‘It wasn’t like this before Russia came’

The state of healthcare in Ukraine’s occupied territories after two years of war

Over the last two years, Russia’s full-scale invasion of Ukraine has destroyed hundreds of hospitals and forced countless medical professionals to flee to areas still under Kyiv’s control. Many of the doctors who have remained have had to work under near-constant shelling. To mitigate the damage, the Russian authorities have allocated over eight billion rubles (over $88 million) to rebuild destroyed infrastructure and sent thousands of medical workers from Russia to Ukraine’s occupied territories. However, according to doctors in the occupied areas, these measures have failed to compensate for the lack of personnel, the corruption, and the medication shortages. For insight into how this failing healthcare system looks on the ground, journalists from Verstka spoke to doctors and patients in occupied Ukraine. Meduza shares some of their findings in English.

Mikhail is a pediatric surgeon from Siberia. His first trip to occupied Ukraine was in September 2022, when he went to work as a volunteer at Mariupol’s regional intensive care hospital.

“When I arrived, I immediately had this ambiguous feeling: I wasn’t scared anymore, but I still felt a kind of horror,” he told Verstka. “All of the people there had pain in their eyes, the imprint of what they’d been through. The adults could understand what was happening, whereas the children…”

Yelena, a psychologist from Moscow, went to volunteer in the occupied territories in October 2022 along with 11 of her colleagues. After a few months in Mariupol, she went to the Luhansk region.

Even when we were living [in Mariupol], there was no heat, power, or water. A lot of people were still living in basements. The most shocking, disheartening thing was when you would see black buildings with holes in the walls, charred homes, and next to them you would see light coming from a window where people were still living.

According to Verstka’s calculations, at least 2,500 doctors from at least 50 regions of Russia traveled to the occupied parts of Ukraine’s Donetsk, Luhansk, Zaporizhzhia, and Kherson regions during the first two years of the full-scale war, though the total is likely higher.

From volunteers to state employees

The medical professionals who spoke to Verstka said they were unprepared for the experiences they faced in the occupied territories.

“You see these poor old people in a tent that’s practically impossible to walk through,” said Yelena, the psychologist from Moscow, recounting her first day of work. “For many of them, either their children left or somebody [from their family] had died; some of them had been abandoned. Imagine reaching the end of your life and having it be like that.”

Mikhail, the pediatric surgeon, said the most common issue he encountered in Mariupol in late 2022 was dog bites in children and their parents. “At that point, the dogs had been fending for themselves on the streets for six months, subsisting on whatever they could find,” he said. He continued:

In other words, these weren’t puppies, these were dogs, and they’d been there since before the start of the [full-scale] war. They’d once been pets, but they’d been left behind and had eaten everything they could, including corpses. And so they’d started going after people, attacking small children.

In addition to children, Mikhail said, he treated wounded soldiers. “That was new for me,” he told Verstka. “I was used to talking to children. But these were extreme conditions — a region that had seen combat. I adapted.”

Alexey, a doctor from St. Petersburg, said that by late summer 2022, the most common medical issue he encountered was not bullet wounds or shrapnel wounds but a bacterial skin condition called erysipelas. “This was a consequence of people spending so much time in basements. It wasn’t just the echoes of war, it was its ongoing reverberations.”

In the first months of the war, Russian medical workers who went to the occupied territories did so as volunteers under the patronage of Russian politicians or soldiers. Typically, they would take vacation time from their workplaces at home and travel to Ukraine at their own expense. Yelena said she spent about 200,000 rubles ($2,200) on two of these trips. “I’m not complaining, but should it really be like this?” she asked. “Even food wasn’t always provided.”

By the second half of 2022, these trips had been incorporated into official Russian state policy: Russian Health Ministry institutions, hospitals, state corporations, and various pro-government organizations began sending doctors to occupied Ukraine. And around the end of the year, regional health ministries and government agencies officially began paying medical workers to go there. After Moscow annexed the occupied territories, the Russian government allocated more than a billion rubles ($11 million) to these initiatives.

Ivan, an endocrinologist from Russia’s Mordovia Republic, said that he traveled to Ukraine’s Zaporizhzhia region after an offer from his local health ministry. Mikhail from Siberia also signed an employment contract to work in the occupied territories. When asked how much he was paid, he declined to give a number.

“You wouldn’t go there for the money — it’s not worth it,” he said. “When a lot of people learn about [the payments], they go there, and then they realize that the territories are being shelled, and it all goes downhill… You don’t go there just for the money.”

At the end of 2022, the first set of doctors sent by the Russian authorities to occupied Ukraine were rotated out and replaced. Many of them received state awards and other accolades upon returning to Russia.

‘That’s the kind of local corruption we have now’

According to residents of the occupied territories, the healthcare system there is in significantly worse shape than it was before the full-scale war. Mykhailo, a resident of the occupied part of Ukraine’s Kherson region, said even the doctors who have been practicing there since before February 2022 have started acting “condescending” towards patients because they know the patients have no alternative. “There’s nobody to complain to; nobody cares,” he said. “Either you’re friendly towards the doctor or you’ll be forgotten about and nobody will help you.”

Another difference, according to Mykhailo, is the variety of drugs available. After the start of the full-scale invasion, he said, local pharmacies stopped carrying the Ukrainian medicine his mother used to take.

Mom went to the pharmacy sometime in late spring [2022]. She says she saw some soldiers, right in front of the pharmacy, beating some boxes of capsules and pills with sticks. She asked what they were doing. They told her it was Ukrainian-made medicine and that she wouldn’t find it there anymore. This punitive action by soldiers against boxes of medication was only witnessed once. But the result is obvious: there’s no longer any medication that was made in Ukraine.

Mykhailo said that people are still selling one another their remaining packages of Ukrainian medication today — there’s even a Facebook group for it. Russian medications, he said, generally cost about twice as much as their Ukrainian analogues. People buy them out of necessity, he said, although life-saving drugs are free with a prescription.

“Mom bought some chocolate for her doctor so that she would give her medicine for two months rather than for one. That’s the kind of local corruption we have now. It wasn’t like this before Russia came; [back then], if you complained about anything aloud, everyone would rush around to prevent, God forbid, a conflict,” he said.

One Telegram channel in the “Luhansk People’s Republic” (“LNR”) has written about people reselling disability certificates, patients paying bribes for surgeries and treatment in hospitals, and medical workers not receiving their full salaries.

“Before the start of the special military operation, the LNR was surviving on humanitarian aid,” the channel’s administrator told Verstka on condition of anonymity. “There wasn’t such a limited range of medications, because a lot of things were brought from Ukraine. You could get practically any type of medicine, including Western ones.”

But in 2022, he said, “times changed and the chaos began”:

They stopped bringing medications from Ukraine; they did a rushed, makeshift job with the import substitutions. Most parts of the [Donetsk People’s] Republic that they managed to liberate have been totally left in the Middle Ages: even now, it’s hard to find anything but paracetamol and activated charcoal in the villages.

‘Nobody can guarantee anything’

In addition to the lack of medication and other supplies, Ukraine’s occupied territories are facing a critical shortage of doctors. “Medical workers (and anyone in their right mind) are reluctant to come here from the rest of Russia, so other regions have to send doctors on rotation,” said the Telegram channel administrator. “For every five medical positions, there are three vacancies.”

Since the start of the full-scale war, the WHO has recorded at least 1,616 attacks on medical facilities in Ukraine. Medical personnel have come under attack in at least 134 cases, and at least 118 medical workers have died, while at least 253 have been injured.

In the Zaporizhzhia region, the shortage is worst in small towns and villages, according to endocrinologist Ivan. “Nobody wants to come here permanently while fighting is still going on,” he said. “They’re trying to normalize the situation, posting job ads, and the [Russian] Health Ministry is working, but there aren’t really many takers.”

Many Ukrainian medical workers who have remained in the occupied territories have done so at high personal cost. “A major aspect of my work in Mariupol had to do with providing psychological support to the medical workers who live there,” said Russian psychologist Yelena. “Not only are they suffering themselves, but they’re expected to help others as well.”

Dozens of medical workers living under Russian occupation refused to speak to Verstka. Some said that they had nothing to share. Others cited fear that their identities would be revealed and they would face repressions. “Nobody can guarantee anything to me,” one nurse said through an intermediary.

“They’re trying to lie low right now, yes,” one Russian doctor said of their Ukrainian colleagues.

Several sources who served as intermediaries between Verstka’s journalists and Ukrainian doctors in the occupied territories also said that many medical workers fear persecution from the Russian-installed authorities. One former official from the Zaporizhzhia region told Verstka that he himself had faced such repressions at the start of the full-scale invasion, when Russian forces tortured him and held him in captivity for several months. He declined to discuss the conditions of his release publicly.

Many medical workers in the occupied territories also fear being charged with collaboration by the Ukrainian authorities for working with the Russian authorities by participating in the healthcare system under occupation. According to the Ukrainian authorities, however, only medical workers who assume leadership positions, publicly support the occupation authorities, and contribute to their activities are at risk of facing collaboration charges.

Most of the Russian doctors who spoke to Verstka said they support the Russian army’s actions in Ukraine. They gave various explanations for their views, from stories about alleged acts of cruelty by Ukrainian soldiers to narratives about the “heroism” of Russian soldiers. All of them said that they went to the occupied territories out of a desire to help civilians.

Reporting by Regina Gimalova for Verstka. Abridged English-language version by Sam Breazeale.