The fourth year of full-scale war in Ukraine poses unprecedented challenges to the healthcare system, testing its resilience and effectiveness. The growing number of civilian casualties, the destruction of medical facilities and the depletion of financial resources are compounded by demographic and epidemiological changes. Against this backdrop, the situation with chronic diseases is deteriorating, the need for rehabilitation and mental health support is growing, and new, less obvious threats are emerging. Analysis of the situation indicates that a superficial look at the statistics can be misleading, and the real consequences of the war for the nation’s health are much deeper than reflected in the official figures.
Demographic realities and humanitarian profile
Civilian casualties and infrastructure damage
The continuous escalation of hostilities has had a significant impact on the civilian population. Between February 2022 and 1 July 2025, the Office of the United Nations High Commissioner for Human Rights recorded 47,695 civilian casualties in Ukraine, including 13,580 deaths and 34,115 injuries. The number of casualties increased significantly in 2025: 2,737 and 4,017 casualties were recorded in the first two quarters, respectively.
At the same time, the number of attacks on medical infrastructure is also growing. From February 2022 to August 2025, the World Health Organisation (WHO) confirmed 2,574 attacks on medical facilities, of which 2,149 were on medical institutions and 470 on medical transport. In the first three quarters of 2025 alone, 382 attacks on healthcare facilities were verified. In total, 2,176 medical facilities have been damaged since the start of the full-scale war. These brutal statistics also apply to ambulances: 278 vehicles have been destroyed, 131 damaged and 80 captured.
Attacks on medical facilities have far-reaching consequences that go beyond material losses. The total damage to medical infrastructure is estimated at US$1.56 billion, with projected reconstruction needs reaching US$19.6 billion. However, the true cost cannot be measured solely in financial terms. The systematic destruction of medical facilities and ambulances in frontline areas such as Kharkiv, Donetsk and Zaporizhzhia limits access to vital services, which in turn leads to increased morbidity and mortality rates.
Humanitarian profile
In the context of prolonged war, millions of people have been forced to leave their homes. According to data, approximately 5.6 million people have become refugees, and 3.76 million have acquired the status of internally displaced persons (IDPs). These processes place an additional burden on the healthcare systems of host communities, which have to provide assistance to a significantly increased population.
IDPs face particular problems in accessing healthcare services. According to the survey, 11% of IDPs do not know the location of their primary care physician, compared to 8% of the non-displaced population. The lack of necessary documents is a barrier for 28% of IDPs, making it impossible for them to receive subsidised services. This creates not only logistical but also epidemiological challenges. The mass displacement of large numbers of people from frontline regions, where the health care system has been disrupted, to safer areas may contribute to lower vaccination coverage and the spread of infectious diseases. This creates a complex public health situation that requires more careful monitoring and an adapted humanitarian response.
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Demographic crisis: birth rate, mortality and leading causes
The gap between birth and death rates
According to data from the Ministry of Justice of Ukraine, in 2024, there were 495,090 deaths registered compared to 176,679 births. Although mortality decreased by 0,2% and fertility by 5,7% compared to 2023, regional indicators reveal an even more depressing picture.
Data collected for 2024 shows huge regional disparities in the ratio of deaths to births. While the national average is 2.82:1, in frontline regions it is significantly higher, reaching 4.54:1 in Kharkiv, 4.73:1 in Sumy, 4.74:1 in Zaporizhzhia, and 8.47:1 in Donetsk. The most critical ratio is in the Kherson region, where there are eleven deaths for every birth. This demographic imbalance is a powerful indicator of population depletion and ageing. Young people and families with children tend to leave, while those who remain are often elderly people who cannot evacuate or those living in occupied territories.
Leading causes of death: chronic diseases against the backdrop of war
According to the latest official data available for 2021, cardiovascular diseases were the leading cause of death in Ukraine, accounting for 65% of all cases. Cancer (10%) and complications from COVID-19 (8%) ranked second and third, respectively. It is important to note that these figures do not take into account mortality directly caused by the full-scale war, which makes the overall picture even more alarming. In other words, the war not only creates new medical problems but also exacerbates existing ones.
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Non-communicable diseases: from hidden threat to epidemic
Exacerbation of cardiovascular diseases and diabetes
Cardiovascular diseases in Ukraine have shown steady growth. In 2023, the number of hospitalisations related to these diseases reached 37.5 per 1,000 population, which is 8.6% higher than in 2014. In particular, the Kharkiv region saw a sharp increase in cases of hypertension (+9.5%), angina pectoris (+17.1%) and acute myocardial infarction (+20.4%).
The course of diabetes has also significantly worsened. A national study showed that the average HbA1c level in patients increased, and the proportion of patients with uncontrolled diabetes doubled. The main factors contributing to this deterioration include stress, interrupted medical supervision, disruptions in the logistics of drug supply, and changes in diet.
Limited access to specialised medical care remains a critical issue. According to data, only 12% of general hospitals can provide care for acute myocardial infarction. Diabetes treatment services, although available in 79% of facilities nationwide, have significant regional gaps in the frontline regions of Donetsk, Kherson, and Zaporizhzhia.
Access to cancer care
Cancer also poses a significant threat. In 2024, 111,153 new cases of malignant neoplasms were registered in Ukraine. The most common were cancer of the digestive organs, non-melanoma skin cancer, and cancer of the reproductive organs. However, access to diagnosis and treatment remains critically limited. Only 17% of medical facilities offer cancer diagnosis, 14% offer screening, and access to chemotherapy and radiotherapy is minimal: less than 1% of facilities are able to provide such services.
Problems with access to treatment for non-communicable diseases create a delayed effect. The lack of early diagnosis and interrupted treatment of cancer and diabetes mean that diseases are detected at later stages, when treatment is less effective or impossible. This leads to increased mortality and complications in the long term, placing a huge burden on a health system already exhausted by war.
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Infectious risks: dichotomy of trends
Vaccine-preventable infections: measles outbreak
An analysis of infectious disease trends in 2025 shows a decline in the number of cases of diphtheria, tetanus and meningitis, while the number of measles cases has risen sharply. In the first seven months of 2025, there were 1,377 cases of measles, which is almost nine times more than in the same period in 2024. The largest increase was among children under the age of 17, who account for 73.7% of all cases.
Regional data indicates a concentration of measles outbreaks in the western regions of Ukraine. Ivano-Frankivsk region reported 323 cases, which is 323 times more than in 2024. It is followed by Chernivtsi (+286 cases), Vinnytsia (+200) and Zakarpattia (+158) regions. This increase is not accidental. It indicates gaps in population immunisation, which have been exacerbated by mass movements of people. Regions such as Zakarpattia, Chernivtsi and Odesa had low measles vaccination coverage rates as early as 2024, which created the conditions for further outbreaks.
HIV, tuberculosis and viral hepatitis: a misleading decline
The situation with the spread of HIV and tuberculosis is particularly difficult to interpret. In the first half of 2025, HIV incidence fell by 14.4% and tuberculosis incidence by 16.6%. However, these statistics can be misleading. The number of HIV tests conducted among key populations, including sex workers, fell by 85.3%, and among people who inject drugs, by 38%. This is a classic example of statistical distortion in a crisis.
Reduced testing, lack of reports from temporarily occupied territories, and population movements create the illusion of an improving epidemiological situation. Undetected cases lead to further spread of infections and risk losing the gains made in the fight against these diseases.
Antimicrobial resistance (AMR): an accelerating threat
Antimicrobial resistance remains one of the main threats to global health. Even before 2022, Ukraine had growing rates of bacterial resistance to antibiotics. War is the perfect environment for accelerating this process. Factors such as injuries requiring long-term antibiotic treatment and the chaotic use of antibiotics in conditions of limited access and logistical disruptions contribute to the development of resistant strains of bacteria.
Medical evacuation from frontline areas and the movement of refugees can contribute to the cross-border spread of these resistant strains, turning a local problem into a regional and then a global one.
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Mental health and rehabilitation: urgent needs
Mental health crisis among the population
Survey data show that 83% of adult Ukrainians experience stress and nervous tension. The main reasons are the war (78%) and financial difficulties (52%). The most vulnerable groups are internally displaced persons (80%), people with disabilities (45%) and the unemployed (54%).
Despite the growing need for psychological assistance from 41% in 2022 to 71% in 2025, only 13% of the population seeks professional help. The main barriers include a lack of specialists, stigma, damaged infrastructure, and limited access to services. According to data, only 13% of medical facilities provide outpatient mental health care, and less than 1% provide inpatient care. This indicates a significant gap between demand and availability of services. This gap leads to delayed treatment, an increase in comorbidities, and chronic disorders, which ultimately negatively affects the social and economic stability of the nation.
Challenges of rehabilitation care
The scale of war-related injuries and amputations requires an immediate and comprehensive response. By mid-2024, approximately 100,000 amputations had been recorded in Ukraine. However, access to rehabilitation services is critically limited. Only 4% of hospitals across the country provide inpatient rehabilitation care. Access to prosthetics and orthopaedic services is minimal, accounting for less than 1% of all medical facilities.
A huge number of people with amputations and other war-related injuries are left without adequate rehabilitation care. Limited access to rehabilitation leads to long-term disability and the inability to return to a full life and work. This is not only a tragedy for individuals, but also a huge burden on the social protection system and the economy, as thousands of people remain dependent on assistance and cannot integrate into society.
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System status and humanitarian response: depletion and support
Functioning of the healthcare system
The Ukrainian healthcare system is operating under extreme pressure. The most acute problems are observed in frontline areas, where 42-54% of respondents report a deterioration in access to medical services. Among the key barriers are the high cost of medicines, transport problems and damage to medical facilities.
The system also faces a shortage of personnel. Although the density of doctors in Ukraine is close to that in Europe, there is a critical shortage of nurses (43.8 per 10,000 population compared to 92 in the EU) and physiotherapists. A significant number of doctors (over 50%) are over 50 years old, which creates a risk of losing qualified personnel. Overall, it is estimated that approximately 5,000 doctors and 11,000 nurses leave the system each year.
From 2022 to 2023, real consolidated health expenditure fell by 21.3% as funds were redirected to defence and security. This reduction led to a decrease in the target audience of humanitarian programmes from 3 million to 2.2 million people, despite the fact that 9.2 million people were identified as needing assistance. In other words, financial constraints have a cascading effect, undermining not only the immediate humanitarian response but also the long-term sustainability of the system.
The role of humanitarian organisations
In 2025, humanitarian partners focused on the Health Cluster continued to provide support to the Ministry of Health. Due to limited funding, the 2025 humanitarian plan was refocused on four strategic areas: support for vulnerable groups in frontline areas, assistance during evacuations, rapid response to attacks, and assistance to IDPs.
The shift in humanitarian aid priorities from long-term projects to emergency response reflects the worsening situation on the ground. This allows lives to be saved immediately, but at the same time means that programmes for recovery, system strengthening and prevention are postponed. Although humanitarian organisations are demonstrating extraordinary flexibility, continued dependence on external funding and the reorientation of donors creates a risk for the future sustainable development of the health system.
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