Ukraine’s Wartime Healthcare: Inna Ivanenko on Access, PMG, and Medicines

Inna Ivanenko is the Executive Director of the Patients of Ukraine Charitable Foundation, a leading Ukrainian NGO that defends patients’ rights and access to treatment. She has worked for years to advance transparent medicine procurement, curb corruption, and shape health-system reforms, and now steers patient advocacy through wartime disruption. Under her leadership, Patients of Ukraine collaborates with national authorities and international partners to improve reimbursement, supply chains, and service delivery, while elevating patient voices in policy. Ivanenko frequently briefs global forums, including the European Health Forum Gastein and the Ukraine Recovery Conference, on resilience, recovery, and equitable access to care in Ukraine.

In this discussion, Ivanenko outlines wartime damage and hard-won resilience. She cites 2,530 facilities hit, 327 destroyed, alongside hundreds restored. The Program of Medical Guarantees and Affordable Medicines sustain nationwide access, including mobile clinics and pharmacies. However, supply chains falter from unreliable suppliers, registration delays, and destroyed warehouses. Scott Douglas Jacobsen probes bottlenecks, equity for IDPs, and funding gaps. Ivanenko notes a mid-year budget increase, three oncology drugs moving to outpatient coverage, and persistent shortages of costly second- and third-line therapies. She urges investment to keep families home, protect medevac teams, and secure resilient procurement.

Scott Douglas Jacobsen: Thank you very much for joining me today. The World Health Organization has documented thousands of attacks on healthcare since the full-scale invasion. How significant are delayed care, forced referrals, and medicine shortages?

Inna Ivanenko: I can start with the statistics on how many hospitals have been damaged, ruined, or rehabilitated. Since the start of the full-scale invasion, 2,530 medical facilities (within 815 healthcare institutions) have been confirmed damaged or destroyed; of these, 327 were destroyed. The regions that have suffered the most significant damage to medical infrastructure include Donetsk, Kharkiv, Dnipropetrovsk, Kherson and Zaporizhzhia. Despite this, we continue rehabilitation wherever possible: as of November 2025, 700 facilities have been fully restored and 320 partially restored, but 57 previously repaired facilities were damaged again. In frontline areas, people who still live there have the worst access to care because even reaching medical services can be dangerous; civilian travel routes and infrastructure face frequent attacks, including with short-range drones and aerial bombs. Even in these conditions, there are still possibilities to seek healthcare services outside their communities, though disrupted supplies, staff shortages, and transport barriers continue to delay or prevent care.

The healthcare system in Ukraine is designed so that people can access state-funded medical care without restrictions. It does not matter where people live or where they are registered; they can receive medical care anywhere in the country whenever they can reach it and access medicines or healthcare services. This flexibility exists because of the 2017 reform of the entire healthcare system. Also, to help people access healthcare services even in territories close to the frontline, the country has developed various types of mobile clinics that bring doctors, medicines, and diagnostic equipment directly to communities. These are relatively simple but effective in mobile conditions. The same applies to mobile pharmacies—there are many projects in which pharmacies travel to communities so that residents can obtain medicines.

It is also essential that primary healthcare facilities and hospitals are being rehabilitated across controlled territories, as the primary healthcare network is considered optimal for the country. Even in the first and second years of the war, our organization, Patients of Ukraine, received support from Crown Agents, a British company. With their help, we rehabilitated 46 hospitals in newly liberated territories. This was a successful and motivating project because when a hospital begins operating in a community, people start to return. They come back knowing that they can access medical services and that doctors are present.

The hospitals we rehabilitated were relatively small, providing only primary care, but we tried to make them as independent as possible—with their own heating, internet, and generators in case of blackouts—so electricity was always available. People knew that in their community, they had such a hub, not only for receiving healthcare services but also as a safe, warm place to gather during blackouts. Other organizations and donors are still rehabilitating these primary healthcare facilities, since our project has ended, but there remains a strong need for this work across Ukraine.

We have also seen that Russia attacks medicine warehouses. Recently, at the end of October, during an attack on Kyiv, a vast warehouse belonging to one of the largest medical suppliers, Optima Pharma, was destroyed. Fortunately, these companies distribute their goods across multiple locations, so although many medicines were lost in that particular warehouse, it did not cause a collapse in the Ukrainian market.

Everyone understands these risks, and there are other storage sites for life-saving medicines. The situation remains under control through the efforts of private companies, the Ministry of Health of Ukraine, and the State Enterprise Medical Procurement of Ukraine, which purchases medicines with state funds for distribution to hospitals across the country. Another major problem concerns medical evacuation teams operating on the frontline. They are frequent targets for Russian attacks, especially from drones. We respond by supporting them and purchasing electronic warfare systems to protect these teams. This helps save the lives of medics and defenders on the frontline. So far, we have purchased about 100 such systems, but the need is in the hundreds, and with our current resources, we can only meet a portion of that demand.

Jacobsen: One thing that comes to mind, particularly regarding the Optima bombing, was whether there were other similarly devastating effects on the supply lines, such as shortages of vehicles for mobile clinics or medical supplies? Given the complexity of the medicine-delivery and treatment process, were there specific points along this chain that have been particularly vulnerable or targeted?

Ivanenko: Regarding the Optima warehouse, the medicines stored there were primarily for pharmacies. As far as I know, the company has a backup warehouse system for pharmacies, but some of the drugs were stored at that facility, which was destroyed. Some of the medicines procured through state funds for hospitals and patients with severe diseases were also affected. Optima has its own vehicles and an extensive distribution network to deliver drugs directly to pharmacies from other warehouses that were not damaged.

As for hospital distribution, it is managed directly by the State Enterprise Medical Procurement of Ukraine, which has its own vehicles. This is a serious challenge for distributing life-saving drugs to oblasts close to the front lines. Not all drivers are willing to risk going to Kherson or to parts of Mykolaiv or Zaporizhzhia regions, but frankly speaking, there are no alternatives. They must rely on their own transport. Regarding mobile pharmacies, theydo not have enough vehicles, as these operate mainly through donor-supported projects. Expanding this network across all Ukrainian regions takes time, and while it provides essential access, it does not yet cover every area with high demand for such services.

Jacobsen: One small follow-up to that would be the reverse of what I just mentioned. Are there areas where the need is not as great because supply lines and delivery mechanisms are sufficient, even in wartime? In other words, while some regions lose access to medicines after events like the Optima bombing, are there other regions where supplies and conditions remain relatively stable?

Ivanenko: I can divide the answer into two parts. Mobile pharmacies typically serve regions far from oblast centers, bringing medicines under Ukraine’s Affordable Medicines program, which provides essential drugs for people with chronic diseases. This program ensures that patients can access their medication even when there is no permanent pharmacy in their village or community. Local and regional administrations are aware of residents who rely on these medicines and coordinate with mobile pharmacies to meet their needs. Regarding other life-saving drugs administered in hospitals, these are delivered by the state enterprise using its own vehicles, and patients receive them at hospitals.

Despite the war, the system continues to develop and improve access to medicines, bringing services closer to patients. For example, as a patient-based organization, we advocated with the Ministry of Health and the National Health Service of Ukraine to move certain oncology drugs from the state procurement system to the Affordable Medicines program. Starting from November, three oncology drugs have been transferred to this program and are now available in pharmacies and mobile pharmacies. This means patients no longer have to wait for hospital deliveries—they can go to a pharmacy and get their treatment. It is a patient-oriented approach introduced at the right time, and patients have welcomed these changes since the drugs can be taken on an outpatient basis, making treatment more convenient and accessible.

Jacobsen: According to the World Health Organization, more than 65 percent of households encounter barriers when seeking care due to out-of-pocket costs. Are those constraints felt most by patients with chronic diseases, such as those with oncology or rare conditions?

Ivanenko: The answer to this question lies in budgetary constraints on healthcare. Unfortunately, there is still not enough funding allocated from the state budget, particularly for medicines and especially for second- and third-line therapies, which are life-saving for patients with severe diseases such as cancer and rare conditions. As a result, people often have to pay out of pocket—if they can even find these medicines in Ukraine, since availability is also a significant issue. Many second- and third-line therapies are not available in pharmacies because they are costly, and not all manufacturers are willing to register these drugs in our country. This creates a serious problem for patients with severe illnesses who need access to such treatments.

We are doing our best to persuade the government and parliament to allocate more funding for life-saving medicines. This year, for the first time in my 17 years in healthcare, parliament increased the budget for essential drugs mid-year, adding 3 billion hryvnias. It is not enough, of course, but it is progress. Thanks to this funding, the state was able to sign contracts with one pharmaceutical company to supply three innovative oncohematology drugs. It is a step forward, though the gap remains large.

Overall, Ukraine faces a severe problem in this area. The healthcare, education, and social sectors all rely heavily on international support and donor funding, since Ukrainian tax revenues are directed primarily toward defence. Healthcare today continues to function essentially thanks to the ongoing assistance of our global partners.

According to calculations by the Ministry of Health of Ukraine, the need for 2026 is 228 million euros solely for medicines, to ensure patients can access life-saving treatments. Perhaps you are not aware that not all patients with severe diseases have access to state-covered drugs. For example, certain rare conditions, such as autoimmune diseases, achondroplasia, or Duchenne muscular dystrophy, are not covered by the state budget at all. As a result, patients must rely on constant fundraising, which is exhausting and unsustainable. The cost of these drugs is enormous, and families—especially those with sick children—are forced to seek treatment abroad.

Unfortunately, this means Ukraine loses valuable human capital, as entire families emigrate to Europe or other countries. It is not only a tragedy for those families but also a burden on European systems, which must initially provide them with healthcare and support. It would be far better to invest in life-saving drugs here in Ukraine, allowing people to stay, work, raise their children, and defend their country, rather than being forced to leave to survive.

Most people do not want to move abroad—they must do so to access treatment. Families with children who have severe diseases and now live abroad also want to return home. We remain in contact with many of these patients and their parents living in various European countries, and all of them express a desire to come back. However, after experiencing the difference in healthcare accessibility, they know that if they return, their children will not receive the essential treatments they need. Thus, they remain abroad.

Investment in healthcare could bring people back to Ukraine. These families are ready to return and work here—if only they could have reliable access to treatment at home. I think that fully answers your question.

Jacobsen: From a patient perspective, where does the Program of Medical Guarantees (PMG) succeed in practice, and what are the areas that still need improvement?

Ivanenko: In general, we are satisfied with the Program of Medical Guarantees, especially during wartime, because it allows people to receive medical services anywhere in the country. We are not tied to a specific territory or doctor. Patients are free to choose where they receive medical care, which is a significant advantage of the program.

The same applies to medicines provided through the Affordable Medicines program. People can access their medication at any pharmacy in the country, either free of charge or with a small co-payment, through a system also financed by the PMG. It is a barrier-free program that gives people real access to their medicines. Patients can also book appointments online and have remote consultations with doctors, something that was not possible before the PMG was introduced.

Another essential feature is that the National Health Service of Ukraine pays hospitals for each patient and each specific case. This has helped change the mindset of hospitals, doctors, and patients alike. They now understand that the state compensates them fairly for the services provided, and in many cases, the tariffs are comparable to those in European countries.

As for improvements, the main focus should be on strengthening primary healthcare. Family doctors should have more responsibility and be able to address around 80 percent of patients’ needs, with only about 20 percent referred to secondary or tertiary care. Currently, that balance does not exist in Ukraine. This requires not only better training for primary care doctors but also greater health education for patients. People need to take responsibility for their health, schedule regular checkups, and use the preventive services available to them at no cost. Unfortunately, many Ukrainians delay seeing a doctor until they are seriously ill, making treatment much more expensive and complicated.

Beyond the PMG, another area for improvement is the Ministry of Health’s overall healthcare infrastructure. Ukraine still has a legacy from the Soviet Union—too many hospitals, more than the population requires. Every region and community tries to preserve these large hospital buildings, often without enough patients to justify their operation. It would be more effective to optimize the network, focusing resources on strengthening primary healthcare rather than maintaining extensive, underused facilities.

These are the main areas where the PMG and the broader healthcare system can continue to improve.

Jacobsen: The Affordable Medicines program has expanded significantly, serving millions. Even so, what are the current bottlenecks?

Ivanenko: We need to expand this program further. We are in constant contact with the leaders of patient organizations representing people with 27 different medical conditions, and we understand their treatment needs. Many of these needs could be addressed through the Affordable Medicines program. We already have a list of medicines to add to the program. However, the key issue is budgeting. Some medicines have been added, but there is still a long waiting list of drugs and medical devices that could broaden the program’s scope. We are in continuous dialogue with the Ministry of Health, the National Health Service, and the Ministry of Finance to increase funding for both the Affordable Medicines program and the Central Procurement Program.

Jacobsen: Supply chains and inflation continue to strain medicine availability—not necessarily because of bombings or attacks on storage facilities. Which distribution reforms could help stabilize inpatient drug supplies?

Ivanenko: The main issue concerns the distribution of medicines procured centrally under the state budget through the State Enterprise Medical Procurement of Ukraine. We fully understand how this process works at every stage, and the biggest problem right now lies with unreliable suppliers who fail to deliver medicines on time. They sign contracts with the state but do not fulfill their obligations promptly. Some life-saving drugs are delayed for up to nine months. This is not a logistical issue like postal delivery—it is about medicines that need to cross Ukraine’s borders, often from India or other countries, and they are not being supplied on schedule.

In some cases, the winners of state tenders are suppliers of drugs that are not even registered in Ukraine. This situation is technically legal under current regulations because tenders are often awarded to the supplier offering the lowest price, even if their medicine is not yet registered. Those suppliers are then given a specific number of days to complete the registration and deliver the drug.

This process, however, is a nightmare for patients. There are frequent delays because these suppliers fail to register the drugs on time, which in turn prevents timely delivery. Oncology patients, for example, have been left waiting nine or ten months without access to life-saving chemotherapy. It is devastating.

We have been working with the Ministry of Health and the State Enterprise Medical Procurement of Ukraine to develop mechanisms to prevent such suppliers from winning future tenders. There are discussions about introducing blacklists or other accountability measures, but we will have to see how effectively they are implemented. At the moment, this remains one of the most urgent and challenging issues in the medical supply chain.

Jacobsen: Finally, there are millions of returnees and internally displaced persons (IDPs). What measures are improving equitable access to medicines and guaranteed healthcare services for IDPs, older people, and people in remote areas?

Ivanenko: As I mentioned earlier, IDPs—like all Ukrainians—have access to medical care under the Program of Medical Guarantees throughout the entire country. It does not matter where they are currently located; they can choose any clinic or hospital that has a contract with the National Health Service of Ukraine to receive free care.

The same applies to the Affordable Medicines program. People can use it anywhere in Ukraine. Recently, the Ministry of Health issued an order requiring every pharmacy in the country to have a contract with the National Health Service under this program. Previously, participation was optional; now it is mandatory, which significantly improves access.

So, regardless of where someone lives—whether they are displaced, elderly, or in a rural area—they can receive both medical services and medicines through these national programs.

Jacobsen: Thank you for the opportunity and your time, Inna.

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Scott Douglas Jacobsen is a Writer-Editor for The Good Men Project with more than 1,800 publications on the platform. He is the Founder and Publisher of In-Sight Publishing (ISBN: 978-1-0692343; 978-1-0673505) and Editor-in-Chief of In-Sight: Interviews (ISSN: 2369-6885). He writes for International Policy Digest (ISSN: 2332–9416), The Humanist (Print: ISSN, 0018-7399; Online: ISSN, 2163-3576), Basic Income Earth Network (UK Registered Charity 1177066), Humanist Perspectives (ISSN: 1719-6337), A Further Inquiry (SubStack), Vocal, Medium, The New Enlightenment Project, The Washington Outsider, rabble.ca, and other media. His bibliography index can be found via the Jacobsen Bank at In-Sight Publishing comprised of more than 10,000 articles, interviews, and republications, in more than 200 outlets. He has served in national and international leadership roles within humanist and media organizations, held several academic fellowships, and currently serves on several boards. He is a member in good standing in numerous media organizations, including the Canadian Association of Journalists, PEN Canada (CRA: 88916 2541 RR0001), and Reporters Without Borders (SIREN: 343 684 221/SIRET: 343 684 221 00041/EIN: 20-0708028), and others.