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Inside the war: life in Ukraine
  1. Alexander Shushkevich
  1. Institute of Pediatrics, Obstetrics and Gynecology named after acad. O.M. Lukyanova of the NAMS of Ukraine, Kyiv, Ukraine
  1. Correspondence to Dr Alexander Shushkevich, Institute of Pediatrics, Obstetrics and Gynecology named after acad. O.M. Lukyanova of the NAMS of Ukraine, Kyiv, Ukraine; a.shushkevich.private{at}

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Ukraine is the second largest European country located in the eastern part of Europe. It consists of 25 administrative regions with at least 140 districts. Ukraine shares land borders with Poland, Slovakia, Hungary, Romania, Moldova, Belarus, and Russia. The population of Ukraine is about 41.5 million people, of which approximately 3 million live in the capital, Kyiv.1

In 2020, among all Ukrainian females 79 402 cancer cases were diagnosed. The most common site of gynecological cancer is uterine cancer with an incidence of 41.3 cases per 100 000 population.2 The average mortality rate from gynecological cancers is comparable to that in other European countries. This is mainly due to the availability of cancer care.

The healthcare system was inherited from the USSR (Semashko Healthcare System) and provides free universal access to care for everyone.3 Unfortunately, the system has been stagnant for years, and this has resulted in a “parallel world” in which patients have to pay out-of-pocket bribes for all the components of treatment and diagnostics due to budget deficits, corruption, and lack of reforms in the healthcare system. However, in 2017 the parliament of Ukraine announced a set of reforms for building a new patient-orientated healthcare system. The main idea was to implement a new financing mechanism whereby the state pays directly for the specific needs of patients instead of financing hospital beds. This reform has demonstrated its worth, but there has been insufficient time for the changes to take effect.

On February 24, 2022, at around 5:00 a.m., the Russian Federation started bombing Ukrainian cities. By this act, they officially declared war against Ukraine. On the first day, Russian invaders attacked the largest cities in Ukraine: Kyiv, Kharkiv, Chernihiv, Mariupol, Sumy, Odesa, Kherson, Mykolaiv, and Zhytomyr. They commenced active offensive military movements in the East and North of Ukraine and occupied a number of territories. According to the official report of the Ministry of Health, after 3 weeks of war, 117 hospitals have been damaged, and seven of these destroyed (Figures 1 and 2). The healthcare system has ceased to function in the areas where fighting is taking place. Nearly 15 million people lost access to sufficient complex cancer care in the space of a day. Many of these individuals were forced to move to the West of Ukraine seeking help. This led to queues for professional cancer care and a shortage of chemotherapy agents.

Figure 1

Destroyed regional hospital in Volnovakha, Ukraine, 2022.

Figure 2

Maternity Hospital No. 3 after Russian Air Force bombing, Mariupol, Ukraine, 2022.

At the time of writing this article, there are nearly 3 million Ukrainian refugees as a result of the war. Poland has accepted almost 1.7 million refugees. Many of them, as well as women from eastern Ukraine who did not leave the country, need specific cancer treatment. To our delight, the Polish Society of Gynecologic Oncology have organized a "green corridor" for women with gynecological cancer. Ukrainian oncogynecologists moved online in order to triage patients and send them directly to a specific hospital in Poland. This union has helped us to balance cancer care in Ukraine. However, we cannot provide medical assistance for everyone who needs it.

Only 1 day of full-fledged war has been enough to destroy all that had been built up over a period of years by doctors and healthcare workers. Damaged hospitals, destroyed logistics, and refugees worsen the healthcare system. There is no place in war for modern cancer care for all the patients who need it in Ukraine and consequently our country urgently needs assistance from the global community to ease the burden for all our patients.

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  • Contributors AS is the sole contributor.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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