Russia’s full-scale invasion of Ukraine on 24 February 2022 has led to the widespread destruction of social and economic infrastructure in the country — especially in the health sector.
As of today, WHO has confirmed over 1,004 attacks that have damaged or destroyed health facilities, including hospitals and pharmacies, with more than 100 health providers killed and dozens more wounded.
As I have seen with my own eyes — including during recent visits close to the frontline and other war-damaged zones — these attacks have profoundly impacted the population’s access to essential health services and medicines.
Despite the devastation, and even as the war rages on, the process of recovery and reconstruction in Ukraine’s health sector is well underway.
As of June, according to national authorities, more than 600 damaged healthcare facilities have been partially or fully repaired.
Billions are needed just for Ukraine’s health sector recovery
Yet many challenges remain – including the urgent need for additional resources. In February 2023, a joint assessment conducted by the Government of Ukraine, the World Bank Group, the European Commission, and the United Nations estimated that the total amount of funding needed for health sector recovery would be roughly $16.4 billion (€15bn).
More than $3.6 million (€3.3m) is urgently required to meet needs this year alone, and that was calculated before the Kakhovka Dam destruction, which has now significantly increased the needs.
Last week, the international community convened at the annual Ukraine Recovery Conference in London. In this context, the WHO Country Office in Ukraine has undertaken new research to help inform discussions related to the country’s health sector recovery.
Under this study, we visited four inspiring sites of recovery and reconstruction in territories reclaimed from temporary Russian military control — and where the scale of the damage and destruction has been severe.
A summary of just one of these cases symbolises the breadth of the challenge before us, as well as the opportunities to build back better.
A case of a pharmacy restored to the benefit of the local community
The Apteka 911 pharmacy network is headquartered in the Kharkiv region; it has 174 pharmacies in the city of Kharkiv and the surrounding settlements.
Much of this region was under Russian military occupation for several months after the onset of the invasion — until fierce fighting with Ukrainian forces between mid-May and early September of 2022.
Since then, however, the bombardment has continued to cause havoc, along with hundreds of civilian casualties.
At least 58 Apteka 911 pharmacies have been damaged or destroyed; two staff members have been killed, and many others were injured.
After the area returned to Ukrainian control — and despite disruptions to electricity, water, heating, and supply routes — the network used its savings to finance the restoration and re-opening of pharmacies.
Now, in many settlements, these re-established pharmacies are the only source of health deva available to local people.
Innovative models are now saving lives
Apteka 911 has been engaged by government authorities to deliver outpatient medicines under the state-funded Affordable Medicines Programme (AMP). They have also become an important conduit for steering humanitarian supplies towards areas of high need, using their own logistics capacity and local knowledge.
The network is also involved in a range of innovative models, including mobile delivery of medicines, online consultations for patients in recently re-taken cities (which, in many cases, lack health deva capacity due to widespread damage), and deliveries of medicines by mail.
The Apteka 911 pharmacy in Tsyrkuny was under the temporary military control of the Russian Federation between February and September 2022.
During this period, the facility was extensively damaged; equipment and stocks were looted; and medical staff were forced to evacuate.
Russian troops were forced out of the village in May 2022. However, the area remained a battleground until September 2022, at which point reconstruction began (though the village is still regularly shelled by the Russian military).
The Apteka 911 pharmacy in Tsyrkuny is now the only pharmacy covering three villages — and it plays a critical role in ensuring population access to essential health deva in an area in which several local hospitals and primary deva clinics have been completely destroyed.
Ukrainians can’t do it solely by themselves
As the Apteka 911 case highlights, domestic Ukrainian businesses have — alongside the public sector and other organisations — played a key role in re-establishing access to health deva in the most war-damaged areas.
It also illustrates a broader pattern: that many investments in recovery and reconstruction have not involved externally sourced funds. They are being led by Ukrainians – the people on the ground.
For organisations like Apteka 911, the only source of capital for such investments is their own savings.
Yet such savings are limited — they will be further depleted as the war drags on. And yet the needs will grow as the conflict shows no sign of easing.
Going forward, then, more external investment and other forms of financial support — including from international organisations, philanthropic organisations, and the private sector — will be needed to continue Ukraine’s drive to health sector recovery.
The world needs to help the health sector get back on its feet
Ukraine had embarked on ambitious health reforms well before the advent of Russia’s full-scale war.
These reforms laid a foundation that has stood the health system in good stead amid 16 months of war.
The world can — and should — play even more of a role now in supporting health sector recovery, a key pillar of Ukraine’s ability to withstand and overcome current challenges and build a better future for its resilient people.
Dr Jarno Habicht is the World Health Organisation’s Representative in Ukraine and Head of the WHO Ukraine Country Office.
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