Ukraine’s Health System Braces for Toughest Winter as Russia Targets Critical Infrastructure
Emergency Response 13/09/2024 •
Attacks on energy and water also threaten health services as Ukraine approaches its third winter in wartime.

As Russian missiles rain down on hospitals and critical energy infrastructure keeping their lights on, Ukraine’s health system faces what could be its most challenging season yet in its third winter of full-scale war, the World Health Organization’s top European official warned Thursday.

“This will likely be the toughest winter of the three that Ukraine has faced since the war started,” Dr Hans Kluge, WHO’s regional director for Europe, told Health Policy Watch in an interview following a press briefing from Kyiv. “Many partners are scaling up assistance to ensure uninterrupted heating, water, electricity – but who knows what tomorrow will bring.”

Since the war began, nearly 2,000 Russian attacks on Ukrainian health facilities, workers and vehicles have been confirmed, resulting in 171 medical staff and patient deaths and 529 injuries. In the last six weeks alone, WHO verified over 30 attacks on 22 facilities across Ukraine.

On Thursday, shelling killed three ICRC staff members at a planned aid distribution site near the frontline in eastern Donetsk.

Power grid attacks cripple healthcare

Large Russian attacks on frontline Ukrainian regions over the past two weeks have targeted energy grids as well as cities.

Russia’s failure to overrun Ukraine militarily has led to a new strategy: making the country unlivable by targeting schools, hospitals, railways and energy systems. The assault on Ukraine’s energy grid directly affects the health system’s ability to provide care. 

The largest missile barrage since the war began occurred just two weeks ago, damaging key energy infrastructure and leaving nearly 250,000 people without power in the Sumy region alone.

“All the attacks on civilian energy infrastructure have direct impacts on hospitals,” Kluge said, speaking at the conclusion of a weeklong WHO tour of the country’s health services. “If you don’t have fridges to safely store blood, for example, then you don’t have blood transfusions – that has an immediate and drastic impact.”

Vaccine storage is another potentially deadly knock-on effect of power outages. If vaccines cannot be refrigerated, routine vaccinations cannot be conducted, putting patients at risk of easily preventable diseases.

 “If this continues, we may well see an increase in vaccine-preventable diseases,” Kluge said. “This, of course, is very regretful because they can be prevented – that’s the whole point of vaccines.”

Kluge (centre) with Jarno Habicht, WHO Ukraine lead (right)

Despite the attacks, Ukraine’s health system has shown resilience, with 93% of facilities nationwide still operational. WHO and Ukraine’s Health Ministry have installed modular clinics near frontline villages where health facilities were destroyed, with 40 such clinics planned across six regions by year-end.

“We had outreach teams who were going to the other side of minefields, ensuring that civilians get their health care services and were equipped with medicines,” said Jarno Habicht, WHO’s representative in Ukraine, who accompanied Kluge on the tour.

 “Every war disrupts, and it disrupts also the health services that we have in Ukraine,” he added. “Ukraine’s system works, but we also see areas where the services are very difficult to access.” 

Blackouts by Design

Russia has destroyed about 50% of Ukraine’s energy infrastructure and 60% of its power generation capacity since the start of its invasion in 2022. Cornerstones of Ukraine’s power grid – including the Zaporizhzhya nuclear power plant, the Kakhovka hydroelectric dam, and the Dnipro hydroelectric power station – have been destroyed or forced offline.

Ukrainians across the country face at least six hours a day without electricity. Even in the capital, some days offer only 10 hours of power. DTEK, Ukraine’s largest private power provider, is operating at 10% of its pre-war generation capacity. The current national power deficit is approximately 35%. DTEK estimates that come winter, blackouts could reach 20 hours a day. 

The consequences of mounting blackouts for a health system already struggling with current outage levels could be severe. Some regions – like Kherson, Mykolaiv, Sumy and particularly Kharkiv – will likely be more impacted due to the extensive destruction of energy infrastructure.

A joint assessment by the WHO and Ukrainian Ministry of Health in July shared with Health Policy Watch found 13% of hospitals were already experiencing significant power outages. Of the facilities with generators available, 33% were not installed or operational. Overall, 16% of all available generators were offline.

Electrical blackouts have also created a new problem: secure and reliable access to clean water. The governors of Dnipro and Poltava sounded the alarm to the WHO delegation led by Kluge this week. 

“Water systems could be compromised – as water distribution sites depend on uninterrupted power supplies,” Kluge said. “This could lead to increased water and foodborne diseases.”

Accessing and affording primary healthcare

Modular primary healthcare clinic, opened 9 September in the Odessa region, offers one response to shortages.

The war has also dealt a significant blow to the finances of Ukrainians, particularly those forcibly displaced – with knock-on effects on families’ ability to access the health care services they need. 

“One in four households is living below the poverty line,” said Habicht, who also accompanied the delegation. “With less means available and rising prices for medicines and other goods, health needs are increasing while access is becoming more challenging.”

Recent WHO assessments reveal that over 80% of households report problems obtaining needed medicines, with 6% unable to access essential medications. One-third of respondents cited insufficient funds to purchase medicines. Some 8% of households lack access to primary healthcare facilities. 

In health clinics, staffing shortages are another critical issue. “Some people are leaving,” Kluge said, noting the snowball effect of COVID-19 and the war on health workers. “In one instance, a hospital went from 800 staff to only 120. Fatigue, burnout, and anxiety are very prominent among the health workforce.”

Mental health problems escalating

Ukrainian children take refuge in a shelter – frontline children have spent the equivalent of 4-7 months underground.

Mental health problems are escalating, with an estimated 10 million people at risk. Ukraine has responded with a national program, training nearly 100,000 non-specialists online to provide mental health support.

A recent UNICEF survey estimates that children in Ukraine’s front-line areas have spent 3,000 to 5,000 hours — about four to seven months — underground since the war began. Half of children ages 13-15 have trouble sleeping, and three-quarters of those ages 14-34 reported needing emotional or psychological support.

“What struck me very much were the children who lost a leg or an arm. How, if they got modern prosthetics, they bounce back,” Kluge said. “They want to be a champion in the Paralympics – their dreams don’t stop.”

Image Credits: @hans_kluge/Foreign Policy, @pavlentij, X/@hans_kluge, @WHOUkraine, UNICEF.

Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.