Maintaining essential healthcare services in a war-hit Ukraine
How BACKUP Health supports two NGOs that stand up for the most vulnerable
Ukrainian health services have been under continuous attack for over a year. BACKUP Health is lending vital assistance to two Ukrainian organisations that deliver healthcare to frontline areas and provide shelter for the most vulnerable.
When their country was attacked in February 2022, the Ukrainian NGO Alliance for Public Health (APH) sprang into action. Before the war, APH’s core mission had been health service delivery to people living with HIV, TB and Hepatitis C across Ukraine. In this new situation they decided that their support was now most needed near the war’s front lines. ‘All the usual ways to transport essential goods from Kyiv to the eastern and southern Ukraine had broken down. People in these areas were cut off. We decided to use our own trucks to take food, warm clothes, and medicines to them,’ says Pavlo Smyrnov, Deputy Executive Director of APH.
Near the frontlines, Ukraine’s healthcare system has broken down
APH conducted their first frontline mission in December 2022. ‘When we went there, the first thing I learned was that people had not seen a doctor for more than eight months,” says Smyrnov. ‘During the [Russian] occupation there were no doctors. In the small clinics all the equipment has disappeared. There are no more pharmacies, no more doctors, no more hospitals – everything has either been destroyed or stolen by Russian troops.’ he adds. The people they found appreciated the food, the clothes and the medicines. However, what they needed the most was medical care:
In these areas, the healthcare system has completely collapsed. People need medicines but they also need doctors to diagnose their conditions and to advise them on how to take the medicines.Pavlo Smyrnov, Deputy Executive Director of APH
The mobile clinic teams encountered a huge spectrum of medical problems, he says. ‘Most of the patients are older people, so they suffer from high blood pressure, diabetes, chronic diseases – and most of them had run out of medications,’ he says. ‘People were self-medicating with whatever they had access to’, he added. ‘There were some very difficult cases where people couldn’t move, so we had to go to their homes. It is very sad to see how these people are trying to survive under the current circumstances.’
BACKUP Health supports efforts to maintain basic health services
The Federal Ministry for Economic Cooperation and Development (BMZ) has commissioned BACKUP Health to support health systems strengthening and service delivery to people living with HIV and TB in selected partner countries. Given the precarious situation of the health system in the war-torn country, BMZ decided to include Ukraine amongst the countries eligible for BACKUP Health support. The BACKUP Health team quickly identified the NGOs APH and 100% Life as suitable partners in Ukraine.
BACKUP usually focuses on strengthening health systems. Yet, in a war situation, essential services are at stake and we must respond flexibly. Care for vulnerable groups must always be an important part of the work. We support these two organisations because they are the Global Fund’ main partners in Ukraine, committed to vulnerable groups and able to broaden the scope of their work in times of war.Dr. Gesa Walcher, Team Lead, BACKUP Health
Doctors and drivers on a mission
Since January 2023, BACKUP has supported APH in running four mobile clinics which, in pairs, go on weekly 3-day missions deep into the war-affected areas to provide essential health services to at least 120 people.
It takes several hours to drive there, and then you have a queue of 60 people waiting. We spend 10 to 15 minutes per person and try to provide them with quick medication. Some people are traumatised and want to just talk to a doctor.Pavlo Smyrnov, Deputy Executive Director of APH
Ania Korobchuk, APH’s project manager for the mobile clinics, remembers that, when they first started, the biggest challenge was finding doctors and drivers who would agree to go to these dangerous parts of the country.
‘We asked our existent pool of drivers. Many of them didn’t want to go there. But eventually some came forward,’ she says. Finding doctors was even harder. Many of them had already been drafted into the forces, others had left the country and those who remained were needed in Kiev’s hospitals. Ania reached out to the professors of the public health department at her university, and this helped. ‘We’ve got a few doctors and nurses who are working with us right now. These people are passionate about what they are doing,’ she says.
Delivering healthcare between landmines and artillery fire
Every week, the APH team spends two days preparing for a mission and three days doing it. ‘We leave very early to reach the villages and must leave again before dark. Once night falls, the risks multiply,” says Smyrnov. ‘There’s the artillery fire. You don’t want to be a target. Our vans are big and easy to spot.’ Then there are the landmines placed by the Russians. ‘You always have to make sure you stay on the asphalt road – you simply can’t veer off.’
Between December 2022 and early March 2023, APH conducted 16 3-day trips to the region, providing consultations and treatment to over 1000 people. In addition, they used these short trips to deliver 30 tonnes of warm clothing and hygiene products as well as first aid home kits with basic fever and pain medication.
100% Life: Shelter for the most vulnerable, including people living with HIV or TB
The second partner for BACKUP Health in Ukraine, 100% Life, has been working for decades to provide treatment, improve the quality of life and ensure the human rights of people living with HIV, Tuberculosis and Hepatitis C. 100% Life is the largest patient-led organisation in Ukraine. Each year, it provides services to more than 190,000 patients, 90,000 of whom are people living with HIV.
Since the start of the war, it has set up shelters for those fleeing the violence, particularly the most vulnerable groups. In Lviv, the heart of Western Ukraine, where tens of thousands of Ukrainians have fled for safety since the start of the war, the organisation runs its biggest shelter.
‘We saw this emerging need to help people who fled to Western Ukraine. Those who arrived from the war zones simply didn’t have anywhere to stay. So we decided to help them,” explains Oksana Opara, Head of the 100% Life shelter in Lviv.
‘All of this started as a volunteer initiative by the local staff of our Lviv branch. They collected bedding, clothes, and food for those who arrived here without anything. Then, after one month, we managed to get some funding to open this shelter.’
The people who come to us have lost everything
Today, the shelter houses about 130 men, women and children. It can provide basic hygiene products and three meals a day. A nurse is on duty and the shelter has access to a psychologist and social workers, who provide counselling and help people find their bearings. ‘On average, people stay here for a month. But every situation is unique – some stay for six months if they have no other place to go,” says Opara.
The people who come to us have often lost everything – their houses have been destroyed, they lost crucial identity documents, they have no savings. Some people arrive here with nothing but the clothes they are wearing.Oksana Opara, Head of the 100% Life shelter in Lviv
About half of the residents are members of the vulnerable groups the NGO also worked with before the war: HIV & TB patients, ex-prisoners, former drug addicts and sex workers. ‘People living with HIV have been refused shelter in other places,’ says Opara. The funding we receive from BACKUP Health allows us to make sure that there is a safe space for them here in Lviv.’
One of our principles is that people with HIV, TB or other conditions must feel safe here,’ she says. ‘There is absolutely no difference in how they are treated compared to others. And we don’t reveal their status to others unless they do it themselves.Yuliia Chechotkina, 100% Life Senior Communications Officer
The profile of those seeking emergency shelter keeps changing, she adds. In the first few months, people often moved on relatively quickly. ‘Now there are many who are totally lost,’ says Opara. ‘Especially those coming from the occupied territories who have endured months of bombardment – they are traumatised and don’t have any vision for the future.’ Many of them are elderly: ‘Right now, we have woman in her eighties, who doesn’t have anywhere else to go, there are no relatives and she lost everything,” says Opara. ‘And there is another old lady who fled from Donetsk when her house got bombed, wearing only her robe and slippers. Luckily, we found some of her relatives.’
In times of war, innovative ways of service provision are called for.
Going forward, what the project needs most, says Opara, is basic funding to stay afloat. ‘We need to be able to pay the bills for heating, electricity, water, food – hygiene supplies and basics like plates and cups. Everything runs out so fast as people keep arriving and moving on.’
The demand for the basic services 100% Life and APH provide has continued to grow while peace remains elusive. And even if the war ended tomorrow, says Smyrnov, meeting the medical needs of people in war-hit parts of Ukraine will continue to pose enormous challenges:
‘Given the scale of destruction and devastation, mobile health care may well be the only solution for these areas for the foreseeable future,’ he says. ‘We can’t afford to wait for medical facilities to be rebuilt and for all doctors to come back. Our people need help now. And we will do all we can to provide it.’