First published by FHI 360 on February 21, 2024. Read the original article, and stream the videos, here.
Since the full-scale invasion into Ukraine began on February 24, 2022, there have been more than 1,100 attacks on the country’s health care system. Nearly half of those attacks damaged or destroyed hospitals and clinics. In some areas of Ukraine, nearly all the health facilities were damaged, leaving people without medical care for months.
Health facilities in Kherson oblast that have been severely damaged by the war.
The effects have been harmful. “I believe that every person’s [health] was impacted by this situation,” says Mykola Mykhalchuk, who lives in a village in Dnipropetrovsk oblast, which was occupied by Russian forces for several months.
Mykhalchuk also believes it is his responsibility to keep track of his health. But his village’s health facility, like many others in formerly occupied areas, suffered extensive damage and can no longer offer services.
So, Mykhalchuk is a regular patient at a mobile medical unit run by FHI 360. There, a primary care doctor checks his blood sugar and blood pressure, and he also sees a specialist cardiologist. The doctors provide him — and others — with medication free of charge. Mykhalchuk says he “trusts these doctors very much.”
Mykhalchuk is seen by a specialist cardiologist at a mobile medical unit.
Connecting people to comprehensive services
To address the gaps in health care caused by the war, FHI 360 is carrying out the Ukraine Humanitarian Assistance Response Program (UHARP) program, funded by USAID’s Bureau for Humanitarian Assistance. The program provides health, protection and mental health and psychosocial support services in conflict-affected areas of Ukraine.
Eleven mobile medical teams serve six regions of Ukraine that were occupied during the early months of the war. The program has a particular focus on rural and hard-to-reach areas, like where Mykhalchuk lives. Many of these areas have not had consistent access to primary health care services since the invasion began.
The mobile medical units focus on restoring health services in rural and hard-to-reach areas of Ukraine. They visit each location every two weeks, sometimes traveling for hours at a time.
Dr. Natalia Kolisnyk leads one of the mobile units. Each mobile medical team is composed of a doctor, nurse, psychologist and social worker.
Kolisnyk says the “overwhelming majority” of the patients are elderly, and the most common medical issues the team treats are hypertension and coronary heart disease.
“Without any doubt, we have seen an increase in the number of hypertension patients and deterioration of those with hypertension already,” says Dr. Natalia Kolisnyk. “Since the beginning of the war, people have started developing diabetes. These are not isolated cases and not [just] the elderly; they are working-aged people in their forties or fifties. Besides, there are many diabetic patients whose condition has worsened since the start of the war.”
The mobile units travel each weekday, providing a range of clinical services and medications to residents and people who are internally displaced. On the weekends, they coordinate visits from specialists, such as cardiologists and endocrinologists.
People can receive psychological support in addition to accessing medical health care. This is especially important because people lived for a time under occupation — and the war is ongoing. “People who have been under occupation here … say they want to cry all the time,” says Kolisnyk. “These are depressive disorders.”
Patients visiting the mobile units also struggle with anxiety, acute stress or trauma and post-traumatic stress disorder. Oftentimes, the provider refers patients to the psychologist — increasing the uptake and acceptance of mental health care. In 2023, FHI 360 psychologists provided psychological support consultations to more than 9,000 Ukrainian people through the UHARP program.
In addition to medical and psychological support, each unit has a social worker who can help people navigate disruptions to the national bureaucracy, supporting them to regain access to pensions and other government services.
Top row, left: Kolisnyk cares for patient Tamara Kalinicheva outside of a mobile medical unit in Kherson oblast, Ukraine. At right is Ruslan Kostov, the mobile unit’s nurse. Top row, right: The mobile unit’s staff, from left, are Kolisnyk, Kostov, social worker Dina Pushkina and psychologist Oleksandr Belan. Middle row: Pushkina speaks on the phone while seeing a patient. Bottom row: Pushkina distributes medical supplies to residents of Kherson oblast.
Reaching the hard-to-reach
More than 46,000 people have received medical services from UHARP’s 11 mobile medical units as of January 2024. Kolisnyk estimates that her mobile team alone sees more than 100 patients per week, including many who visit regularly.
The mobile medical teams are designed to integrate with the existing medical system. They hold clinic hours at existing health posts that stopped functioning because of the war, working with staff from the Ukrainian Ministry of Health when possible.
The teams also ensure access to health care for people with limited mobility or those who cannot travel for other reasons by conducting phone and virtual consultations and making home visits. They can even perform electrocardiograms and ultrasounds in patients’ homes.
Kolisnyk and Kostov provide medical care to Valentyna Davydko in her home.
Amid a crisis, FHI 360 and our partners are coordinating resources and relationships to ensure that people have access to the health care they need so they may lead healthier lives.
Mykhalchuk says the mobile medical teams’ work is very important because not everyone in his village can afford to travel to larger towns to visit a health care specialist or they have other mobility challenges.
He’s the father of two adult daughters, one who sought refuge in Poland and one who is still in Ukraine. Since he “has some health left,” Mykhalchuk wants to spend his time working in his kitchen garden. The war, he says, “is hard on the soul.”
More than 1,100 attacks on Ukraine’s health care system have been documented since the invasion began in 2022. FHI 360 is connecting people who live in previously occupied areas of rural Ukraine to the health care they need. Eleven mobile medical units have expanded access to high-quality medical, social and psychological care for tens of thousands of Ukrainians. The work, through the Ukraine Humanitarian Assistance Response Program (UHARP), is funded by USAID’s Bureau for Humanitarian Assistance.
About this story
FHI 360’s work on UHARP consists of UHARP I, which ended on July 31, 2023, and UHARP II, which began on August 1, 2023. The January 2024 results described in this story comprise both programs.
FHI 360 is committed to carrying out humanitarian solutions that address communities’ urgent needs and restore long-term, lifesaving services for all. Learn more about our work in crisis response.
All photos and videos are credited to Ivan Fomichenko for FHI 360.