Ukraine, two years since the escalation

“About six months ago, everything was shelled—the medical point, the pharmacy, and all the infrastructure destroyed,” said Liudmyla Karatsiuba, a resident near Kupiansk, one of the most volatile areas on the front line in Ukraine, in the northeast of the country. “But it wasn’t the end. We built houses; we strengthened our community.”

Following Ukrainian forces’ partial retaking of the Kharkiv region in September 2022, and the front line shifting further from Kupiansk, an MSF medical team arrived in Liudmyla's village to provide medical treatment. The shelling had left no public buildings for the team to set up a clinic, so Liudmyla agreed to let the team use her home, where they provided medical and psychological consultations to people from the entire community. 

“I still follow the advice given by MSF psychologists, and I teach my neighbors the candle breathing exercise for calmness and balance,” said Liudmyla. “It has helped me remain focused on being useful at the age of 75. Currently, I am engaged in farming and raising rabbits.” 

The breathing exercise Liudmyla refers to is a simple technique used to ease stress and anxiety. MSF mobile teams in Ukraine have shared breathing exercises that can be easily passed on to people to treat and raise the profile of mental health care. The same teams worked with Liudmyla’s community to rebuild the only local medical point, where Ministry of Health workers have now returned.

Bringing care to communities impacted by fighting

There are many people like Liudmyla living near the front line. Since the dramatic escalation of the war in Ukraine in February 2022, MSF has been conducting mobile clinics in the adjacent regions.  

“Most of our patients have been women over the age of 60, many of them suffering from chronic diseases like hypertension and diabetes,” said Maksym Zharikov, MSF deputy medical coordinator in Ukraine. “While some were evacuated, others either couldn’t leave, or chose to remain in their communities. The urgent need remains to provide medical services to patients residing 20–30 kilometers [about 12 to 19 miles] from the front lines.”

This trend has been a constant since the war began in 2014: supplies in markets and medical centers near the frontline dwindle, along with the number of people in the villages. Today, nearly 10 million people are displaced either inside Ukraine or as refugees abroad. Organizations like MSF have been able to support some of these communities with supplies, medical care, and reconstruction. However, more often it is the communities themselves, with the aid of local volunteer organizations, that carry out the work. In the last two years, it has become increasingly difficult to reach areas cut off by fighting or close to the front lines. 

MSF runs mobile clinics in 100 different towns and villages near the frontline in the Donetsk, Kharkiv, and Kherson regions. These clinics usually comprise a therapist, a psychologist, a medical doctor, and a social worker. 

Psychological support during wartime in Ukraine

“I can see that my younger son, Vania, needs more care and attention now,” said Olena Beda of her nine-year-old son. “He often asks to be hugged and asks how much I love him.” 

Olena and her two children have been living in a shelter for displaced people in the Kirovohrad region for over a year after fleeing war in Donetsk. Although they settled in an area relatively far from the frontlines, drones and missiles have become a relentless part of life in the last two years.

Vania began to have trouble sleeping, particularly due to shelling. After a team of MSF psychologists began conducting group sessions for children at the shelter, Olena felt Vania’s anxiety diminish. He was able to go back to school and make new friends.

“However, sudden loud noises and conversations about the war can trigger a sudden change in his condition,” Olena explained. 

In the last two years in Ukraine, MSF has provided 26,324 individual psychological consultations. In shelters for internally displaced people, the main group of patients consists of mothers with children.

“At the onset of the escalation, we observed symptoms among children such as anxiety, panic attacks, and fear,” said Alisa Kushnirova, an MSF psychologist. “However, we notice that children have begun to perceive the abnormal situation as normal—they have adapted to the sounds of explosions—though we still observe neurotic reactions.” 

Our teams provide psychological support to families, including adults. The mental health of adults is key in maintaining a positive psychological environment within the family, as the parents’ condition often reflects that of their children.

Emergency evacuations and early physical rehabilitation 

“On April 18, 2023, I lost my leg,” said Tetiana Doloza. “The market where I worked as a salesperson in the city of Ukrainsk, in Donetsk, was hit by missiles and I was severely injured.” 

It’s been 10 months since Tetiana lost her leg. Today, she walks in Kyiv with confidence, relying on a prosthetic limb and crutches for support. Tetiana was evacuated from the market to a hospital and transported by an MSF medical train to the Lviv region, where doctors and physiotherapists have fitted her with a prosthesis. 

“When MSF doctors took me to the hospital in the west of the country, I felt lost,” said Tetiana. “I didn't know how I would cope with an amputation. Now, with a prosthetic limb, I live in Kyiv with my son. At 72 years old, I am happy to have survived.”

“Between March 2022 to December 2023, MSF’s medical evacuation train transported 3,808 patients, 310 of whom were in critical condition,” said Albina Zharkova, MSF project coordinator. “In 2022 and early 2023, the evacuation train was essential for referring people to safer locations and hospitals for treatment. Now the needs have shifted, and our ambulances are the ones doing shorter referrals.” 

Today, due to a change in the war’s dynamic, patients are now staying in eastern Ukraine rather than being referred to the west. But our teams continue to operate 15 ambulances that refer patients wounded by shelling and those with chronic illnesses to medical facilities farther away from the front.  

The fighting on the frontlines of Ukraine remains as devastating as ever, despite waning international attention on the humanitarian consequences. From 2014 to 2022, more than 14,000 people were killed. Since February 2022 this number has multiplied, with hundreds of thousands wounded physically and psychologically, and almost 10 million people displaced.