ZOLOCHIV, Ukraine (AP) – Dr. Ilona Butova looks almost out of place in her neatly ironed lavender scrub as she walks through a doorway hanging from a crumbled wall into what used to be an administrative office at her Zolochiv hospital.
Not a single building at the facility in the northeastern Ukrainian city near the Russian border was spared artillery shells.
Since the Russian invasion on February 24, the space available to treat patients in the hospital has steadily shrunk due to damage. Their staff has shrunk from 120 to 47. And the number of people seeking treatment in the small town 18 kilometers from the border is often higher today than it was before the fighting began.
For years, Ukraine’s healthcare system has struggled with corruption, mismanagement and the COVID-19 pandemic. But the war has only made things worse as facilities have been damaged or destroyed, medical staff have been relocated to safer locations and many medicines are unavailable or in short supply. In the hardest-hit areas, care is being provided by doctors who have refused to evacuate or who have rushed in to volunteer, putting themselves at great risk.
“It’s very difficult, but people need us. We have to stay and help,” said Butova, a neurologist and administrator of the hospital in the city near Kharkiv, Ukraine’s second largest city. She added that she needed to do more with fewer resources.
The World Health Organization declared the highest level of emergency in Ukraine the day after the invasion and coordinated major relief efforts there and in neighboring countries whose medical systems are also under pressure.
According to UN estimates, around 6.4 million people have fled to other European countries, and a little more are internally displaced. This poses major challenges for a healthcare system based on family doctor referrals and regionally separate administrations.
Across Ukraine, 900 hospitals were damaged and another 123 destroyed, Health Minister Viktor Liashko said, noting: “Those 123 are gone and we need to find new sites to build replacements.”
In addition, scores of pharmacies and ambulances were destroyed or badly damaged, and at least 18 civilian medical workers were killed and 59 others seriously injured, he said.
“In the occupied territories, the remittance system has completely collapsed,” Liashko told The Associated Press. “People’s health and their lives are at risk.”
Kiev’s economy was drained by the conflict with Moscow-backed separatists in eastern Ukraine that began in 2014. When he came to power five years later, President Volodymyr Zelenskyy inherited a healthcare system undermined by reforms instituted under his predecessor, who slashed government subsidies and closed many small-town hospitals. During the pandemic, people in these metropolitan communities have had to seek help — sometimes waiting up to eight hours for an ambulance in severe cases of COVID-19.
As Russia has expanded territory under its control in eastern and southern Ukraine, the supply of medicines in those areas has shrunk along with the medical staff to administer them. In the southern frontline town of Mykolaiv, “things were very difficult,” volunteer Andrii Skorokhod said.
“Pharmacies weren’t working and the shortage was getting worse: hospital staff were among the evacuees, including medical specialists. We just need more staff,” said Skorokhod, who is leading a Red Cross initiative to provide residents with free medicines.
Volunteers like Skorokhod saved the life of 79-year-old Vanda Banderovska, whose home near Mykolayiv was destroyed by Russian artillery. Her 53-year-old son Roman was killed and she was taken to hospital with severe bruises and barely conscious.
“My son went to the car to get his phone when the Russians started shelling. He was hit in the head,” she said at a convalescent ward, her voice shaking with emotion. “They destroyed everything and I have nothing left.”
Banderovska said she was deeply grateful to the people who saved her life, but was also overcome with sadness and anger.
“The pain I feel is so great. When the doctors took me to the hospital I was bruised blue and blue, but I was slowly recovering,” she said.
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Derek Gatopoulos reported from Kyiv. Vasilisa Stepanenko and Hanna Arhirova contributed to this report from Kyiv.
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Follow AP’s coverage of the war in Ukraine at https://apnews.com/hub/russia-ukraine