The World Health Organization (WHO) has confirmed 82 attacks on healthcare in Ukraine since 24 February. The country’s virtual healthcare services, already strong from the pandemic, have stepped-up in response.
Why it matters
Online healthcare has provided a crucial lifeline to thousands of Ukrainians as the war imposes physical and psychological trauma on those caught up in its fury and medical facilities restrict access, shut, or are reduced to rubble.
Attacks on healthcare facilities have killed at least 72 people and injured at least 43, the WHO’s director general said on Wednesday. In a recent attack on 9 March, the Russian military targeted and destroyed a maternity hospital in Mariupol.
Approximately half of Ukraine’s pharmacies are thought to be closed, according to the UN, while many health workers are displaced themselves or unable to work.
Ukraine’s pandemic telehealth
Ukraine’s digital healthcare infrastructure, bulked up during the pandemic, has aided the country’s resilience under the latest phase of the war.
Ukraine’s ministry of digital transformation, established in 2019, has been expanding the country’s digital infrastructure with the goal of providing 100 per cent of public services digitally by 2024.
As part of this transformation, the ministry of health is digitising all medical records, Oleksii Sukhovii, head of the Center for the Organization of Psychiatric Care of Ukraine’s ministry of health, tells Geneva Solutions.
The digitisation has improved ease of reference for healthcare providers and it will provide greater transparency within Ukraine’s National Healthcare System.
Many non-governmental initiatives have also sprung up. In 2021, UNICEF and Giva Care Group, a Ukrainian medical technology company, launched 50 digital healthcare platforms in the country’s east where the conflict has been ongoing since 2014.
Among the digital healthcare tools UNICEF and GIVA Care Group have distributed are Tyto Care kits for remote medical examination. A kit includes an otoscope for examining ears, a stethoscope for the heart, lungs, and abdomen, a basal thermometer, and a digital camera for taking pictures of skin and the throat. The devices transmit the data to a doctor who can advise patients in real-time.
Virtual mental healthcare
Online services for mental healthcare have grown significantly since February in response to the heightened trauma and distress people are suffering.
UNICEF, together with Ukraine’s ministry of education and science, the Ukrainian Institute of Cognitive Behavioral Therapy, and the All-Ukrainian Public Center "Volunteer", launched a mental health lifeline for children, teenagers, and parents in late March. Known as the PORUCH project, the initiative offers online consultations with psychologists.
Nezabutni, which translates as “Never-to-be forgotten”, is a local charity supporting those living with dementia and their caretakers and offers a similar service. Mental healthcare services for relatives have been central to Nezabutni’s work from the start. These services have gone entirely online since the Covid-19 pandemic and are increasingly in demand since the war’s February escalation, Irina Shevchenko, the foundation’s director tells Geneva Solutions.
Nezabutni’s online services include individual consultations with psychiatrists and psychologists as well as group therapy sessions. Relatives of people with dementia can also connect via a group chat.
Over 90 per cent of Ukrainians have Viber, the calling and messaging app, which is increasingly being used for remote medical consultations, Sukhovii says.
Family members of people with dementia were initially reluctant to continue with online group therapy early in the escalation, says Shevchenko. For two weeks, the groups stopped. “They were afraid to resume; to talk about this painful experience,” she adds. Some were on the move while others sought refuge in bomb shelters.
Two of its three online therapy groups are now back up and running. The other is on hold as one of Nezabutni’s three psychologists is herself in the process of escaping the violence.
Nezabutni’s forty volunteers have been getting medicines to patients as many pharmacies have closed. Early in the escalation, and still in areas of intense conflict, volunteers delivered medicines personally. “Sometimes it was by bicycle, sometimes it was by foot, sometimes by car,” Shevchenko says.
Online deliveries have resumed in some regions over the past couple of weeks and Nezabutni helps with ordering the medicines online.
Nezabutni has fewer members from the eastern Donbas region which has borne the brunt of the war over the past eight years.
Tell Me is another free Ukrainian online mental health service, which was launched in response to the war. It specialises in cognitive-behavioural therapy and receives support from the Ukrainian Red Cross and Ukraine’s ministry of health.
In addition to online consultations, online healthcare information services have grown since February. One is Viyna, which offers continuously updated information on a broad range of issues, including advice for those who are pregnant or have just given birth, what to do if you find an unaccompanied child, and a list of open pharmacies, shops, and gas stations. It has several pages on psychological support with contact information for psychologists in and beyond Ukraine and a page on how to manage insomnia.
Nezabutni expects to launch a prototype website in the coming week that will provide up-to-date information and resources for those living with dementia and other mental and physical disabilities, both in Ukraine and abroad.
Health information is currently not available through the Ukrainian Red Cross website, which the organisation has shutdown until it resolves a cyberattack. Information remains accessible through its Facebook page, Instagram, Telegram, and Twitter as well as by email and telephone at 0 800 332 656.
Innovation and growth in telehealth has been able to fill some of the gaps left by bombarded hospitals, clinics and other medical facilities. But it comes with its own set of challenges.
Elderly patients and medical professionals are often not adept at digital technologies and can struggle to connect with online services, Shevchenko and Sukhovii say. If they live in rural areas, they may lack internet access in the first place, Shevchenko adds.
Digital security is also a concern. Ukraine’s National Healthcare Service has removed all geographic data and doctor’s contact information from the system in case of a cyberattack, says Sukhovii. This means that doctors cannot look up other doctors, which impedes medical referral and getting in touch for online consultations.
On top of this, digitisation of patient records has been slow. Psychiatry’s digitisation has especially lagged, says Sukhovii. This makes it difficult for doctors to assess new patients when conflict or other crises disrupt the transfer of paper files. This disruption has been amplified with both doctors and patients on the move.
On the move
Displacement is a source of trauma and can worsen existing trauma. The WHO, International Organization for Migration (IOM), and Red Cross in collaboration with other members of the UN’s health cluster for emergency response are running mental health and psychosocial support technical working groups to assist those in Ukraine and those migrating to neighbouring countries.
The working groups employ psychologists, counsellors, psychotherapists, and social workers to run mental health hotlines. IOM has set up separate hotlines for those displaced in Ukraine and those migrating to Poland, Romania, Lithuania, Slovakia, and Moldova. The Ukrainian Red Cross offers a mental health hotline at 0 800 331 800. Psychosocial support also can be sought from Red Cross and UNICEF staff at shelters on the ground in Ukraine and neighbouring countries.