Medication is now hard, if not impossible, to access because supplies have been depleted or destroyed and logistical chains broken, says Maistruk. Terminals and storage are generally located near Kyiv, Ukraine’s most populous city. “Now everything is in very poor condition. Unfortunately many companies lost the possibility to transport,” she says. Some health care workers have fled for safety, including Maistruk, who recently left Kyiv to go west. Her husband stayed behind to continue work in a maternity hospital. Emergency supplies are short: oxygen, blood, antibiotics, antiseptics—all of which can be critical in emergency obstetrics.
And a family’s needs don’t stop once the baby is safely born. “The women stay in their clinics for two, three days and then they need to go home,” says Maistruk. “And home is under bombing. Home is under air alarms, when you need to leave everything and in one minute go to the shelter. Imagine: How can you breastfeed—how can you organize your care?”
Global health infrastructure had already been pushed to its limits by the pandemic, says Ann Moore, a researcher with the Guttmacher Institute, a New York-based research and policy organization for sexual and reproductive health and rights. “This humanitarian crisis is starting with depleted resources,” she says. “Health care provider resources, commodity shortages—a weakened health infrastructure overall, globally. That puts all of these reproductive health care needs at even greater risk.”
A rush of humanitarian aid has streamed into Ukraine and bordering countries to help fill this gap. The UNFPA has delivered essential supplies and has made sexual and reproductive health a priority. Médecins Sans Frontières (Doctors Without Borders) has done the same and begun training health care workers in the west on war zone trauma care. Unicef has provided 62 metric tons of supplies, including midwifery kits. The UNFPA also deploys packages of equipment meant to help with normal deliveries, complicated ones, and C-sections. (Maistruk remembers these kits as “excellent” when she previously used them in Luhansk. “It includes the whole operation room,” she recalls. “You can open the box, and in one, two hours you can organize the operation room.”)
Unicef supplies dignity kits containing underwear, soap, a bucket, and other hygiene products, plus basics for safety: a flashlight, a whistle, and information about gender-based violence. “We know that when social norms break down, sexual violence—especially among the most vulnerable—always follows,” says Moore, pointing out that young women and girls, people of color, and the LGBTQ+ and disability communities are always at the most risk. Survivors may have injuries that require immediate medical attention and treatments: antibiotics, post-exposure HIV prophylaxis, and emergency contraception.
People will still need access to routine medications, too, like hormonal birth control. “If people can’t access contraception, they may be confronted with unintended pregnancies at a point which is just perhaps the very worst time in one’s life to have to manage that,” says Hickson. “If you are a person with HIV and you’re taking antiretroviral therapy and it suddenly stops, that’s going to be massively detrimental. There are transgender people who are taking hormone therapy, that’s massively detrimental if they no longer have access.”