Chronic Disease Management in Wartime Ukraine
Chronic non-communicable diseases — diabetes, cardiovascular conditions, HIV/AIDS, cancer, chronic respiratory disease — account for the majority of Ukraine's disease burden even under peacetime conditions, and the demands of managing these conditions do not pause during armed conflict. Over 12 million Ukrainians are estimated to have at least one significant chronic condition requiring ongoing medication and clinical monitoring. The wartime disruption of pharmaceutical supply chains, destruction of primary care infrastructure, displacement that severs patients from their medical records and prescribers, and the overwhelming of health facilities with acute trauma creates a perfect storm of chronic disease management failure. The consequences — preventable deaths from insulin deprivation, strokes from unmanaged hypertension, HIV drug resistance from interrupted antiretroviral therapy — represent a significant but often uncounted dimension of the conflict's human toll.
Diabetes and Insulin Supply
Ukraine has approximately 2.8 million people living with diabetes, of whom approximately 470,000 require insulin therapy (Type 1 diabetes and insulin-dependent Type 2). Insulin is a life-sustaining medication: without it, Type 1 diabetics develop fatal diabetic ketoacidosis within days to weeks. Ukraine's insulin supply chain was immediately threatened by the invasion through multiple mechanisms: the primary national insulin warehouse in Kyiv was relocated as an emergency precaution; three regional pharmaceutical warehouses in conflict oblasts were damaged; and the prescribing and dispensing system that connects insulin-dependent patients to monthly refills was disrupted as primary care physicians evacuated or facilities closed. WHO Ukraine's emergency pharmaceutical response prioritized insulin above almost all other medicines, working with the Ministry of Health to: consolidate national insulin stocks at 8 protected distribution points; establish walk-in insulin access kiosks requiring only patient self-identification; and negotiate emergency donations from Denmark (Novo Nordisk), France (Sanofi), and Germany that contributed approximately 4.2 million insulin units to Ukraine's emergency reserve in 2022. By 2025, insulin supply coverage for registered patients had recovered to approximately 91% of pre-war levels — but coverage gaps remain highest in conflict-adjacent oblasts, and the approximately 280,000 insulin-dependent patients who evacuated to EU countries required rapid integration into EU prescribing and dispensing systems, a process that took 3-6 months on average per patient.
Cardiovascular Disease and Hypertension Medications
Cardiovascular disease is Ukraine's leading cause of death, and hypertension affects approximately 11.5 million Ukrainians — over 30% of the adult population. Antihypertensive medication adherence — critical for preventing strokes and myocardial infarctions — requires continuous prescription access, medication affordability, and regular blood pressure monitoring. All three requirements are challenged in wartime. The Affordable Medicines Program (Dostupni Liky), Ukraine's primary care prescription subsidy scheme that provided free antihypertensives to eligible patients, was significantly disrupted in 2022 when 2,400 of 13,000 participating pharmacies suspended operations due to conflict proximity or damage. The e-prescription system through which Dostupni Liky operates depends on functioning internet connectivity, electricity, and pharmacy terminal operations — all compromised in conflict areas. WHO Ukraine, with UNFPA and international pharmaceutical donors, established an emergency "cardiovascular medicine depot" in each oblast — caches of 90-day supply packs of common antihypertensives, statins, and antiplatelet agents — enabling distribution without intact e-prescription infrastructure. By 2025, approximately 2.1 million hypertension patients are receiving medications through the restored program, with an estimated 580,000 patients experiencing gaps of more than 30 days in medication access during the crisis period — a gap likely associated with a measurable increase in cardiovascular events.
HIV/AIDS and Antiretroviral Therapy Continuity
Ukraine has one of Eastern Europe's highest HIV burdens, with approximately 260,000 people living with HIV (PLHIV), of whom approximately 180,000 were receiving antiretroviral therapy (ART) at the start of the invasion. ART interruption — even for as few as 2-4 weeks — carries severe consequences: viral rebound, development of antiretroviral drug resistance, and renewed transmission risk. The Alliance for Public Health — Ukraine's primary ART program implementer, funded through the Global Fund — developed one of the fastest emergency pharmaceutical responses to the invasion, mobilizing ART distribution points within the first two weeks of the conflict and establishing cross-border medicine transfer protocols for PLHIV evacuating to EU countries. Key outcomes include: PLHIV registered with active ART files could receive emergency 90-day supplies (vs. the pre-war standard 30-day supply) enabling safe displacement without immediate prescription refill; cross-border data sharing agreements with HIV programs in Poland, Germany, Romania, and Slovakia enabled continued ART dispensing to displaced Ukrainian PLHIV within days of Registration; and mobile ART dispensing units reached approximately 38,000 PLHIV in conflict-affected communities who could not access fixed health facilities. Despite these efforts, UNDP and UNAIDS analysis estimated that approximately 22,000 PLHIV experienced ART interruptions of more than 4 weeks in 2022-2023, with modeled impacts including 4,800 cases of acquired drug resistance and increased onward transmission.
Oncology and Chemotherapy Continuity
The management of active cancers requires particularly rigid treatment continuity: chemotherapy protocols are timed based on medical evidence of optimal cycle timing; interruption or dose reduction compromises treatment efficacy and can allow drug resistance development. Ukraine had approximately 150,000 patients in active oncological treatment in early 2022. Treatment continuity measures implemented include: WHO emergency chemotherapy procurement fast-tracks delivering critical oncology drugs within 2-3 weeks vs. standard 6-8 months; establishment of regional staging centers in Lviv, Vinnytsia, and Dnipro as overflow oncology treatment hubs receiving patients from damaged or evacuated eastern centers; international partnerships with Polish, Czech, German, and Slovak oncology centers accepting Ukrainian cancer patients into treatment protocols; and a national oncology patient database enabling treatment records to follow patients across institutions. A global network of oncologists — the #CancerCare4Ukraine initiative — provided remote clinical consulting to Ukrainian oncologists managing complex cases with compromised access to standard diagnostic tools.
| Condition | Patients Requiring Treatment | Pre-War Coverage | 2022 (Worst Point) | 2025 Recovery Level |
|---|---|---|---|---|
| Insulin-dependent diabetes | ~470,000 | 94% | 72% | 91% |
| Hypertension medication | ~11.5 million | 68% | 49% | 64% |
| HIV antiretroviral therapy | ~180,000 (on ART) | 88% | 71% | 84% |
| Active oncology treatment | ~150,000 | 91% | 58% | 76% |
| Tuberculosis treatment | ~28,000 | 82% | 61% | 78% |
Tuberculosis and Drug-Resistant TB Management
Ukraine has a significant tuberculosis (TB) burden — approximately 28,000 new cases annually — including a high proportion of multidrug-resistant TB (MDR-TB), which requires 18-24 months of specific antibiotic treatment with poor adherence outcomes even in peacetime. TB treatment interruption carries dual consequences: risk of treatment failure for the individual patient, and generation of drug-resistant strains that pose a broader public health threat. Ukraine's TB program, supported by the Global Fund and implemented through the Public Health Centre, responded to the invasion by: extending multi-month dispensing to 6-month supplies for stable TB patients before displacement; establishing a national TB patient tracking system enabling seamless transfer of treatment between facilities; and working with WHO and UNAIDS to establish TB treatment protocols in EU receiving countries for Ukrainian TB patients evacuated abroad. By 2025, MDR-TB treatment continuity among patients who remained in Ukraine stood at 78% (vs. 82% pre-war), a significant preservation of treatment continuity given the conflict conditions — achieved largely through pre-positioning of anti-TB drugs and mobile directly observed therapy (DOT) teams in IDP accommodation facilities.
Frequently Asked Questions
- How many Ukrainians depend on insulin, and was supply maintained during the war?
- Approximately 470,000 Ukrainians require insulin. Emergency measures including emergency donations from Novo Nordisk, Sanofi, and others, protected distribution points, and walk-in kiosks maintained coverage — with the worst point reaching 72% of patients in 2022, recovering to 91% by 2025.
- How did Ukraine maintain antihypertensive medication supply?
- Emergency cardiovascular medicine depots in each oblast, holding 90-day supply packs of common antihypertensives, enabled distribution without the e-prescription infrastructure damaged by conflict. An estimated 580,000 patients still experienced 30+ day medication gaps during the crisis period.
- What happened to HIV patients' antiretroviral therapy during the conflict?
- The Alliance for Public Health provided 90-day ART supplies for displaced PLHIV, established cross-border dispensing agreements with EU countries, and deployed mobile ART units. Despite this, approximately 22,000 PLHIV experienced problematic ART interruptions in 2022-2023.
- How did Ukraine protect cancer patients in active chemotherapy treatment?
- Emergency WHO chemotherapy procurement, regional treatment hubs in western Ukraine, international partnerships with EU oncology centers, a national patient database for record portability, and the global #CancerCare4Ukraine consulting network all contributed to partial continuity.
- What is tuberculosis treatment continuity like in wartime Ukraine?
- MDR-TB treatment continuity stood at 78% by 2025, preserved through 6-month dispensing pre-displacement, a national patient tracking system, and mobile directly observed therapy teams at IDP accommodation facilities.
Sources
- WHO Ukraine. Essential Medicines and Chronic Disease Management Emergency Response 2022-2025. 2025.
- Alliance for Public Health Ukraine. HIV Program Wartime Continuity Report 2024. 2025.
- Global Fund. Ukraine HIV/TB Programs Emergency Adaptation: Results Report 2024. 2025.
- Ukrainian Ministry of Health. Dostupni Liky Program: Restoration and Coverage Analysis 2025. 2025.
- UNAIDS. Ukraine HIV Response Annual Update 2024. 2025.
Humanitarian Impact Assessment: Chronic Disease Management in Wartime Ukraine
The humanitarian consequences of Russia's invasion of Ukraine have created one of the world's most severe displacement and protection crises. Chronic Disease Management in Wartime Ukraine sits within this complex humanitarian landscape, addressing specific dimensions of civilian suffering, protection needs, and international response mechanisms. With millions of Ukrainians displaced internally and externally, and systematic attacks on civilian infrastructure creating ongoing protection threats, the humanitarian situation requires continuous monitoring and analysis to guide effective response.
Russia's targeted attacks on civilian infrastructure—including power stations, water treatment facilities, heating systems, and hospitals—have created deliberate humanitarian crises designed to pressure Ukrainian society and demoralize the population. These attacks, which international humanitarian law experts have documented as potential war crimes, have left millions without heat, electricity, and clean water during harsh winter periods. Chronic Disease Management in Wartime Ukraine addresses specific aspects of this infrastructure destruction and its cascading effects on civilian welfare, healthcare access, and protection vulnerabilities.
The international humanitarian response to challenges represented by Chronic Disease Management in Wartime Ukraine has involved UN agencies, international NGOs, and bilateral donors coordinating through complex mechanisms to maintain humanitarian access and provide life-saving assistance. Protection monitoring, trauma care, shelter provision, food security programming, and mental health support have all scaled significantly to address wartime needs. The geographic distribution of needs—spanning frontline communities through temporarily occupied territories to internally displaced populations in western Ukraine and refugees abroad—requires differentiated response strategies.
Long-term recovery and reconstruction needs related to Chronic Disease Management in Wartime Ukraine extend well beyond emergency humanitarian response. The psychological trauma experienced by Ukrainian civilians, including children who have spent years under regular missile attacks, will require sustained mental health support for generations. Community-level recovery, economic reintegration of displaced populations, and rebuilding of social infrastructure all require parallel investment alongside physical reconstruction. The humanitarian community's evolving role in the transition from emergency response to recovery and development planning is a critical dimension of Ukraine's path forward.
Protection Frameworks and Accountability
The documentation of humanitarian law violations related to Chronic Disease Management in Wartime Ukraine serves both immediate protection and long-term accountability purposes. Organizations including Human Rights Watch, Amnesty International, the UN Human Rights Monitoring Mission (HRMMU), and the International Criminal Court are systematically documenting violations to build evidentiary records for potential prosecutions. Ukraine's cooperation with these documentation mechanisms, combined with national investigative capacities, is establishing accountability frameworks that may shape post-conflict justice processes. The protection of civilian witnesses and evidence preservation are essential components of this accountability infrastructure.