Ukraine: When chronic turns critical, a silent health crisis
Limited access to healthcare is leading to late treatment and severe complications from chronic illness
Across Ukraine, war-related insecurity combined with extremely stressful living conditions is triggering a worrying trend of late consultations, with people developing complications that could have been prevented with timely care.
For months, many patients seeking routine consultations with Doctors Without Borders/Médecins Sans Frontières (MSF) teams have ended up requiring hospitalization care, particularly older people. Manageable chronic conditions worsen in silence until they become emergencies.
“People are living under constant stress, exposed to daily attacks, power cuts and prolonged uncertainty. This makes it difficult for them to recognize when a condition is serious. What should be manageable chronic conditions are becoming life-threatening.”
Robin Meldrum, MSF country director in Ukraine
Vira, a 64-year-old woman, from Mykolaiv city, is one such person. Having fled the city following Russian shelling, she now lives in Ostrivka.
“My apartment was destroyed, just like those of my daughter and son,” she says. “That’s why we came here. But insecurity persists. A farm has recently been hit. Many cows were killed. I was scared. I started to feel weak and experienced double vision. Luckily, as I couldn’t find any family doctor, I went straight to the hospital.”
After being examined by an MSF physician, Vira, who lives with diabetes, was rapidly referred to one of the hospital’s inpatient wards.
Vira, a 64-year-old woman, from Mykolaiv city, is one such person. Having fled the city following Russian shelling, she now lives in Ostrivka.
“My apartment was destroyed, just like those of my daughter and son,” she says. “That’s why we came here. But insecurity persists. A farm has recently been hit. Many cows were killed. I was scared. I started to feel weak and experienced double vision. Luckily, as I couldn’t find any family doctor, I went straight to the hospital.”
After being examined by an MSF physician, Vira, who lives with diabetes, was rapidly referred to one of the hospital’s inpatient wards.
Since the beginning of the year, MSF teams have seen more than 3,200 patients like Vira — people who receive a consultation in an MSF-supported hospital near the frontline then are directly referred to specialist hospital departments to stabilize their chronic disease. This represents over 75 per cent of all patients seen by MSF at triage stage. The most common diagnoses are hypertension, diabetes and ischemic heart disease.
Mobile clinic teams working in shelters for displaced people and remote communities near the frontline report the same trend. In some cases, people are in such severe conditions that ambulances must be called for critical care.
“People are living under constant stress, exposed to daily attacks, power cuts and prolonged uncertainty,” says Robin Meldrum, MSF country director in Ukraine. “This makes it difficult for them to recognize when a condition is serious. What should be manageable chronic conditions are becoming life-threatening.”
Among patients seen by MSF, many are older people presenting complications from disruption of chronic ambulatory care for medical conditions such as hypertension, diabetes and asthma. Such complications – some of them life-threatening – could have been prevented with continuous care. In Kherson city, for instance, the average age of patients admitted to the intensive care unit we support is 63.
“By the time they reach a doctor, they are often already in critical condition — and sometimes [it’s] too late,” says Meldrum.
“I live in this village. We constantly hear explosions. Drones and missiles fly over our village almost every night. Against the background of all this stress, my husband had a stroke in 2023. He has been lying down for 2 years and has not gotten up. It’s all nerves. And, of course, against the background of all this, I felt very bad,” says 70-year-old Nadiia about her life near the front line in southern Ukraine.
MSF mobile clinics come to Chornomorka two times a month. More than 2,000 people live here, including internally displaced persons. “I’m already used to the doctor who constantly comes to our village with mobile clinics of MSF. After all, there have been no doctors in our outpatient clinic since the beginning of 2022. Recently, I felt a little better, my condition has stabilised, and they have selected good medications for me. Finally, my blood pressure and pulse are normal,” says Nadiia.
MSF mobile clinics provide medical and psychological assistance, as well as provide patients with free medicines. We continue to support the most vulnerable categories of people in difficult life circumstances.
Bringing care closer
Access to healthcare remains a major challenge. Since the start of the full-scale invasion launched by Russian forces in February 2022, many local clinics have been damaged or destroyed, medical staff have left and pharmacies are often closed.
Reaching a physician can require travelling long distances — sometimes 20, 30 or even up to 100 kilometres — along damaged roads and under the constant threat of drone strikes. Public transport has mostly collapsed.
“Humanitarian workers are also operating under constant threat. We have had to suspend activities in dozens of locations near the frontline because of missile and drone attacks.”
Katsa Brenneman, MSF health promotion manager in Ukraine
Disruptions to healthcare are also affecting people with tuberculosis and other infectious diseases. Many must travel long distances to continue treatment, while reduced access to diagnostics means cases may go undetected — masking the true scale of needs.
To address these gaps, MSF supports hospitals near the frontline and runs mobile clinics in Donetsk, Dnipropetrovsk, Kherson, Mykolaiv and Zaporizhzhia regions.
“We try to reach settlements where access to medical care is most limited,” says Katsa Brenneman, MSF health promotion manager in Ukraine. “However, due to insecurity — including attacks on civilian infrastructure, railway stations and passenger buses — people are afraid to leave their homes. Humanitarian workers are also operating under constant threat. We have had to suspend activities in dozens of locations near the frontline because of missile and drone attacks.”
MSF teams continue to maintain some level of primary healthcare in areas too dangerous to access physically by conducting remote consultations. In these cases, a volunteer in the community is trained by MSF to take vital signs and assist with patient interaction, while consultations are carried out via video call with an MSF physician.
As the war continues, ensuring access to basic healthcare is not only about treating emergencies but preventing them. Without timely care, manageable chronic diseases will continue to escalate into life-threatening conditions, silently worsening the health of people already living through extreme hardship.
