February 24, 2024, marks two years since Russia’s full-scale invasion of Ukraine. Believed to have inflicted hundreds of thousands of casualties, including tens of thousands of civilians, this violent and destructive war shows no signs of ending.

Apart from the devastating human losses, the damage inflicted on Ukraine over these past two years is immense: according to the World Bank’s newly published damage and needs assessment, as of December 31, 2023, the total cost of reconstruction and recovery in Ukraine is $486 billion over the next decade.

In health care, the damage has been near-ruinous in the most war-affected parts of the country. Overall, the health sector has so far sustained approximately $1.4 billion in damage, rising to a staggering $17.8 billion if including the removal of debris, demolition of destroyed facilities, and other losses.

Of the 9,925 public facilities in the sector prewar, 1,242 have been partially or fully damaged. The destruction was especially severe in the eastern Donetsk and Luhansk regions, and the neighboring Kharkiv region, which also borders Russia. Additionally, 787 pharmacies were damaged or destroyed.

The dire health care situation was exacerbated by the huge movement of people since the start of the war. In addition to the 6.5 million people who have fled and remain outside of Ukraine since February 2022, an estimated 3.7 million remain internally displaced, placing a huge strain on healthcare facilities in more protected parts of the country.
While many refugees have since returned to their country, the humanitarian crisis and human tragedy are deepening as attacks on Ukraine’s energy infrastructure, homes, and health facilities continue to kill and injure people and cause widespread psychological trauma.

Against this stark backdrop, Direct Relief ramped up the largest humanitarian aid response in its 75-year history and has continued to assist its core partners in Ukraine, including the Ministry of Health, with more than 1,900 tons of medical aid, valued at $1.1 billion wholesale, to support the efforts of health workers and community organizations. The organization has also provided more than $42 million in financial assistance to groups offering essential health services in response to the prolonged crisis.

As the war continues, Direct Relief is focused on rehabilitation services for war-injured people, psychosocial and mental health services, support of emergency, specialized, and primary care and support for making health care mobile as people continue to move throughout the country, and resilient power to sustain continuous health services.

Who Donated to the Response?

In response to the crisis, Direct Relief received contributions from 105,033 donors totaling $115,067,879 from individuals, foundations, businesses, and organizations located in 84 countries (including the U.S.). Donations from all 50 U.S. states and four territories were received.

Of the total amount of Ukraine Relief-designated contributions —
• $42,194,219 was contributed by 104,358 individuals
• $61,267,946 was contributed by 314 businesses
• $10,426,607 was contributed by 212 foundations
• $1,179,107 was contributed by 149 organizations

How Were the Funds Used?

Of the total Ukraine Relief-designated cash contributions received to date, Direct Relief has expended or committed $68,763,863 to improve the health and lives of people affected by the disaster.

This includes:

• $42,358,000 on financial assistance to entities and organizations supporting emergency response
• $16,556,544 on procurement of alternative power and backup batteries, field medic packs, specialized requested equipment and other supplies
• $5,372,683 on transportation (paid and pending)
• $4,476,636 on emergency personnel costs and other organizational response management expenses

Consistent with Direct Relief’s Donation Policy, 100 percent of funds received for specific emergency events are devoted entirely to those events, and none of the funds donated for the Ukraine response have been used for fundraising.

(As explained here, all Direct Relief's fundraising expenses are paid by the Direct Relief Foundation, which uses earnings on previously received bequests to the organization for this purpose and other non-programmatic costs.)

Medical Material Assistance

Direct Relief’s Ukraine relief response support can be divided into three categories: medical material assistance, direct financial assistance, and information assistance.

Direct Relief’s main objective in any large-scale disaster response is to deliver emergency medical resources safely and securely – requested, approved by the responsible government authority, and appropriate for the circumstances – where they are most needed, as fast and efficiently as possible.

In January 2022, prior to the start of the war, Direct Relief had been working in coordination with Ukraine’s Ministry of Health to import specialized Covid-19 monoclonal antibody therapies, a donation that established a key relationship that would provide a channel into the country weeks later under wartime conditions.

After the war broke out, Direct Relief was in constant communication with local, regional, and country-level organizations, including the Ministry of Health, to determine needs and requests for aid.

Direct Relief’s first emergency shipment consisted of field medic backpacks outfitted with triage tourniquets and other specialized equipment for first responders treating injuries of war.

As more requests became known, Direct Relief began to channel large volumes of aid via charter flights to the region as part of the response.

In March, a 76-ton charter, with transportation donated by FedEx, included specifically requested emergency medicines and supplies, including trauma and wound care products, chronic disease medications, oxygen concentrators, and Covid-19 antiviral tablets. A subsequent 52-ton charter departed in June, and FedEx also provided funding for many of the emergency medical backpacks sent.

As of Feb. 21, 2024, Direct Relief’s Ukraine relief response efforts have resulted in the delivery or pending delivery of 1,900 tons of medical aid, valued at $1.1 billion wholesale, to support health services.

As the response continued, Direct Relief began to focus on emerging needs:

REHABILITATION SERVICES

Both military troops and civilians have endured wartime injuries, and many 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.

People needing complex surgeries, long-term rehabilitation and prosthetics have sought care at Unbroken National Rehabilitation Center in Lviv. Direct Relief granted $1 million to Unbroken to procure rehabilitation equipment, develop treatment protocols, and train rehabilitation personnel.

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 Protez Foundation connects Ukrainians living with amputations to customized prosthetics and rehabilitation and is another organization Direct Relief supports. While Protez has recently opened a clinic in Ukraine, some patients are flown to the U.S. as a reprieve from the combat environment and are fitted for prosthetics. They spend at least three weeks, sometimes more, learning to use their bionic limbs and have access to familial-like support through the Ukrainian-American community.

Read more: Rehabilitation Effort in the Twin Cities Helps Ukrainians Recoup from War

Direct Relief has also been able to connect amputees with high-intensity prosthetic lower limbs, or running blades, equipment that is generally not covered by the Ukrainian health system. Access to these advanced prosthetics is drastically changing the lives of many victims of the war who thought their injury had put an end to their sporting activities or ability to serve their country.

RESILIENT POWER

War-time power interruptions can greatly impact health services, so Direct Relief has focused on providing resilient power options to Ukraine. The organization has provided more than 2,000 Tesla Powerwalls - rechargeable 13.5 kW lithium-ion batteries that can provide power during peak times, outages, and at night - to help keep healthcare and educational facilities operating during disruptions to the national power grid. This is a direct response to previous Russian attempts to destroy Ukraine’s energy supply during the coldest months.

Memories are still fresh of power cuts, with surgeons operating by flashlight during relentless missile and drone attacks last winter. Building on a separate project to supply more than 500 Powerwalls donated last year by the Polish government, this further installation of Tesla units will make a huge difference going forward.

In the town of Derhachi, five miles northwest of Kharkiv, two Powerwalls donated by Poland were installed last November at the local 100-bed hospital to supplement its generators in emergencies.

"Now we can be sure that all operations will go ahead and that no patients are lost because of power outages," said head surgeon Oleg Donchak.

- Recipient of donated back-up power at a hospital near Kharkiv, Ukraine

The impact of the combined lines of support is amply evident on the ground in Ukraine’s hardest-hit cities like Kharkiv. Here, assistance rendered via Direct Relief’s partners, as well as aid received from other international organizations, ensures quality health care for hundreds of thousands of people.

"We are grateful for all assistance with medicines, medical supplies, and electrical power. We wouldn't have survived without such support," said Kostiantyn Loboiko, the acting director of the Kharkiv Regional Hospital, which has 830 beds, a staff of 550 doctors and serves the whole of the heavily war-impacted Kharkiv region.

MENTAL HEALTH SUPPORT

About one-third of Ukrainians may be affected by mental health issues, with up to 15 million in need of psychosocial support and 3–4 million of those requiring direct pharmacological interventions by mental health professionals, according to a United Nations Development Program report issued in June 2023. 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.

The organization has funded psychosocial support programs for war-affected people, including through Razom's "Together with You” program in July 2022, providing psychological help to impacted individuals, including children. Direct Relief has provided $550,000 in funding to Razom for Ukraine for this program.

Razom currently provides care at seven centers in Lviv, Ivano-Frankivsk, Vyshkiv, Khmelnytskyi, Bucha, Kharkiv and Dnipro, where teams of experienced psychologists work with different age groups and specialize in different types of psychological trauma. In addition to individual therapy sessions, the specialists conduct group sessions at centers for displaced persons, hospitals, rehab facilities, geriatric institutions, and orphanages.

Direct Relief has also supported HromadaHub, a nonprofit providing humanitarian medical supplies to medical facilities throughout Ukraine and providing emergency psychology treatment. A key project supported by Direct Relief in 2023 was its emergency psychology training for Ukrainian psychologists and members of the state civil defense service to improve care for the civilian population after military attacks, disasters, and other traumatic events.

Outside of Ukraine, Direct Relief has also funded programmatic efforts of the League for Mental Health, which provided mental health outreach to Ukrainian refugees in Slovakia.

PRIMARY CARE AND HEALTH SYSTEM STRENGTHENING

Direct Relief is engaged in several different lines of activity to bolster health care in Ukraine. In areas where rural geography and the impact of war have curtailed access, support for primary and specialized community outreach health services, expanding capacity for early diagnosis, treatment, and prevention of disease. 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.

Direct Relief is continuing to support emergency, specialized, and primary health care services through the provision of funding, ambulances, medicines, and supplies in Ukraine.

Outside of Ukraine in support of primary healthcare services, Direct Relief provided funding for prescription medication support and telehealth services for Ukrainian refugees in Poland. Poland-based organization Pelion had, by the end of 2023, supported 318,000 Ukrainian refugees to purchase medicines under its Health4Ukraine program, or 18% of the total number of people that came to Poland after the war's start.

Direct Financial assistance

Thanks to the outpouring of financial support from donors, Direct Relief continues providing cash assistance to help facilities and organizations effectively respond to the ongoing needs of patients impacted by the war.

To date, Direct Relief has identified, vetted, and awarded emergency financial support totaling more than $42 million in cash support for groups responding to medical needs related to the war.

Funding has been focused on the following categories and organizations:

Information Assistance

In addition to the provision of medical material and financial aid in response to the crisis, Direct Relief has been a critical supplier of information. Working with software company partners, academic institutions, and medical centers, Direct Relief has used crowdsourced data, geospatial analysis, and other data collection and analytics instruments to help understand key issues in the war.

Within Ukraine, Direct Relief has focused mainly on assisting with crowdsource data collection on the needs of internally displaced persons, including their origins and destinations, access to key services and goods including health care, food, water, shelter, and livelihoods, and their sentiment in terms of subjective concerns.

At the same time, Direct Relief collected data on the needs and goods availability of over 950 private pharmacies throughout Ukraine, including many located in areas of significant conflict. The pharmacy data has been incorporated into the cross-validation of MOH needs lists. Important insights were shared with first responders, healthcare partners, and Ukrainian health officials, as well as with United Nations agencies and international assistance organizations to help them determine how to best prioritize and deploy their respective resources.

Supporting Ukrainian Refugees

Direct Relief’s principal role in providing information assistance for the refugee crisis in the European Union and Moldova comes through the analysis of human mobility data. Analysis of this data allows for an improved understanding of refugee movements at granular time and space scales for the sake of resource planning and allocation across several different sectors of activity. This analysis has been performed through Direct Relief’s CrisisReady partnership with Harvard University School of Public Health and shared broadly with a range of agencies who have requested specific types and locations of analysis.

Key analysis-sharing partners include the World Bank, UNICEF, UNHCR, IOM, the Health Cluster, Mercy Corps, and others. In partnership with Meta, Direct Relief is in the process of assembling an EU-based research network that is capable of supporting municipal-level analyses, with the immediate focal point of that effort being support for a collaboration between UNHCR and the city government of Budapest which aims to understand changes in refugee clustering throughout the city for the sake of housing retrofits for long-term refugees.

Corporate Support

Direct Relief was able to supply a large array of medical material support without the expenditure of donor funds due to the medical product donations from healthcare manufacturers and distributors, many of which Direct Relief works with on an ongoing basis.

Healthcare company donors responded expansively to requests for their participation. Included among them are 3M, Abbott, AbbVie, Accord Healthcare, Amgen, Apotex, AstraZeneca, Baxter, Bayer, BD, BioMarin, BMS, Boehringer Ingelheim, Carlsbad Technology, Cencora, Corza Medical, Edenbridge, Eli Lilly & Co., Embecta, Genmab, Gilead, Grifols, GSK, Haleon, Henry Schein, Hikma, ICU Medical, Integra Lifesciences, Janssen, Jazz Pharma, J&J, Kenvue, Liquid IV, McKesson, Medline, Merck & Co., Merck KGaA, Pfizer, Sandoz, Takeda, Teva, Ultragenyx, Unilever, Unite to Light, Vertex, Viatris, and Westminster.

The war continues, with no end in sight, and medical needs remain urgent as attacks continue. Direct Relief remains committed to providing support to strengthen local health systems, as well as to a number of focus areas in Ukraine.

As the response continues, Direct Relief remains able to provide support as a result of its existing strong relationships with non-governmental organizations that were already receiving Direct Relief medical product shipments, ongoing work with clinical experts in the field to guide distribution and procurement decisions, existing partnerships and contracts in place to quickly request and receive high-quality medications from pharmaceutical manufacturers and distributors, and a strong track record of shipping large volumes of product, including those requiring cold chain packaging and storage, to difficult-to-access places to reach the most vulnerable patients.

Direct Relief is focusing on these areas for long-term recovery by directing funding and medical product support for the continued strengthening of the health system.