Ever since taking over Ukrainian territory, the occupiers have increased pressure on residents to apply for Russian passports. Switching citizenship is a key feature of their claim that occupied Ukraine is now part of Russia, but it is not happening fast enough for the Kremlin.
To further coerce residents, the occupying authorities have toughened the rules on free medical treatment. To access healthcare, it is necessary to have an insurance certificate but to get a certificate you need a Russian passport.
Yevgeny Balitsky, the Russian-appointed governor of Zaporizhzhia Oblast, announced late last year that from January those with Ukrainian passports would be denied treatment.
“We will take more stringent measures to ensure that only citizens of the Russian Federation will live on our territory,” he said in October. “If before the New Year, a person still receives medical coverage using a Ukrainian passport, then after they will not.”
While emergency assistance is still provided, according to locals, it is very hard to get any planned treatment or medication. For that, people are sent to Crimea, where they face additional hurdles and costs.
Yurii Sobolevskii, first deputy head of Ukraine’s Kherson Oblast Council, receives a lot of messages from people on the occupied bank of Kherson Oblast who are trying to get medical help. Someone from Kalanchak contacted him and told him they were “running in circles” trying to get a kidney operation, he said.
“People are sent to Crimea to be treated, mainly in Simferopol,” he said. And when they get there, some are told their insurance isn’t valid. “People are forced to pay to receive qualified medical care, and it’s way more expensive,” he said.
Before the full-scale invasion, the Kherson region boasted a high standard of healthcare, with successful kidney transplant operations and ambitious plans for the region’s first heart transplant. Today, such aspirations seem like distant fantasies, overshadowed by the impact of occupation.
In the occupied parts of the Kherson region, hospital medical facilities are now severely limited, with only Skadovsk and Henichesk hospitals performing some surgical interventions.
“The attitude of the doctors towards the locals is hostile, they feel the residents’ attitude to them as occupiers,” Sobolevskii said. “At first it was one problem – no Russian passport, no certificate – so they simply refused to provide medical assistance, now a large number of people have received passports and certificates and there aren’t enough qualified specialists.”
After the full-scale invasion, a lot of doctors and other medical professionals left the occupied territories or refused to work there, he said.
“There were 1,500 people working in the Melitopol city hospital, including middle staff and junior doctors,” said Ivan Fedorov, exiled mayor of Melitopol. “Currently there are fewer than 900, a 40% shortfall of doctors and medical personnel.”
Specialists have been brought in from Russia, but they provide only a temporary solution. The occupiers brought a neurologist, surgeon, and orthopedic traumatologist from Rostov Hospital to the Novotroitske district, for example, but they left after three days.
“If someone is brought in from Russia, then it is demonstrative, not systematic action,” Fedorov said. “They will work for several weeks, and after that, they leave.”
Another problem, after almost two years of war and occupation, is a lack of hardware. And what is provided isn’t always usable.
“There is looted medical equipment, taken by Russian forces from regional hospitals, but there are no specialists to assemble it,” Sobolevskii said. “They stole it, but it doesn’t work. For ordinary people, it’s simply better not to get sick.”
Russian forces say they are delivering equipment from Russia, for example, a mobile fluorographic imaging system was taken to the Henichesk Central District Hospital from Krasnodar Krai, but the priority appears to be propaganda rather than healthcare.
“They are trying to earn political dividends,” said Serhii Nikitenko, editor-in-chief of the news magazine Most (“Bridge). “Recently they said they had donated ambulances to the hospital – to show that Russia came and helped – but it turned out the ambulances were stolen in Kherson during the evacuation. They didn’t even change the number plates.”
When healthcare facilities are available, people have to travel long distances to access them. There’s also a chronic lack of family doctors and many people in rural areas have to rely on small centers run by midwives or paramedics, Nikitenko said.
Sobolevskii and Fedorov say the faster Ukraine can liberate occupied territory, the faster people will get access to qualified medical help. Healthcare has been one of the first priorities when Ukrainian forces reclaim territory, they said.
“Vysokopillia was the first liberated settlement where the hospital was nearly destroyed. Within three or four months, work was done to restore and establish its functionality,” Nikitenko said. “In nearby Arkhanhelske, everything is operational, with Doctors Without Borders aiding in anti-crisis efforts.”
Since the beginning of the full-scale invasion, Russian forces have damaged 1,474 medical facilities and completely destroyed another 195, the Ukrainian government said. At least 103 emergency medical aid vehicles have been damaged, 253 vehicles destroyed and a further 125 seized by the occupiers.
Almost 850 medical facilities have already been restored, the government said in December, and plans have been drawn up to quickly restart healthcare when more territory is liberated.
“It is clear that everything will have been destroyed on the left bank, but modular medical centers are being prepared to deploy there,” Nikitenko said. “The operating rooms cannot be restored very quickly, but primary first aid can be established. As a good example, in liberated Kherson, they are equipping a whole underground surgical department.”
Elina Beketova is a Democracy Fellow at the Center for European Policy Analysis (CEPA), focusing on the occupied territories of Ukraine. She worked as a journalist, editor, and TV anchor for various news stations in Kharkiv and Kyiv, and currently contributes to the translator’s team of Ukrainska Pravda, Ukraine’s biggest online newspaper.
Europe’s Edge is CEPA’s online journal covering critical topics on the foreign policy docket across Europe and North America. All opinions expressed on Europe’s Edge are those of the author alone and may not represent those of the institutions they represent or the Center for European Policy Analysis. CEPA maintains a strict intellectual independence policy across all its projects and publications.
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