The war in Ukraine is not only displacing millions, straining the economy, and ravaging infrastructure. It’s also creating a mounting health crisis. In this week’s New Security Broadcast, ECSP’s Director Lauren Risi hears from Ambassador Daniel Speckhard and Dr. Mariia Dolynska about the health impacts created by the war in Ukraine and what is still needed to strengthen the health system—as well as what one NGO is doing to deliver healthcare in the embattled nation.

Millions Displaced and an Economy Under Strain

Ambassador Speckhard, a former U.S. Ambassador to Greece and Belarus who is now president and CEO of the global NGO Corus International, says that what stood out to him on his recent visit to Ukraine was the sheer magnitude of suffering. “Fifteen million people have been displaced—about 7 million have moved outside the country, but there’s still 7 million people who are trying to find other places within the country,” he says. “And most of those people had to leave without really anything but what they could carry.” Some Ukrainians fled west within the country to escape the war, only to face continued threats as Russians expand their attacks.

As the war stretches on, Ukraine confronts a humanitarian crisis that encompasses security, economy, and health. The country is experiencing economic collapse, and at least 15 million need humanitarian assistance. One in three Ukrainians is reportedly food insecure. The elderly and those with disabilities are particularly vulnerable, says Speckhard, given Ukraine’s age structure and the hamstrung health system.

Health Crises amid a Frayed System of Care

The war’s impact on health is manifold, suggests Dr. Dolynska, the medical director of the NGO Infection Control in Ukraine. She explains that severe health issues like coronary heart disease and tuberculosis are going undetected, the country’s already subpar waste management has gotten even worse, and unreliable power supplies pose a central challenge to healthcare delivery. Risi points out that that the war’s environmental damages, like polluted air and drinking water, are creating health risks too.

Yet Dolynska and Speckhard also stress an additional—and underappreciated—dimension to the crisis: mental health. The untold violence and broader humanitarian consequences of the conflict have taken a huge toll on the mental wellbeing of Ukrainians. “It looks like every Ukrainian survivor will have some more or less severe psychological trauma,” says Dolynska.

Speckhard recalls hearing about children’s trauma in particular during his visit to Ukraine: “Mothers were telling me how their children would still startle whenever a ball bounced—even months later they just are not feeling safe.” And those responding to the crisis, whether they be primary healthcare workers or emergency responders, are at high risk of trauma themselves.

Extending the Focus and Reach of Health Services 

In response to this multidimensional health emergency, Dolynska and her team at Infection Control in Ukraine are working bravely on the front lines to support primary healthcare workers across the country. The new focus represents a shift for the NGO, which worked more narrowly on infection prevention prior to the conflict.

With help from Corus International, Infection Control in Ukraine is filling a critical healthcare gap for the Ukrainians it serves in rural areas, where healthcare facilities don’t have adequate capacities or their services have been interrupted. Dolynska says that her NGO is deploying mobile teams of experts in specialties like cardiology and psychology and offer a combination of in-person and remote care—though internet connectivity has sometimes limited delivery. They also have a mobile clinic.

 “We’re trying to reach the most remote areas where people have limited access to large clinical centers,” explains Dolynska. “[We] provide them screening for the most common health conditions, infectious and non-infectious, and also importantly, provide psychological support, which is quite new and quite uncommon for Ukraine.” Infection Control in Ukraine also works to ensure that their own staff and service providers receive psychological care.

Building Solutions and Looking Beyond Ukraine

Dolynska and Speckhard share their perspectives on the key messages that listeners should take away regarding efforts to address the war’s impacts, especially in the health sector.

When developing interventions in Ukraine and elsewhere, Speckhard says international actors must avoid duplication and ensure local involvement. “If we create those parallel structures, we’re actually going to be duplicative and not building and strengthening the resilience and capacity of existing structures.” He adds that donors also need to heed this advice by giving to organizations that engage on the ground and prioritize capacity building—like Infection Control in Ukraine. Consistent funding for these efforts, as opposed to one-off donations, is key: “This is a multiyear challenge for this country. If we don’t see it as a multiyear challenge, you’ll win the battle [but] you’ll lose the war.”

Dolynska sees a need for the international community to focus on basic infrastructure and reliable electricity supply in Ukraine in the months ahead. “You can do nothing with even advanced specialists and advanced equipment if you do not have necessary basic water supplies, electricity and heating,” she observes, adding that improving clinical services and health infrastructure should go hand-in-hand.

Ukrainians will need time to rebuild health systems and other infrastructure. Speckhard says that this process will be slow even when the conflict is finally over and Ukraine can build back more surely and securely. He warns that this drawn-out recovery process could erode unity in the country if Ukrainians start blaming their own government, not the aggressors, for a lack of clean water, electricity, or heat—as he has seen happen in other countries. Ukrainians should remember that Russia is ultimately to blame for the damage, and Speckhard calls on the EU to bolster Ukraine’s political resilience by “supporting [its] aspirations for a European future.”

Addressing the impacts of the war in Ukraine also means looking beyond the war-torn country. “The situation has pushed another 71 million people into poverty through cost-of-living increases, with about 50 million people in the world now facing emergency levels of starvation,” says Speckhard. There is growing recognition that the impacts of the war—including consequences for health—are not confined to Ukraine alone. Moving forward, international actors must continue to both watch out for and tackle these global shock waves.