Overcoming barriers to accessing rehabilitation in Ukraine amidst conflict

Injuries sustained during a war can lead to devastating and long-lasting physical and psychological complications. To minimize such impact and promote steady recovery, it is important to start rehabilitation care as early as possible. In Ukraine, the need for rehabilitation has arguably never been greater.

Rehabilitation needs on the rise

Rehabilitation helps a person to be as independent as possible in their daily life. It enables participation in education, work, recreation and meaningful activities, such as taking care of family. In 2019 half the population of Ukraine could have benefited from rehabilitation services, a number that even then was considered an underestimation, as it was linked to noncommunicable conditions such as cardiovascular disease or diabetes. The COVID-19 pandemic and the ongoing war have vastly increased the country’s rehabilitation needs.

“The war has increased the demand for rehabilitation, but also the difficulty in accessing these services,” said Dr Satish Mishra, Technical Officer for Disability, Rehabilitation, Palliative and Long-term Care at the WHO Regional Office for Europe, while opening a high-level online event on the issue organized by WHO/Europe on 7 March. “The barriers we’ve seen include targeted attacks on health-care facilities, fewer available health-care workers due to displacement, reduced public transport, interrupted supply chains, and power shortages. Yet, despite these challenges, health authorities and partners, including WHO, are finding ways to strengthen rehabilitation efforts nationwide.”

WHO/Europe is supporting the development of rehabilitation services in Ukraine, as well as its citizens’ access to assistive technology and disability-inclusive services at home and in neighbouring countries. This is done in close collaboration with key ministries and many national and international partners.

Modernization of rehabilitation systems

Ukraine had launched the creation of a modern and effective rehabilitation system and accelerated the development of health systems reforms years before the invasion by the Russian Federation on 24 February 2022.

The war added new challenges to that process but did not halt it, noted Iuliia Sokolovska, Deputy Head of the Office of the President of Ukraine. “All injured citizens start receiving rehabilitation assistance in the hospital immediately after surgical or other interventions, with the involvement of multidisciplinary teams,” she said, emphasizing the enormous complexity of amputations and reiterating the importance of assistive technology, which WHO supplies to the country in partnership with ATscale, the global partnership for assistive technology. “The restoration of Ukraine is primarily the restoration and development of human capital,” Sokolovska concluded.

WHO experts conducted a technical mission to Ukraine in July 2022 to further assess the situation and requirements for rehabilitation and assistive technology in the country, including for people with disabilities.

The Ministry of Health of Ukraine and WHO have been conducting strategic collaboration in the field of rehabilitation since 2015, after the conflict with the Russian Federation first escalated. In his remarks at the session held on 7 March, Minister of Health Viktor Liashko noted the impact of this work, such as the adoption of the law about rehabilitation in health care in 2020, which placed an emphasis on rehabilitation starting from the onset of an acute health condition.

In the past few years new rehabilitation-related professions have been introduced in Ukraine: physical, occupational, speech and language therapists. The unique skills of these specialists are essential to helping patients with complex traumas, such as traumatic brain injuries or spinal cord injuries. Rehabilitation specialists receive comprehensive training and mentorship from international experts, including at a WHO-supported centre in Rivne.

Resilience in health care

Insufficient rehabilitation can have devastating consequences, leading to mental and physical decline, as well as exclusion from society, but Ukraine’s health system continues to be resilient, even after well over 800 attacks on health care, according to Dr Jarno Habicht, WHO Representative in Ukraine. “As of today, WHO has supported more than 4000 people in more than 25 facilities with rehabilitative services,” he said, thanking health-care workers across the country. “We need to work on response, recovery and reforms at the same time.”

Rehabilitation is an essential component of universal health coverage and of emergency response. WHO/Europe is committed to supporting rehabilitation efforts in Ukraine together with many partners and donors, including the United States Agency for International Development, United Nations Office for the Coordination of Humanitarian Affairs, United Nations Partnership on the Rights of Persons with Disabilities, Directorate-General for European Civil Protection and Humanitarian Aid Operations, United Kingdom’s Foreign, Commonwealth & Development Office, and the Ministry of Foreign Affairs of Norway. This work is also supported by the WHO European Framework for action to achieve the highest attainable standard of health for persons with disabilities.