BAD HOFGASTEIN, Austria — Strokes in children are now common in Ukraine as Russian air strikes rain down death, stress and trauma on civilians for a 947th day, Ukrainian Health Minister Viktor Liashko said on Wednesday.

“We see strokes in children aged 12 to 13,” Liashko said. “Before the war, such cases were really unique. But now, our health system has children with strokes.”

Inna Ivanenko, Director of Patients of Ukraine, the nation’s largest patient organization, added in an interview she knows of even younger stroke victims.

“Ten,” she said quietly.

The surge in pediatric strokes is just one facet of the escalating health crisis affecting Ukrainian civilians, the country’s health minister said. Years of war have left the entire population, not just children, at higher risk due to extreme stress and untreated post-traumatic stress disorder (PTSD).

“People have strokes 10 to 15 years earlier,” Liashko said. “Also heart attacks, 10 to 15 years earlier.”

The physical toll of prolonged stress is well-documented, particularly in conflict zones. Research links untreated PTSD and extreme stress to higher rates of strokes, heart attacks and an array of other cardiovascular diseases. These range from ischemic heart disease to high blood pressure and atrial fibrillation — a heartbeat irregularity that can cause blood clots and raise stroke risk.

This gets worse during wartime. The first-ever systematic review of links between armed conflict and cardiovascular disease, published in the British Medical Journal, found that war is associated with higher rates of heart problems, including strokes.

Further evidence published by the National Institutes of Health in 2023 found PTSD was associated with a 59% higher risk of incident stroke. The British Heart Foundation also found associations of PTSD with increased risk of stroke and other cardiovascular diseases. 

In wartime Ukraine, researchers in the southwestern city of Ivano Frankivsk found a 22% increase in stroke episodes in the population from 2022 to 2023. The study attributes the spike to “increased psychosocial stress … among Ukrainians affected by the Russo-Ukrainian War.” 

While the paper was not focused on children, its authors warn an entire generation of young Ukrainians will be affected in the long run. 

“Based on the situation in the country, we predict that stroke incidences will, unfortunately, continue to grow,” the researchers wrote. “Especially considering that war-induced PTSD targeting the young population typically manifests later in life, commonly in the form of cardiovascular problems, such as stroke.” 

For the next generation, many still hold out hope for a brighter future.

“Sixty thousand children were born in bomb shelters during these two and a half years,” he said. “They were born because their mothers wanted to save their lives. They wanted them to start their life in this world with hope of a better life.”

Targeted Russian strikes on health escalate

As the war enters its third year, the indirect consequences of Russia’s military actions are mounting. Direct attacks on civilians mesh with frontline casualties, stretching Ukraine’s medical resources to the breaking point. The relentless demand for emergency care compounds an already critical situation.

“All of this causes an influx of patients and our facilities have to respond,” Liashko said. “Where should our priorities be? Pediatric, or should it be care facilities for elderly people? Infectious diseases or cardiac diseases? Or do we have to redirect our resources to hospitals and clinics that help to cope with mental disorders?” 

The health minister further described the difficulties in responding to wartime emergencies, noting health services often need to evacuate people for complex surgeries and treat polytraumas inflicted by explosives and gunfire. 

“Sometimes it is not possible to start treatment with just one team. We need surgeons, traumatologists,” Liashko said. “It takes a lot of time and is very expensive. All of this is conducted under the circumstances of air alarms and interruption of energy supplies.” 

The number of surgeons in Ukraine has increased by nearly 25% since 2023, from 55,000 to 68,000 currently active across the country, as medical professionals adapt to the growing need amid an explosion of wartime injuries. Despite the surge, many regions still face dire shortages. 

In the eastern region of Zahporzhia – just 20 kilometers from the frontline and 70% occupied by Russian troops – complex surgeries are at their most challenging. Russia has destroyed hundreds of medical buildings across the region including the main hospital that served tens of thousands of people.

“We have a lack of specialists, [particularly] different kinds of surgeons, anesthesiologists and other kinds of specialists,” Zahporzhia mayor Ivan Fedorov said via video link from his office 30km from the frontline. “Our citizens … need care. We have no other choice.” 

The unrelenting assault on Ukraine has also inflicted a heavy toll on the mental health on all of society. An estimated 90% of Ukrainians – civilians, generals, doctors, and politicians – require mental health support. 

The number of patients requiring psychological or psychiatric assistance nearly doubled in the first year of the war, with over 375,000 Ukrainians now receiving active care. The Ministry of Health estimates 3.5 million Ukrainians will develop a mental disorder due to the war – 800,000 of those being of moderate to severe. 

“Every day, from five to seven hours per day, we hear air alarms. Enemy shelling doesn’t stop for any silence a day,” Fedorov said. “The greatrest problem is mental health. All our citizens, also doctors, fear for their futures. Nobody knows if they sleep, they can wake up tomorrow.” 

With psychiatric facilities overwhelmed nationwide, Ukrainians are learning to address mental health problems on their own. Nearly 100,000 non-specialists have completed online training to manage mental health issues and help others cope with stress, fear and anxiety, according to government figures. 

“We don’t only have physical injuries – we have mental health,” Liashko said. “We can’t talk about this later. If we wait for later, we will have a big problem.” 

Cost in lives and dollars 

Another consequence of attacks on the health sector is delayed diagnosis of rare diseases and chronic conditions easily detectable in peacetime. These delays come with a high price — in lives and dollars.

“As a rule, these are simple treatments, but only for the first stage,” said Ivanenko, the patient organization leader. “The huge issue for us is the expensive medications of the second, third, fourth stage of treatment for cancer, for rare diseases. They are not available in the country due to budget limitations.”

Ukraine’s health system covers 60% of medications and all treatment for rare and late-stage diseases but doesn’t routinely buy expensive drugs for advanced stages of illnesses like cancer or rare conditions. This gap often leads to reliance on foreign donors for individual patients’ specialized care.

“Through international partners and donors, we can access these therapies through donations. We can help such people in a manual way, but it’s not systematic” Ivanenko explained. That’s why it is very important to invest in the Ukrainian healthcare system to allow systematic treatment access for these patients.” 

Ukraine’s health system has endured 2,013 direct attacks on personnel, hospitals, ambulances and primary care facilities since the full-scale invasion began, causing $7 billion in damages, according to the WHO Surveillance System for Attacks on Health Care.

In March 2024, Russia’s tactics evolved. Targeting Ukraine’s power grid became a priority, threatening the health system’s stability as it faces a third wartime winter. Attacks on telecom infrastructure further cripple hospitals’ communication and civilians’ access to 103, the emergency number for medical help.

“We have a winter coming, and that puts additional pressure,” said Dr Jarno Habicht, director of the World Health Organization’s (WHO) Ukraine office. “That pressure comes not only because we have below-zero temperatures, but because the Russian Federation continuously attacks energy infrastructure.”

A July report by WHO and Ukraine’s Health Ministry found significant power outages in 13% of the country’s hospitals. The assessment, shared with Health Policy Watch, revealed that a third of facilities with generators couldn’t use them, and 16% of all generators were offline.

Even functioning generators serve only as temporary solutions.

“Reserve generators can run for four or eight hours,” said Fedorov. “We need to be ready to work without electricity for three, four days. Nobody knows yet. That’s why we need to be ready.”

Russia targets power grid

The United Nations Office for the Coordination of Humanitarian Affairs warned last week that ongoing attacks on Ukraine’s power grid could leave citizens without electricity for up to 18 hours a day this winter. The grid is already 50% destroyed, with only 40% of its prewar power generation capacity remaining.

“This will have huge implications for health care, but also everybody who is at home,” Habicht said. “Can you imagine that you are living 18 hours per day without electricity? Keep that in your mind when we go through the winter.”

For now, the onslaught has failed to cripple Ukraine’s health system, with WHO reporting that more than 90% of medical facilities are still functioning. Health workers — from doctors, to nurses, to front-line clinic operators — work 24- to 36-hour shifts to keep the lights on. Some spend time living in the hospital wards. 

Over 200 health workers have been killed.

“We have lost too many health care workers because of the attacks, too many ambulances,” said Habicht. “But human lives are more important. We can buy new ambulances. We are losing health care workers because the war goes on.”

As the death toll on Ukraine’s health workforce mounts, several hundred more remain in Russian captivity. Some have been there for over two years.

“Ukrainian health care staff who are kept as prisoners of war contrary to the Geneva Convention must be freed,” Liashko said. “Russia does not allow them to be assessed by anybody, to check under which circumstances they are kept, or if they receive medical services.”

“Please exert pressure so Ukrainian health workers are freed as soon as possible and come back to Ukraine.” 

Image Credits: UNICEF, Matteo Minasi/ UNOCHA, Lily Hyde/ The New Humanitarian.