cancer Epidemiology, 2023, Volume 82, 102315, https://doi.org/10.1016/j.canep.2022.102315.

After a few days of panic, our city turned into a deserted place for the next few weeks. I did not know how to behave in case of an air raid, so I preferred not to stay outside. There were also messages about Russian spies and looters in the city. I remember that I was scared to go out of the house and I wished I had a gun in those days. It was a period of great uncertainty and insecurity; everybody was literally stuck to their cellphones in search of news from the battlefield. It was also a time of lack of products in shops, lack of gas at gas stations and drugs in pharmacies.

However, not everybody left the city. Those who decided to stay rushed to the volunteer centers and to the points of recruiting to army. Everywhere in the city there were organizations who took care of refugees, collected ammunition/meals/supplies for militaries, prepared the city for defense, and so on. This was happening throughout the whole country and, from this point of view, it was amazing how our nation united against the external threat.

Curfew, introduced on the first day of the war, taught us to stay at home in the evening and to avoid extra lightning when it is dark. I became anxious and suspicious of sudden sounds. I am constantly worried about my friends on the frontline. I am tired of frequent “air raids” announced by the sirens. Although I understand that hearing a siren is a good sign – there is a siren, while in many Ukrainian towns there isn’t any – it is difficult to get used to it. And when I am sitting in the shelter and the walls around me are shaking, I couldn’t say better than Ukrainian comic Michael Schur. Paraphrasing his words, during the bombing there are few thoughts in my head: “What am I doing here? Will I be fine?”, but after the bombing, bravery appears out of nowhere: “Ha-ha, once again you’ve missed, you should have eaten better” (a common saying in Eastern Europe). But this is only till the next air raid, an endless emotional roller coaster… Of course, I don’t remember when I normally slept the last time. And I find it difficult to maintain my productivity and pay attention to education and self-improvement in such conditions.

As well as my daily routine, my working life has also changed. Public transport issues make it more difficult to commute to my hospital, and for the same reason not all the patients are able to reach us. A lot of them were lost for follow-up due to being directly involved in the war or because of migration. Those who did not flee are usually not too attentive to their own health. So, while we see fewer patients on the planned follow-ups, the number of acute or decompensated diseases is increasing. People are hesitant to go to the hospitals. Often, people from our region who need in-patient treatment decide to postpone it because they are afraid to leave their families even for a short period of time. Moreover, after each received signal about the anticipated attack from the air, we ask our patients to go to a shelter. Of course, they quickly become anxious and unsatisfied with their stay in the hospital. We also have a lot of inner migrants here in Dnipro, many people from the places where severe battles took place, like Mariupol. And it is difficult sometimes to remain a professional and do your job instead of asking them about their escape.

As a closing note, I would like to tell the words of gratefulness to our Army, Government and our friends from different countries that make it possible to maintain relatively normal lives for a large part of our country. I am inspired by the resilience of our people, and their bravery inspires me to do my job as a clinician and as a researcher, again and again. There is still a lot to do, but I am sure that with the help of our partners we will overcome existing challenges, Russian soldiers will be expelled from our territory and peace will return to Ukraine.