In May 2023, Direct Relief reported on the work of a new NGO distributing donated oncological medicines across Ukraine amid the chaos of a major war.

Fourteen months later, Mission Kharkiv, based in the eponymous eastern city, has grown into a robust healthcare provider. It is also garnering kudos from international agencies for a ‘first’ in this highly specific field.

According to organizations that form the Ukraine health cluster, “no one provided a complete course of chemotherapy in a city under siege before,” said Ross Skowronski, who founded Mission Kharkiv 18 months ago.

“So it looks like we are the first NGO in the world, despite that we are very small, who did that,” he adds with some wonderment at how far the NGO with 15 employees has come in such a short time.

It’s not just the large number of unique oncological cases it handles – up from 700 patients last year to more than 2,500 today. The last piece of the chemotherapy cycle was the provision of niche therapy sessions for people grappling with a harsh new reality.

“Since our team members communicate on a daily basis with the patients, for us it became evident very early that mental health is needed for them and their relatives as well,” said Skowronski, a mathematician who relocated to his birthplace Kharkiv from Spain just before the Russian invasion in February 2022.

A survey conducted among the NGO’s patients and their relatives showed that 68% needed mental health support, and 35% expressed a strong desire to participate in any mental health sessions offered.

In collaboration with large international organizations, the first two attempts to organize support in both online and offline formats incurred a high dropout rate among participants. “Obviously there is a stigma surrounding mental health in Ukraine, which is very substantial,” said Skowronski. “What was interesting to know was that the oncology patients felt detached from sessions conducted by very big organizations because they perceived this [as a] corporatized and standardized approach.”

The elusive successful pilot project finally came about with the hiring of Ihor Prokopiuk, a Ukrainian psychotherapist living in Spain who has 16 years’ experience working with terminally ill patients. “Regardless of the setting, this [group therapy] helps, it provides a means of living differently,” said Prokopiuk.

“If we are talking about really difficult situations, like cancer sickness and war on top of that, it’s obviously terribly difficult for people to deal with, to find meaning in their life and to stop wanting to hide themselves away every morning.” He also noted the entrenched stigma, linking it to the former Soviet authorities’ use of psychiatric institutions as a punitive measure, often causing deep psychological harm to people in the process: “These prejudices are now easing, but Ukrainians are still very ‘specific’ in this regard.”

The pilot project in Kharkiv lasted two months, with one two-hour online session a week for ten participants. It produced extremely positive feedback at the end.

“Only one patient dropped out and the others reported that for them it was a life-changing and life-supporting experience and expressed a strong desire to continue,” said Skowronski. “It looked like we had finally cracked this problem into a mental health project for oncology patients. Now we want to continue.”

According to the Ukrainian Ministry of Health, the country currently has almost 1.2 million registered oncology patients, with the addition of some 100,000 new patients each year. State cancer treatment is free, but in war conditions, specialized medicines are often unavailable at hospital dispensaries, leaving patients to find and buy them themselves. That’s where Mission Kharkiv comes in.

The work is complicated by the dispersal of its patients across Ukraine. The country covers more than 600,000 km2 (230,000 square miles), or almost the size of Texas, making the transportation of costly medicines at controlled temperatures difficult.

In the early months of the war, however, there were cases where people came to war-torn Kharkiv from as far as Lviv and other western cities, making a more than 2,000-km (1,240-mile) journey in hazardous conditions to collect their medication.

Today, in addition to its bomb-proof, temperature-controlled storage “bunker” in Kharkiv, the NGO uses secure storage facilities in the cities of Dnipro, Kyiv and Lviv to make collection easier for patients and their relatives.

One medicine supplied to Mission Kharkiv by Direct Relief is Trastuzumab, which is typically administered at three-week intervals over several months to treat different types of cancer, often in combination with chemotherapy and other drugs.

If privately purchased, a single dosage costs more than ten times her monthly pension, said Lyubov, 68, who lives in the Lviv region. Now, thanks to the organization, she either receives the medicine there or it is relayed from the stocks in Kharkiv in a cold box via a courier.

“It’s a really good organization, they helped me so much, and their people really understand oncology,” said Lyubov. She is frank that while the treatment doesn’t ultimately change the outcome for her, it does change her outlook. “This is incurable, that’s just the way it is. But right now, life goes on, and it goes on normally.”

Of several Mission Kharkiv patients with different oncological conditions who were consulted for this article, it is notable that no one dwelled on themselves when asked about the future. The focus was rather on the greater good as Ukraine fights for its survival.

“I want there to be peace,” said Galina, a 68-year-old former sports school administrator, also from the Lviv region, who has received support from Mission Kharkiv since January 2023. “Everyone dreams of things being like they used to be, when you just went to work and there were no air alarms, and it was just peaceful.”

At the start of the year, Skowronski took a much overdue break and went to Pakistan. While there, he also contacted local oncology specialists to inquire about the situation in the South-Asian country.

What he discovered opened his eyes to the possibilities of transferring Mission Kharkiv’s expertise to other countries burdened by some of the same problems as Ukraine: “Their energy grid is quite bad, there is a lack of supplies of chemotherapy medicine, they are facing a corruption situation, and cancer data is not collected properly.”

After 18 months developing Mission Kharkiv, he believes they are ready to launch something further afield, be it in Pakistan or beyond: “We have our standard operating procedures, we know how to build the bunker, we corrected lots of mistakes that appeared and that we were not aware of, so we now have the experience and can replicate that in other countries.”

Meanwhile, there is still a missing part in Ukraine’s oncological system. Another project in preparation is for Mission Kharkiv to assist the Ukrainian government to gather exact data on where active substances are prescribed.

While its medical statistics department records cancer incidence rates, the prescription of active substances and dosages are not monitored. As a result, government procurement is based on approximated data, rather than actual demand.

“If we do that [data gathering] on a sustainable basis we can close completely the medication aid project and the government can hopefully take care of it forever,” said Skowronski.

Mission Kharkiv is among Direct Relief’s core partners in Ukraine. Since 2022, Direct Relief has provided the organization with more than $40 million in medications and supplies to care for patients across Ukraine.