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The Russian invasion of Ukraine in February 2022 caused widespread and long-lasting disruptions to the country’s health care system while drastically increasing the need for health services across all geographies and demographic groups. As of the end of January 2023, over 3.6 million people remained internally displaced, and another 8 million remain outside Ukraine as refugees. In areas of Ukraine where Internally Displaced Persons (IDP)s are concentrated, the number of people seeking healthcare has strained local resources, particularly at the primary care level.

Persistent attacks on health, power and water infrastructure have reduced service capacity across the health system. The greatest impacts occurred in areas close to the front lines in the eastern and southern regions. The intensified attacks since the beginning of October 2022 have destroyed or damaged more than half of Ukraine’s power infrastructure, leaving millions of people without a steady supply of power and limited access to water or heat. To battle cold weather, generators and fuel tanks are in high demand. Medical facilities are no exception. Power remains a challenge for the maintenance of the existing services – the medical equipment requires an uninterrupted power supply to operate and to ensure it remains calibrated and functional.

Likewise, reduced access to transportation – given damage, cost, and safety issues – continues to affect every aspect of Ukraine’s health system, from patient visits to supply chains. Transportation limitations have reduced physical access to care for many patients and led to persistent stock-outs of needed medications throughout the pharmacy and clinical network. Shortages of medicines exist at the primary health care level, particularly for chronic diseases, including insulin, thyroid gland medication, hormonal therapy, and medicine for heart diseases and chronic obstructive pulmonary disease, as well as a lack of vaccines for tetanus, diphtheria, and other common vaccinations. Access to care remains better in larger towns and cities, but outpatient clinics in smaller settlements and villages are left with almost no equipment and supplies. The situation is worse in frontline areas and recently de-occupied areas, where there are shortages of primary health care providers and almost no functional pharmacies.

Despite the impact of attacks on health infrastructure and other services, health care within Ukraine remains manifestly resilient to shocks. A recent survey by the World Health Organization (WHO) found that 95% of Ukrainians were still receiving primary care services, 90% reported having access to chronic disease care, and 93% were able to access a family doctor either at a clinic or through an expanding network of telemedicine services. The resilience of the health system is a testament at once to the commitment of Ukrainian health professionals and to the strength of international support and collaboration.

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Direct Relief is prioritizing the following strategic areas in its response to the humanitarian crisis in Ukraine:

• Increase access to health services, including primary health care, prevention and treatment of non-communicable diseases, emergency medical services, and specialized care
• Ensure delivery of medicines and medical supplies to Ukraine
• Develop and strengthen rehabilitation services for people wounded by war
• Increase access to mental health and psychosocial support services
• Increase access to medical supplies and services for Ukrainian refugees

In its Ukraine response, Direct Relief continues offering two types of support: medicine and supplies to address disruptions in the medical supply chain, and financial assistance to increase access to health services, improve the supply of medications, and improve the health and well-being of the population.

Direct Relief has built within Ukraine an extensive and constantly expanding network of medical provider partners that include the Ministry of Health, the World Health Organization, regional health departments, public hospitals and clinics, select private hospitals providing services without charge, and local humanitarian foundations and associations.

Since February 2022, Direct Relief has donated 8.3 million units (e.g., bottles, vials, pre-filled syringes) of prescription medications. Direct Relief also provided millions of units of non-pharmaceutical products such as pen needles, oxygen concentrators, generators, ambulances, medical consumables, and other health care technology.

Letter from The Ukrainian Ministry of Health

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Direct Relief is engaged in several different lines of activity to bolster primary health care in Ukraine. In areas where rural geography and the impact of war have curtailed access, support for mobile health care units will be expanding capacity for early diagnosis, treatment, and prevention of disease. Where health care facilities have seen reduced ability to provide services due to loss of power, the installation of generators and fuel tanks ensures continuous electricity. At the same time, access to medicines is being ensured through a vetted network of non-governmental partners capable of providing regular distribution to primary health facilities and community pharmacies.

In many cases, primary health care can be an excellent place to provide rehabilitation services for those injured by war. Direct Relief is assessing the possibility that an expanded landscape of rehabilitation services can be developed through primary care networks. Likewise, primary care services are linked in Ukraine to the provision of emergency care. Direct Relief is continuing to support emergency services through provision of funding, ambulances, medicines, and supplies.

Issue Spotlight

Primary, Emergency, and Specialized Care Grants

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When the war began, Direct Relief had existing relationships with Ukrainian health providers and the Ukrainian Ministry of Health, but it quickly established a far more robust pipeline working closely with European pharmaceutical companies, warehouses, and logistics companies. Direct Relief has increased its agility and flexibility while deepening its relationships and capacity in Europe.

Supporting the Humanitarian Medical Supply Chain

In a country with a government-led healthcare system, Ukraine’s Ministry of Health has played a central role in the medical supply chain, both pre-war and during the war. As humanitarian donations of medical supplies poured into Ukraine from around the world, the capacity of the MoH to handle the flow was strained. Direct Relief stepped in to shore up Ukraine’s medical supply chain, ensuring that humanitarian medical supplies reached the people that needed them most.

For the first few months of the war, the MoH estimated operations costs related to the receipt, handling, and distribution of humanitarian aid at up to $750,000 per month. Currently, with the volume and frequency of donations significantly decreased, the MoH has estimated the added cost of warehousing, handling, and distributing humanitarian medical supplies at $200,000 per month.

Direct Relief has approved a grant of $2 million to the MoH to cover these humanitarian logistics costs for 10 months through the end of 2023.

Direct Relief also provided seven organizations with operational grants to offset the expenses for the receipt and distribution of donated products:

Deploying from Europe

While Direct Relief’s Santa Barbara, California,warehouse remains its global distribution hub, the outbreak of war drove Direct Relief to establish a very strong medical supply chain within Europe. More than 40% of pallets of product delivered to Ukraine over the past year have been fulfilled within Europe. Direct Relief has more than doubled the number of healthcare companies donating medicine to the organization from within Europe.

Direct Relief achieved this significant increase in part by establishing exceptional pharmaceutical warehousing capacity in the Netherlands – fully licensed, professionally staffed, with space for thousands of pallets, and experience in complex humanitarian product imports, exports, and customs clearance. Direct Relief has also arranged large medicine donations drop-shipped directly from donor manufacturer facilities within Ukraine and elsewhere in Europe to its Ukrainian partner organizations.

Cold-Chain Requirements

Many of the most important pharmaceutical products needed in Ukraine – such as insulins, cancer therapies, antibiotics, and immunotherapies – require cold-chain logistics (maintaining temperatures between 2° C and 8° C from factory to patient). Direct Relief has developed a very robust capacity for global cold-chain medicine delivery, using modern software to validate shipping lanes and properly pack the shipments, as well as extensively monitoring temperatures in real-time during the delivery process.

Direct Relief has been able to deliver over 2.1 million units (vials/cartridges/prefilled syringes) of various types of insulin to its many partner organizations in Ukraine that treat diabetic patients, as well as over 320,000 additional units of cold-chain medicines to treat cancer, infections, immune conditions, blood disorders, and other serious conditions. Included in these figures were shipments to the WHO of donated insulin. Direct Relief also provided 40-foot refrigeration containers to help Ukraine address cold-chain storage capacity issues at key facilities such as the Ukrainian National Cancer Institute in Kyiv.

Generic Industry Provides Vital Essential Medicines

With important coordination and support from the Association of Accessible Medicines (AAM), Medicines for Europe, and the International Generic and Biomedical Association (IGBA), Direct Relief worked closely with its generic pharmaceutical company donors to provide over 130 million defined daily doses of generic medicines to the impacted population of Ukraine.

The companies providing these prescription medicines, which fulfilled them to Direct Relief from both Europe and the United States, include Accord Healthcare, Ajanta Pharma, Alvogen, Apotex, Baxter, Edenbridge, Hikma, ICU Medical, Meitheal Pharmaceuticals, Perrigo, Teva, and Viatris. Their products have been vital to the success of Direct Relief’s humanitarian response in Ukraine and provided over 2.5 million units (bottles or vials) with a wholesale value exceeding $170 million. The medicines address therapeutic areas including infections, diabetes, cardiovascular disease, respiratory illness, mental health conditions, ulcers, pain, cancer, and other serious conditions.

Amalia Adler-Waxman, SVP and global head of ESG at Teva, said, “Whenever we are considering an impending donation in the most difficult of conditions and the question is raised internally, ‘Who might be able to handle such a formidable task?’ The answer is always clear. For that reason, we feel proud and humbled to be working so closely with Direct Relief and look forward to many more years of collaboration and support.”

Support from Pharmaceutical and Medical Supply Companies

Sixty-nine global healthcare companies have thus far donated medicine and medical supplies to Direct Relief for its humanitarian response in Ukraine, with a wholesale value of over $763 million USD. The companies that provided the donations include:

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According to the United Nations High Commissioner for Human Rights (UNHCR), Ukrainian civilians have suffered nearly 12,000 injuries since the start of the war, and Ukrainian soldiers many more. Many of these individuals require significant medical interventions to repair trauma and physically rehabilitate. Supporting rehabilitation and recovery from war injuries, both physical and psychological, has been a central tenet of Direct Relief’s financial support strategy in Ukraine since the war’s start.

To strengthen rehabilitation services in Ukraine, Direct Relief is prioritizing the following areas:

• Strengthening in-patient rehabilitation departments in hospitals identified by the Ukrainian Ministry of Health (MOH) to enable them to receive civilian and military casualties by providing equipment, training, and supportive supervision by expert teams
• Targeting rehabilitation centers with some existing capacity while making sure not to neglect regions with high needs and no existing capacity. The priority list will be determined jointly with the MOH
• Supporting the development of highly specialized services (wounds, burns, prosthetics-orthotics) to further develop capacities at the Unbroken center in Lviv while also providing equipment for smaller centers closer to the front lines
• Assessing the feasibility of providing assistive devices and community- and home-level follow-up by trained professionals through existing primary healthcare services (including by training primary health care providers on specific rehabilitation needs and interventions)

Partner Spotlight

UNBROKEN

As the war rages on in Ukraine’s east, it creates a steady flow of wounded people needing complex surgeries, long-term rehabilitation and prosthetics. Many of these patients arrive by evacuation trains and ambulances at the Unbroken National Rehabilitation Center in Lviv.

Direct Relief has granted $1 million to Unbroken to procure rehabilitation equipment, develop treatment protocols, and train rehabilitation personnel. The rehabilitation programs focus on amputation recovery, occupational therapy, speech therapy, and psychosocial support.

Unbroken is part of the First Medical Union of Lviv, an umbrella association of multi-specialty clinics that has provided care to 80,000 internally displaced persons since the beginning of the war.

Direct Relief has also provided $250,000 to UNITED24 for renovating the Mental Health and Rehabilitation Center Veterans “Lisova Poliana” in the Kyiv region of Ukraine. The center specializes in treating disorders related to combat stress, assisting survivors of captivity and torture, and providing physical rehabilitation services.

The institution needed to scale up operations urgently due to the rapidly increasing number of people impacted by the war. The funds will expand patient services and improve the facility. The 220-bed center, which provides inpatient services for physical rehabilitation, will undergo reconstruction and overhaul to meet demand.

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The World Health Organization estimates that more than 20% of individuals who directly experience war develop or have increased effects from mental health disorders, including depression and anxiety, PTSD (Post Traumatic Stress Disorder), schizophrenia, and many other issues. Based on these estimates, WHO places the number of Ukrainians needing mental health care for one or more conditions at nearly 10 million people.

Mental health is an integral part of Direct Relief’s Ukraine response, cutting across many categories of work: medicine donations, primary care, rehabilitation aid, care for refugees and more.

Partner Spotlight

Grants for Mental Health

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More than 18.5 million Ukrainians have fled their country since the war began, and more than 8 million of them remain outside Ukraine as refugees, according to the Centre for Research & Analysis of Migration. An estimated 90% of the refugees from Ukraine are women and children. Most have fled to Poland, but significant numbers have sought safety in Hungary, the Republic of Moldova, Romania, Slovakia, and other countries in the region.

Immediately following the invasion, Direct Relief offered support to Ministries of Health of the neighboring countries and has since established strong partnerships with nonprofit health organizations in Poland and Slovakia, working to increase access to health care for Ukrainian refugees abroad.

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Direct Relief recognizes that the generous supporters who made financial contributions over the last year to help people in Ukraine did so with the express intent that their contributions benefit people in Ukraine and those who fled to neighboring countries as a direct result of the war.

In accepting funds for the response to the situation in Ukraine, Direct Relief understands that both those who contributed and the Ukrainian people for whose benefit the contributions were made deserve to know, in detail, how Direct Relief is using these funds.

contributions to the response

In response to the war in Ukraine, Direct Relief received 151,669 Ukraine-designated financial contributions totaling $101,129,967.

Donations were received from people in 83 countries (including Russia and Belarus) and from people in all 50 U.S. states, Washington DC, five U.S. territories, and three U.S. overseas military addresses.

*Data from February 24, 2022, to January 31, 2023

To date, Direct Relief has spent and committed a total of $39.4 million (39%) on the response. Of that, $38.6 million has been disbursed, and $748,000 has been committed.

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Total Grants Committed: $30.8 MILLION

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SUPPORTED GROUPS DISTRIBUTING AID TO 400+ HOSPITALS & CLINICS

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