On the anniversary of Russia's invasion, the World Health Organization reports on how it's supporting health services in Ukraine 

How do we ensure, amid a relentless war, that we can deliver the right health services in the right place, at the right time?

The answer: health data.

It’s only by clearly assessing and knowing the critical health needs of individuals and communities, using the best data and evidence possible, that we at the WHO can provide strategic support in Ukraine, working closely with the Ministry of Health and almost 200 partners, including civil society organizations, on the ground.

This allows for our supplies to be sufficiently planned and distributed, our health interventions to be designed appropriately and our overall health strategy to positively impact our intended targets.

On February 24, 2022, with the Russian Federation’s invasion, the Government of Ukraine introduced martial law. This made access to primary and secondary data collection - so crucial to identifying health needs and planning interventions - even more challenging.

In those early weeks and months, amid a looming humanitarian crisis, we adopted a so-called ‘no regrets’ approach to health service delivery - designing our response with limited or incomplete information.

We had reliable information on health needs in Ukraine prior to the war and we used that knowledge in the days immediately after the invasion to deliver support to people and to prepare a public health situation analysis, outlining major public health risks at that moment in time.

We managed to reach many conflict-affected areas with essential medicines and supplies, ensuring the health system could function. This allowed Ukraine’s truly heroic doctors and nurses to continue to deliver urgent medical care to patients in desperate conditions, even as health facilities were under attack.

The war changed everything. To fill the data gap that ensued, we applied innovative methods. First, we partnered with a market research firm specialising in crowdsourcing to conduct three health situation reviews between April and October 2022.

This gave us a more comprehensive understanding of the unfolding scenario. It showed us the extent of emerging healthcare needs and medicine shortages and, crucially, which parts of the country to focus our attention on, especially in regained areas where health services and the supply of medicines needed to be re-established.

These reviews revealed, for instance, that two-thirds of the adult population were facing difficulties or barriers when trying to access primary healthcare. Armed with this vital knowledge early on, we were able to better design and implement mobile primary health clinics in areas recently regained by the Government of Ukraine, where the health system had been badly damaged by fighting. We ensured the delivery of vital medicines and supplies to treat noncommunicable diseases in hard-to-reach areas. And, we ensured collective centres housing displaced people were reached with routine immunisation services.

Over the year of war, a more systematic process to collect information on population health status and access to care was gradually established, enabling us to conduct two in-depth rounds of health needs assessments.

The results were sobering. The first round revealed that one-in-three people were struggling to afford the medicines they needed, especially for chronic conditions, such as diabetes, cancer and cardiovascular disease. The second round, conducted a few months later, showed encouraging improvements in overall access to care and medicine, but barriers as well - especially the increasing cost of services and supplies at a time when more and more families were struggling to make ends meet.

Unsurprisingly, we learnt that people living in or near active conflict zones had more difficulty accessing medicines than the rest of the country. And people displaced from their homes faced far bigger barriers to accessing health services than those who weren’t.

Another challenge was determining the extent of Ukraine’s war-related mental health needs.

Globally, an estimated one-in-five people in conflict settings have a mental health condition An estimated 22% of the population living in Ukraine’s conflict-affected areas will, at any time during the next decade, likely have some form of mental health challenge. This means almost 10 million people are potentially at risk of mental disorders, such as acute stress, anxiety, depression, substance use and PTSD – with one-in-10 suffering from a moderate or severe condition, such as depression with suicidal behaviour or psychosis.

Using these estimates, however broad, the government has launched an urgent and ambitious nationwide mental health programme, championed by First Lady Olena Zelenska, with the WHO providing technical support to train mental health professionals and help scale up efforts significantly.

Beyond ad hoc and representative household health needs assessments, we are working closely with the Ministry of Health of Ukraine to gather core information on the present and likely future availability of vital health services and resources to ensure our support is targeted.

The first phase of this data collection has covered ten priority regions in the east, north and south of Ukraine, encompassing different aspects, including the functionality of health facilities; the availability of utilities, such as water, heating, electricity and waste disposal; and the availability of specialised services, such as emergency obstetric care. This data has been and continues to be a vital source of information across a variety of activities, from planning humanitarian convoys to deploying emergency medical teams.

The ongoing movement of populations, worsening living conditions and a massive disruption of healthcare services make traditional surveillance and data-gathering methods less reliable. We are always looking for new and innovative ways to be steered by the numbers.

Behind the numbers, of course, are human beings. Time and again, it is those already vulnerable before the war who are left behind – including the elderly. Eighty-year-old Iryna, for example, lives with high blood pressure and had no access to medicine. After months of intense fighting in her vicinity eased, a UN convoy, including WHO supplies, reached her region – allowing her to access the medicine she so desperately needed.

Amid such stories of resilience and hope, we have distributed nearly 3,000 metric tonnes of supplies to practically every corner of Ukraine over the past year. But it’s never enough and the needs are increasing all the time.

Our ultimate goal is to ensure the long-term health and well-being of the people in Ukraine. That is a challenging goal, to say the least, but not an impossible one, despite the devastation caused by this war.

Our efforts so far have allowed the WHO to support 8.4 million people in Ukraine over the past year. In the coming year, we aim to continue reaching millions of people nationwide.

Without health, society cannot function, it cannot heal, it cannot rebuild. We must rehabilitate the health system and affected populations, using the data and evidence already gathered and the increasingly sophisticated information we will be gathering going forward.

Ultimately, with or without data and evidence, there remains a simple, yet profound truth: the best medicine for Ukraine is peace.