Three years after Russian forces invaded Ukraine, dramatically escalating an international armed conflict that began in 2014, people continue to bear the burden of the war’s devastation in lost lives, lost limbs, and lost homes.
Over the years, Doctors Without Borders/Médecins Sans Frontières (MSF) has seen an increase in patients with war-related trauma in need of early rehabilitation, namely post-amputation physiotherapy, as well as patients requiring treatment for post-traumatic stress disorder (PTSD).
“The ferocity of this war has not diminished, and the medical humanitarian needs have only grown more complex,” said Thomas Marchese, MSF head of programs in Ukraine. “Even if the war were to end tomorrow, hundreds of thousands of people would require years of long-term physiotherapy, or counseling for PTSD. Ensuring this care requires an ongoing humanitarian commitment.”
In areas close to the front lines, daily shelling means that some of the most vulnerable, including older people and people with chronic conditions, have extremely limited access to medical care. Meanwhile, the strain on Ukraine’s medical services has been exacerbated by frequent attacks on hospitals, ambulances, and medical structures.
Ukrainians are in need of physical and mental health care
MSF runs an early rehabilitation project with centers in Cherkasy and Odesa, where people receive early post-operative physiotherapy, mental health support, and nursing care following violent incidents. In this project, MSF treated 755 patients in 2023 and 2024. From one year to the next, there was a 10 percent increase in the number of patients requiring post-operative care for leg amputations.
In 2024, half of all patients in the project were diagnosed with either PTSD or depression. The need for mental health support in Ukraine is significant. In addition to the centers in Cherkasy and Odesa, MSF has established a project focused on PTSD in Vinnytsia.
Constant state of emergency takes heavy toll on health care system
Today, Ukraine’s health care system faces immense pressure, balancing emergency responses with the ongoing needs of patients affected by the war.
For three years, drone and missile attacks have been a daily occurrence, in some cases striking cities more than 600 miles from the front line. Medical facilities and systems have been forced to adapt to treating patients in bunkers or basements, as well as to frequent power cuts from attacks on energy infrastructure.
In response to this, MSF operates ambulances that transfer patients from overburdened hospitals near the front line to medical facilities in central and western Ukraine that are better equipped to take care of patients. Over the past three years, MSF ambulances have transferred more than 25,000 patients, more than half of whom had injuries caused by violent trauma.
Relocation is not an option for people with chronic conditions
In 2024, MSF mobile clinic and ambulance teams working near the front lines saw a significant increase in referrals for patients with chronic diseases such as cardiovascular issues, diabetes, and cancer. In 2023, these cases accounted for 24 percent of all referrals, rising to 33 percent in 2024.
However, regular shelling and strikes mean that the access of MSF’s teams is not guaranteed. Many of those living with chronic conditions are older and less mobile. In some areas people have begun living in their basements or in bunkers due to the intense shelling.
“For some of the most vulnerable people, relocating isn’t an option,” Marchese said. “Not everyone is able to leave their homes and start their life again, but the continued fighting means that these people are frequently cut off from medical care, just as MSF medical teams are sometimes unable to travel to certain areas due to ongoing shelling.”
Ukraine’s health care system needs ongoing support
As the war in Ukraine enters its fourth year, MSF’s teams witness how the medical humanitarian crisis deepens every day. The strength of the Ukrainian health system in the face of extreme violence is clear, but the need for sustained medical care and mental health support is greater than ever.
Even if the war were to end tomorrow, the long-term effects on people —physical and psychological— will linger for years to come. Ukraine’s infrastructure has also sustained staggering damage, with hospitals coming under direct attack. Hundreds of thousands of people will require ongoing care, rehabilitation, and therapy for trauma long after the last bomb falls.
MSF continues to work in Ukraine, close to the front lines and elsewhere in the country, but more support is required.
