Victoria (not her real name) is a primary health care doctor who lives in Ukraine’s Sumy region. She helps deliver essential health services to people trapped by constant shelling and severe security constraints in frontline areas of the country.
“The day before each visit, we carefully pack everything our patients might need. First, we organize the medicines and medical supplies, provided through humanitarian assistance, and then we prepare all the equipment and materials required to deliver emergency care.
“We work in communities where access to health services and essential medicines is severely limited, and in some places, there is no access at all. In most locations there is no mobile coverage or internet connection, so referrals, prescriptions and patient documentation are all filled out by hand.
“When the project first began in 2022, our team carried out 4 field visits a month. Today, we conduct 10.”
Reaching out to communities
Victoria works in one of the mobile primary health care teams that operate across 7 frontline regions of Ukraine: Chernihiv, Dnipropetrovsk, Kharkiv, Kherson, Mykolaiv, Sumy and Zaporizhzhia. They deliver essential primary health care services across 121 settlements where there are no pharmacies and no functioning health facilities. This is the largest mobile primary health care initiative operating in Ukraine’s frontline regions.
The initiative is implemented by WHO in partnership with the Ministry of Health of Ukraine and the Ukrainian Academy of Family Medicine, with financial support from the European Union.
Most of the patients are older people and women with children. Women account for more than 70% of all patients, reflecting the demographic reality of these communities. One in every 10 consultations is provided to a person with a disability, while nearly 14% of patients are internally displaced people who were forced to flee their homes but are no longer able to evacuate further from danger.
The teams’ routes are continuously adjusted to reflect changes in the security situation and shifts in the frontline.
Home visits
Victoria explains that when the team arrives in a community facing a high risk of shelling, they cannot safely ask people to gather in one place. Instead, they visit patients in their homes, including those with limited mobility who are physically unable to reach the consultation points.
“If, during an examination, I see that a patient needs to see a specialist, I issue a referral right away. If there is mobile coverage after we return from the field, I call the patient and provide the referral number over the phone. If there is no connection, I deliver it during our next visit. Sometimes we end up solving everyday problems because there is simply no one else to help.
“I remember arriving at a patient’s home shortly after a massive aerial bomb attack. As soon as we stepped inside, we realized there was a major gas leak caused by damage to the house. We immediately contacted the emergency services and did everything we could to get help as quickly as possible. It wasn’t why we had come, but we simply couldn’t leave someone alone in such a dangerous situation.
“On another occasion, we visited a village near the active frontline where only 10 residents remained. Public transport had stopped running, food deliveries had ceased and the local pharmacy had closed. Along with medicines, we started bringing bread because people had nowhere to buy it. Most younger residents had already evacuated, leaving older people with no one to support them.
“People genuinely look forward to our visits. In many of the communities we serve, there are no health workers and no pharmacies, and public transport is no longer operating. For many residents, our team is their only access to health care.”
“There is always someone worrying”
“We work very close to the frontline. But the reality is that the frontline changes constantly, and our routes change with it. The closest I have ever worked was about 15 km from active fighting.
“People living close to the frontline often have no way of contacting family members who have relocated to safer areas. With mobile networks and internet access frequently unavailable, their loved ones worry and often ask us to pass on a message or simply let them know that everything is alright.
“As for our own families, every deployment is a source of constant stress for them as well. Our parents worry. Our children worry. Whenever we regain a signal during a mission, one of the first things we do is send a message or call home. When I have to travel to particularly dangerous areas, I leave my relatives’ contact details with the coordinator and ask them to reach out if I remain out of contact longer than expected.
“I have a colleague whose mother worries deeply about every deployment, so sometimes she simply chooses not to tell her about upcoming trips in advance, just to spare her additional anxiety.
“Of course, this is not easy for anyone, but our loved ones understand how important this work is. In many ways, our families are our greatest source of emotional support.
“After a difficult day, all you want is to come home and hug the people you love.”