Four years of full-scale war have changed not only the front line but also the nature of how Ukrainians get sick, are treated, and die. The organization “Doctors Without Borders” (MSF) has released a report “No Safe Place to Heal“, in which, based on its own medical data and patient and staff testimony, it describes how massive shelling and the spread of drones are destroying the healthcare system along the thousands-of-kilometers-long line of contact. Along with visible victims, a quieter crisis is unfolding – elderly and chronically ill residents of frontline communities are gradually losing access to the simplest medications and examinations.
According to the UN Human Rights Monitoring Mission, since February 2022, almost 15,000 civilians have been killed in Ukraine, and more than 40,000 have been injured. The number of civilian casualties in 2025 increased by 30% compared to 2024 and by 70% compared to 2023. More than 5.8 million people have left the country as refugees, and about 3.7 million have become internally displaced persons, and in the spring of 2026, about 19% of the country’s territory was under Russian occupation.
Civilians on the Line of Fire
MSF teams have witnessed the consequences of strikes on settlements. In supported hospitals, doctors provided assistance to the injured during trips to work, everyday shopping, and even in queues for pensions. Typical injuries include complex blast injuries, shrapnel wounds, burns, traumatic amputations, and polytrauma. In some facilities, the massive influx of wounded forced staff to activate emergency sorting protocols several times a week. Urban hospitals, designed to treat non-war-related illnesses, are increasingly receiving streams of wounded civilians, although they are not fully equipped to provide such assistance. According to a trauma doctor, during one massive influx, those who could no longer be saved were given painkillers before death, and less severe patients waited for treatment for up to ten hours, lying in wards and corridors.
How Drones Have Changed the Structure of Injuries
An MSF surgeon working near the front line describes the transition from artillery injuries to drone injuries. If in 2022 and 2023, most injuries were caused by artillery, now drone strikes dominate. Wounds from them are multiple, small, and charred at the edges, with skin burns. Shrapnel penetrates the body in different directions, creating deep wound channels that are almost impossible to completely clean surgically, so the level of infection has increased significantly, and sepsis takes the lives of those who survived the initial trauma.
The number of people with disabilities in Ukraine has increased by at least 300,000 since February 2022, exceeding three million. In the MSF rehabilitation project in Cherkasy, multiple fractures among patients increased by 51%, lower limb amputations by 14%, and cases of multiple amputations tripled.
During this period most injuries were caused by artillery shelling.
Medical Workers as Targets
According to the World Health Organization, since the beginning of the invasion, 233 medical workers and patients have been killed in attacks on healthcare facilities, and 930 have been injured. An example of a targeted strike was the incident on September 29, 2025, when the car of the director of the Primary Medical and Sanitary Care Center in Liman, Andriy Rebrov, and nurse Valentina Kolomatskaya, clearly marked with a medical red cross, was hit by an FPV drone while driving to pick up medication. Rebrov had his leg amputated, and Kolomatskaya suffered burns, a concussion, and hearing damage.
A disturbing phenomenon has been double strikes, where a second strike is deliberately aimed at rescuers arriving at the scene of the first attack. An example is the strike on a bus with miners near Ternivka in the Dnipropetrovsk region on February 1, 2026. About twelve people were killed at the scene, and sixteen patients were taken to the hospital, ten of whom required immediate life-saving intervention. The organization's premises were also not spared: a rocket destroyed the MSF office in Pokrovsk on April 5, 2024, and the office in Sloviansk was damaged on December 9, 2025.
How a “double-tap” strike works
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Hospitals Under Constant Fire
MSF describes the deliberate targeting of medical facilities as part of a military strategy. The WHO has documented 1,373 attacks on healthcare facilities in 2022, 370 in 2023, 488 in 2024, and 580 in 2025. After a decline, the number of attacks is increasing again - by 32% between 2023 and 2024 and by another 19% the following year. According to Ukraine's Ministry of Health, since February 2022, Russia has damaged or destroyed more than 2,500 medical facilities, 327 of which have been completely destroyed. MSF has its own list of more than twenty attacks on facilities it has supported, including the bombing of the Mykolaiv Oncology Hospital, strikes on Kherson hospitals, one of which killed a doctor, and a strike on the largest children's diagnostic and treatment center in Kyiv in July 2024.
Territories That Can No Longer Be Reached
Since 2022, the escalation has forced MSF to withdraw from eight hospitals near the front line. Four of them - in Kostyantynivka, Selydove, Pokrovsk, and Pokrovsky - are now completely destroyed. Selydove remains occupied, and Pokrovsk has largely become a ghost town.
The loss of access is also measured by villages. In the East, access has been lost to 55 out of 85 settlements, and 17 locations were lost in January 2026. In the South, 25 out of 62 villages have become inaccessible to mobile clinics, and twenty-two of them have even been deprived of visits by paramedics. In Kherson, the spread of FPV drones has forced the suspension of mobile primary care clinics, and the polyclinic on the hospital grounds has been declared a no-go zone.
Empty Offices and Exhausted Staff
Danger has become a key factor in the outflow of doctors from frontline areas. In the Kherson hospital supported by MSF, compared to the pre-war level, the number of doctors has decreased from 79 to 27, nurses and paramedics from 195 to 80, and technical staff from 142 to 71, despite an increase in the number of beds from 220 to 270.
Between 2021 and 2024, the number of registered doctors in Ukraine decreased from 143,887 to 127,675 - the country lost more than 16,000 doctors. The remaining staff work at night in a composition of one doctor, one nurse, and one junior medical worker for 30-50 patients. One MSF doctor put it simply - he no longer remembers what it's like to work in peacetime.
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When Chronic Becomes Critical
In MSF mobile clinics and hospitals, the majority of patients are elderly people with non-communicable diseases: hypertension, ischemic heart disease, diabetes. Disruption of treatment turns controlled conditions into acute ones. In 2025, in southern Ukraine, 78% of primary consultations were related to such conditions, and in the East - 77.2%.
Data from the Kherson hospital makes the trend measurable. In the emergency department, the number of visits due to non-communicable diseases increased by 52.5% between 2024 and 2025, cardiovascular emergencies by 33.7%, and conditions related to epilepsy jumped by 432%. In the hospital in southern Mykolaiv region, hospitalizations due to exacerbations of cardiovascular diseases increased by 116% between 2022 and 2025, despite a decrease in population. During the winter of 2025-2026, when temperatures dropped to -25°C, MSF teams almost daily heard about elderly people who died alone in apartments, trapped.
What the Survey Showed
In February and March 2026, MSF teams surveyed 187 civilians in the Dnipropetrovsk, Kherson, Mykolaiv, and Zaporizhzhia regions. The majority of respondents are people aged 65 and older, three-quarters of them women, and almost half are internally displaced persons. Before the full-scale war, 72% of those surveyed had access to medical care always or most of the time. Since February 2022, this figure has decreased to 35%, while the share of those who rarely or never receive assistance has increased from 7% to 35%.
More than three-quarters of respondents reported at least one case where they could not get the necessary medication, and 87% no longer undergo regular check-ups. 92% do not have uninterrupted electricity supply, 65% have insufficient heating, and 71% consider access to food difficult. Among those who faced delays in assistance, 86% reported a worsening of symptoms, and 90% assessed their health condition as worse than before the escalation.
Psychological Burden and Adaptation of Medical Workers
Four years of war have created a prolonged psychological emergency. MSF mental health teams are recording the spread of anxiety, trauma- and stress-related disorders, and depression. In 2025, 981 new consultations were conducted in southern Ukraine, and 1,313 in the East.
Faced with the loss of access, MSF has rebuilt its operational model. Staff in frontline hospitals work on a two-week rotational basis with shared accommodation and psychological support, paramedics have been given broader powers, and patients with stable chronic conditions have begun to be prescribed medication for a period of up to three months. Since September 2025, the organization has introduced remote consultations and has conducted over 1,500 such consultations in the East and over 500 in the Kherson region. One MSF employee described it this way: remote consultations allow preventing the complete abandonment of people, while reflecting the reality in which access to assistance has become the exception.
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