Building back better Ukraine’s healthcare system

With USAID suspending its funding for Ukraine, the EU and its partners should reassess its support for Ukraine’s healthcare system and help it “build back better”. History shows that wartime innovation and technologies have lasting implications for peacetime. Not only will the health chapter of the EU accession negotiations be important for the reform of Ukraine’s healthcare system, the EU and its partners are also instrumental in supporting Ukraine to attract private investors and explore the potential for more private-public health cooperation in Ukraine.

With the war in Ukraine raging on for three years now, humanitarian support to Ukraine’s population is more important than ever as part of its defence against Russia’s terror. The ongoing war severely impacts the health of the Ukrainian population, from hindering maternal and child health conditions, to spreading infectious diseases such as HIV, Hepatitis and Sars-CoV, as well as increasing rates of noncommunicable diseases and antimicrobial resistance. Since the start of the Russian invasion in February 2022, there have been 1762 attacks on Ukraine's healthcare system, with 910 attacks damaging or destroying hospitals and clinics and killing 261 health workers. This not only constitutes a flagrant violation of international law, it also causes severe disruption of the healthcare system.

In addition, mental health issues hugely impact Ukraine’s societal resilience and has dangerous consequences for its long-term ability for recovery and reconstruction. The war takes a massive toll on health workers who are confronted with incredible trauma in the battlefield, leading to burnout and exhaustion. The entire population has been under constant stress, which leads to insomnia and an increased risk of cardiovascular diseases, as well as the development of symptoms of post-traumatic stress disorder (PTSD). Moreover, war veterans and their families are faced with reintegration problems and mental health challenges. To address these issues, the Ukrainian Parliament recently adopted a law on the Mental Health Care System. The law recognises mental health not only as a medical issue but also as a social one, obliging employers to provide their employees with mental healthcare services.

Ukraine’s healthcare system needs a financial lifeline

The immense scale and incessant nature of the war will have tremendous long-term consequences for Ukraine’s healthcare system. The system will need long-term rehabilitation to overcome structural challenges, which already existed before the outbreak of the war. Ukraine is the last of the post-socialist countries to cast off the burden of inefficient, low-quality, Soviet-style medicine. Comprehensive reform of the healthcare system started in 2015 to address corruption in drug procurement and other issues, and a new national health service was created.

The role of the private sector and foreign governments is key in supporting Ukraine to invest in the immediate humanitarian response and longer-term health system recovery. In January 2025, the Commission launched a new €148 million EU humanitarian aid package for Ukraine that will bring the total of humanitarian aid allocated by the Commission to over €1.1 billion. The World Bank, for its part, has mobilised over $57 billion in financial support for Ukraine since February 2022.

Yet a major source of funding has been cut off. Ukraine can no longer count on support from the USAID, following US President Trump’s executive order to suspend funding for all programmes and projects from the Ukrainian USAID office. In 2024, USAID allocated more than $5 billion for Ukrainian programs, with $4.2 billion going to government programmes. Clearly the EU and its partners, such as the UK, Canada and Japan as well as Türkiye and India, should reassess their current support, considering that USAID funding was supposed to last till 2027.

The need for financial support makes it even more urgent for foreign governments and private actors to step in and explore the potential for private-public cooperation in Ukraine. The private sector should be incentivised to play a role in modernising the country in the long run. However, due to current security risks, only a small part of foreign aid is directly used to help current businesses and attract new investors.

Wartime innovation can shore up peace in the future

As counterintuitive as it may sound considering the atrocities happening in Ukraine, the potential to “build back better” in the country is immense. A compelling example is the fact that Ukraine seeks to reclaim its role as a hub for clinical trials despite the war. In the years leading to the war in 2022, the number of clinical trials in Ukraine was already growing, as organising trials in the country is cheaper than in most EU countries. Although an ongoing war poses challenges to maintaining trials – think about the loss of data in crisis situations – companies adapt to this new reality.

History has shown that wartime innovation and technologies have lasting implications for peacetime. In 2024, 12 new modular clinics were installed in Ukraine with the support of the WHO, the EU and the Ukrainian Ministry of Health. Not only do they facilitate access to medicines in wartime, their potential for reaching patients in remote areas is huge in times of peace. The use of drones for medicines supplies is another example, as is the breakthrough innovation of AI-powered prosthetics, developed by a US-Ukrainian startup supported by European investors. Although the use of telemedicine and remote patient monitoring devices has taken off since the Russian invasion, digital health measures make the country more vulnerable for cyberattacks. This was illustrated in December last year when hackers launched a large cyberattack, including on citizens' biometric data.

It is time to double down on supporting the Ukrainian healthcare system with the aim of building the country back better. As the EU stands to benefit from wartime innovation that can revolutionise peacetime industries, the Union should help support Ukraine in developing its public-private partnership (PPP) legislation currently under negotiation. At the moment, a draft law is being prepared for a second reading, with systematic changes introduced in many sectors including healthcare. The EU has the tools and expertise to guide the country and ultimately help them convince the investor community to invest and innovate in Ukraine.

In the context of Ukraine’s path to EU accession, there will be more opportunities for the EU to support the country’s healthcare system. Following the first Accession Conference to open accession negotiations with Kyiv on 25 June 2024, the state of Ukraine’s preparation for opening negotiations in specific areas will be assessed. Chapter 3 on competitiveness and inclusive growth will include health and offers an opportunity to advance Ukrainian healthcare reforms. The EU should see seize this opportunity, knowing that funding wartime innovation and supporting Ukraine’s health system is an investment in its longer-term recovery and reconstruction.

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