4.2.3 Health

People in Need
4.47M
People Targeted
1.47M
People Prioritized
1.27M
Requirements (US$)
$90M
Prioritized Requirements (US$)
$82M
  • SO1: Providing principled and timely life-saving emergency assistance to the most vulnerable displaced and non-displaced war-affected people, the Health Cluster contributes through SP1 (HE101–105), captures acute, life-saving health needs in frontline areas, including acute trauma care (including services across the trauma pathway), lifesaving PHC, first aid, essential medicines, and MHPSS for people proximate to direct hostilities. SP2 (HE101, HE103) reflects lifesaving health needs along evacuation routes, transit hubs/hromadas, and reception areas, where urgent stabilization of trauma, continuity of critical treatment, and rapid referral are essential. SP3 (HE101, HE103–105) corresponds to mass-casualty events and strike-related emergencies, where partners provide surge capacity to emergency medical services, acute trauma care, including basic assistive devices, surgical/burn medical supplies, emergency mental health care, and immediate support to affected facilities. SP4 (HE101, HE102, HE104) addresses the urgent life-saving health needs of highly vulnerable IDPs facing severe disruption, including essential PHC and MHPSS, and life-threatening chronic disease continuity of care. 
  • SO2: Enabling access to prioritized lifesaving services for the most vulnerable displaced and non-displaced war-affected people, the Health Cluster contributes to (SP1, SP2, SP3) primarily through HE201, which supports the health system to maintain functionality, continuity of essential health services, medicine supply chains, and other capacities needed to prevent deterioration of humanitarian conditions, including outbreaks.

Summary of Needs 

Strategic Priority 1 (Frontline Response): Communities along the frontline and northern border face heightened health needs driven by ongoing hostilities, disrupted health facility operations, and limited access to essential medicines. In Donetska and Khersonska, the health severity is highest, with Donetska alone revealing 45% health needs and 17% unmet care (REACH, FL, 2025). Households near the frontline experience security risks, damaged or non-functional facilities, and transport/time barriers, including up to 22% requiring over 60 minutes to reach care in Donetska (REACH, FL, 2025). 

Frontline households also face significant gaps in accessing medicines, with pharmacies often closed, damaged, or inaccessible due to insecurity. Populations report having nowhere to obtain medicines, facing unsafe movement, and being unable to travel to other settlements. (WFP, REACH, 2025). Chronic illness management is heavily constrained within the 0–50 km distance, and households with disabilities are four times more likely to lack needed medication, and older households twice as likely (JMMI, 2025). 

The primary drivers of need on the frontline include insecurity, damaged or non-functional primary healthcare facilities, emergency medical services and pharmacies, transportation constraints, and long travel times. Statistics reveal that up to 22% of households in Donetska, within a 0–20 km radius, require more than 60 minutes for service delivery points (REACH, 2025). Reported high levels of MHPSS distress, ranging from 27% in Mykolaivska to 59% in Kharkivska, and poor access to safe water (5%–25%) and dignified shelter (1%–45%) further intensify health needs, especially in frontline oblasts already reporting severe psychological challenges and inadequate conditions essential for safe, healthy living. Extreme weather conditions during winter (cold) and summer (heat) equally drive the needs of vulnerable people in these locations.  

Vulnerable groups continue to be most affected. These include older persons, PWDS, women-headed households, and IDPs, who present the highest rates of extreme need, with very high severity reaching 70–79% in eastern and southern oblasts (REACH, IDPs, 2025). HelpAge findings reveal that older people and PWDs face the greatest barriers to accessing healthcare, medicines, safe shelter, and WASH due to insecurity, damaged infrastructure, limited mobility, and higher chronic-illness burden, leaving them disproportionately homebound and least able to evacuate or relocate during frontline disruptions (HelpAge, 2025). 

Strategic Priority 2 (Evacuation Response): Populations evacuated from high-risk areas have urgent health needs resulting from disrupted access to lifesaving primary care, the need for trauma stabilization, and referrals for emergency care. Evacuation convoys routinely include patients needing wound care, oxygen support, surgical or burn care, or otherwise urgent stabilization due to shelling-related injuries (“Health Cluster Evacuations: Donetska, Kharkivska, Sumska – Jan 2025”). Evacuated households also report higher unmet health needs, difficulty accessing medicines, and treatment interruptions, which are patterns consistent with 2025 MSNA findings showing IDPs more frequently unable to access care. Older evacuees struggle most with medication access and hospital care, with 31% unable to obtain what is needed. Medicine shortages along evacuation routes and in reception hromadas further compound risks (WFP, 2025). 

Primary drivers of needs during evacuation are intensified hostilities that force rapid movement, relocation of the health workforce, translating into service unavailability, damaged facilities, power outages, and a loss of access to pharmacies are key drivers (“Evacuations – Donetska & Kharkivska – Mar 2025,” “Evacuations – Apr 2025”). Evacuees commonly travel long distances, go through security checkpoints, and lack ambulance services, which exacerbate untreated chronic conditions and result in severe medical complications. Displacement equally interrupts the continuity of care for life-threatening non-communicable diseases and mental health, consistent with MSNA findings, which reveal that cost, distance, and lack of medicines are major barriers in displacement-affected areas (REACH, MSNA Health, 2025). 

High-risk evacuees include older adults with reduced mobility and chronic illness (HelpAge, 2025), PWDs who are significantly more likely to report unmet health needs (REACH, MSNA, Health, 2025), and IDP households who consistently report higher health service barriers (REACH, IDPs, 2025). Evacuation reports also highlight critically ill patients, bedbound individuals, people requiring persistent life-support treatment, trauma patients, and older people without caregivers as priority medical evacuees (Health Cluster Evacuations – June 2025).  

Strategic Priority 3 (Response to strikes): Communities exposed to repeated strikes face severe barriers to accessing urgent healthcare, with MSNA findings showing that households have forgone care after missile or drone strikes (3%) and have also forgone trauma or emergency lifesaving care (4%) (REACH, MSNA, Health 2025). Strike-affected oblasts report damaged or non-functional health facilities, limiting immediate availability of first aid, trauma, emergency medical services (EMS), and primary care following attack-related disruptions (REACH, FL, 2025). Unsafe movement conditions, blocked roads, and disrupted transport routes further delay access to lifesaving care, with up to 22% of households in Donetska being 0–20 km away from a functioning health point, requiring more than 60 minutes to reach it (REACH, FL, 2025). In strike response, these conditions and capacity gaps heighten the need for trauma and surgical care, rapid stabilization, psychological first aid (PFA), and emergency PHC, alongside continuity of essential medicine supplies, minor facility repairs, and strengthened mass casualty management (MCM) and Stop the Bleed competencies.  

The Primary drivers of need include repeated mass-casualty incidents overwhelming local surge capacity, with single attacks generating over 100 casualties and creating sustained pressure on trauma, surgical, and stabilization services (Health Cluster Partner Response to Attacks, Jan–Oct 2025). Continuous strikes are damaging hospitals, disrupting EMS ambulances, and interrupting power and water supplies, resulting in repeated service suspensions and chronic gaps in emergency primary healthcare, diagnostics, and safe facility functionality, as well as timely EMS availability. These system-level disruptions, combined with shortages of trauma kits, essential medicines, blood products, and a protected workforce, drive the need for strengthened MCM capacity, rapid stabilization teams, and flexible service delivery models in strike response. [Health Cluster ‘Partner Response to Attacks’ (2025) #1, #2, #3, #4, #5, #6 , #7, #8, #9, #10] 

Vulnerable groups, including the elderly, PWDs, and households with chronic illnesses, face the greatest difficulty managing essential health needs during and after attacks. As air strikes create urgent health needs and interrupt access to medicines and emergency care, households with PWDs and the elderly face heightened risks of preventable death and disability, as strike-related barriers compound elevated unmet health needs in heavily affected regions such as Donetska and Dnipropetrovska (JMMI 2025; REACH, Health, 2025). HelpAge further notes that older adults and PWDs are least able to reach shelters or flee during missile and artillery strikes and often live in damaged housing, increasing injury risk and further disrupting lifesaving chronic-disease care (HelpAge, 2025).  

Strategic Priority 4 (Support for vulnerable IDPs): IDP households, particularly those in the 21–50 km belt and high-severity eastern and southern oblasts, show consistently higher health needs than non-IDPs, with MSNA 2025 findings indicating that 30% of IDP households report severe or above health needs compared to 19% of non-IDPs (REACH, IDPs, 2025). IDPs also experience a significantly higher MHPSS burden, with 74% reporting MHPSS challenges versus 60% among non-IDPs (REACH, MSNA, Health, 2025), compounding vulnerability and reducing coping capacity. 

IDP-specific analysis further shows that displaced households require healthcare more often yet are more frequently unable to access it, with affordability, especially the cost of medicines and treatment, emerging as a primary barrier, alongside precarious shelter, limited tenure security, and greater reliance on negative coping strategies (REACH, IDPs, 2025). MSNA evidence also identifies the inability to obtain chronic-condition medications as a key driver of health needs (14% unable to access chronic medication/care). IDPs additionally reduce essential health expenditures far more often than non-IDPs (46% vs 30%), heightening the risk of untreated life-threatening non-communicable diseases, worsening disability, and interrupted therapies (REACH, MSNA, Health, 2025). 

The primary drivers of health needs for IDPs are driven by a higher burden of communicable and non-communicable diseases, reduced access to care, reflected in longer travel times and higher reports of insecurity, transport barriers, and service unavailability compared to non-IDPs. IDPs experience substantially higher severe health needs (30 per cent vs 19 per cent), are more likely to cut essential health spending (46% vs 30%), and face significantly higher MHPSS distress (74% vs 60%), underscoring deeper vulnerability and more frequent disruptions in care, including during extreme weather conditions (winter or summer). 

The 2025 HelpAge assessment shows that older IDPs face significantly heightened vulnerability, with 27% reporting a disability, 44% lacking official disability registration, 31% struggling to access medicines, and 63% reporting deteriorating mental health, alongside severe financial hardship affecting 62% of older people. Older women who are more likely to live alone (47%, rising to 51% for those 70+) and face higher income insufficiency (68% vs 51% for men) experience compounded risks in displacement, including isolation, difficulty accessing hospitals, heating, and psychosocial support.  

Response Strategy 

SP1 – Frontline Response: Lifesaving PHC, essential medicines, community first aid, trauma care, MHPSS, and continuity of life-threatening chronic disease treatment in areas where insecurity, damaged facilities, workforce shortages, and transport barriers drive extreme needs. This will also include support during extreme weather conditions (winter/summer). Fixed and mobile teams apply protection principles, safe-site selection, confidentiality, and survivor-centered GBV/MHPSS care. Age and Disability Inclusion (ADI) is embedded through mobile outreach, accessible layouts and communication, and home-based follow-up for homebound older people or PWDs. Localization is strengthened by partnering with local health officials and NGOs, and AAP is ensured through Health Cluster partner two-way communication and feedback mechanisms. Coordination with MoH, oblast health departments, Emergency Medical Services (EMS), and other clusters aligns the frontline response with Protection, WASH, Shelter, and Cash to avoid gaps/duplication and ensure equitable access. Attacks on healthcare will be monitored for advocacy purposes and continuous engagement to ensure health workforce and patient safety in the delivery of care in frontline location.

SP2 – Evacuations: Along evacuation routes, transit centers, and reception hromadas, partners provide urgent PHC, trauma stabilization, wound care, essential medicines, and MHPSS for civilians fleeing intensified hostilities. The wounded, older adults, persons with disabilities, children, and chronically ill patients are prioritized and referred to secondary and specialized services as needed. Continuity of chronic disease treatment and essential medications is maintained throughout displacement in coordination with reception facilities and local authorities. Partners also support the medical evacuation of hospitals and inpatient facilities, ensuring safe transfer of patients and equipment when areas become too dangerous. 

SP3 – Response to Strikes: Following missile and drone attacks, partners deploy rapid first aid, trauma and mass-casualty response, emergency PHC, psychological first aid, and essential medicine support in areas where facilities are damaged or capacity is overwhelmed. Mobile emergency teams stabilize patients, support hospitals with surge capacity, and help restore minimum functionality when services are disrupted. Strike-affected communities receive first aid, MHPSS, and onward referral, with coordination across EMS, hospitals, and authorities to ensure unified casualty management and reduce preventable deaths. 

SP4 – Support for Vulnerable IDPs: In collective centers, transit hubs, and host communities, partners provide mobile lifesaving PHC, MHPSS, and essential medicines for IDPs facing high disease burden, disrupted care, and affordability barriers, especially for non-communicable diseases. Older persons, women living alone, persons with disabilities, and individuals with chronic or mental health conditions are assessed and immediately assisted by partners or onward referral of care. Mobile PHC + MHPSS teams ensure continuity of treatment and equitable service coverage  

Protection, Localization, AAP, Age & Disability Inclusion (ADI): Across all SPs, partners integrate protection, localization, AAP, ADI. Protection is ensured through safe-site selection, confidentiality, survivor-centered MHPSS, GBV and trauma care, clear referral pathways, and PSEA compliance. ADI is embedded through accessible layouts, adapted communication, assessment that accounts for mobility limitations, sensory impairments, and chronic conditions, proactive outreach to homebound older people and PWDs, and continuity of care for life-threatening illnesses. Localization is advanced through continuous coordination with local authorities, PHC providers, OPDs, and national NGOs. AAP is ensured through the health partner's two-way communication, inclusive engagement, and confidential feedback systems that drive real-time adjustments. These measures ensure that all interventions under SP1–SP4 remain safe, dignified, inclusive, and accountable. 

Targeting and Prioritization 

The Health Cluster targets war-affected populations whose access to lifesaving primary health care services is directly disrupted by hostilities, in line with HNRP boundaries established according to the Strategic Priorities (SPs). Subnational coordination with oblast health authorities ensures that humanitarian health assistance is provided only where the national system is unable to meet immediate lifesaving needs. Priority is given to: 

  • Frontline and recently shelled hromadas where lifesaving PHC, first aid, trauma care, MHPSS, and referral pathways are compromised. 
  • Evacuees along SP2 evacuation routes/transit centers, including people with recent trauma, older adults, PWDS, or people with life-threatening non-communicable illnesses. 
  • Vulnerable IDPs in SP4 hosting hromadas where local absorption capacity is overstretched and continuity of care is at risk.  
  • Strike-affected urban areas where the scope and magnitude of the strike stretches local capacity, and mass casualties, hospital damage, or utility disruption limit service availability.

Modality and Implementation Approach  

A mixed-modality approach is required because population movement and health-system functionality vary across SP1–SP4. This allows flexible assistance depending on operational access, market conditions, and the status and functionality of local health services. 

  • Service delivery is the primary modality because hostilities continue to disrupt lifesaving primary health care, trauma care, MHPSS, and referral pathways in frontline, strike-affected, and evacuation settings. Partners must directly provide lifesaving services where capacity is constrained by health worker shortages, facilities are damaged, evacuated, or inaccessible. 
  • In-kind support (medicines, diagnostics, trauma supplies, equipment) is used in areas where the health system cannot procure or distribute essential items due to insecurity, disrupted supply chains, or overwhelmed capacity in strike response. 
  • Cash for Health (CVA) is used only in locations where it can be complementary to ongoing service delivery, as there are functional health facilities and markets, enabling patients to access medicines, diagnostics, transport for referrals, and follow-up care. CVA for health is supported through the digital inter-cluster referral tool to ensure safe, accountable referrals and case resolution. 

Details on Costing Method

To estimate the activity cost for health activities in the 2026 HNRP, the Health Cluster consulted its operational partners, including the SAG, to harmonize estimates based on their programming experience. Inputs were provided by WHO, UNFPA, UNICEF, Premiere Urgence Internationale, ZODOROVI, BLAGOMAY, IRC, Samaritan’s Purse, MdM-Spain, and 100% Life Dnipro, with MSF and the ICRC participating as observers to deliberate during the SAG presentation.  

  • Unit cost estimates for the 2026 HNRP draw on the same partner base used in previous cycles, where 16 operational partners (UN, INGOs, and NNGOs) contributed cost data, and these historical inputs continue to anchor our calculations while updated figures are incorporated as partners provide them. Activity-Based Costing has been applied to maintain comparability year-on-year, using average unit costs from previous humanitarian health responses and multiplying them by the anticipated activity targets. 
  • Cost variations reflect differences in modality (in-kind logistics and warehousing requirements, cash/voucher monitoring costs, and service-delivery staffing and supplies), as well as operational zone factors such as fuel consumption, security-related movement constraints, and rental increases in frontline and 30–50 km areas.  
  • Inflation has been incorporated using the current national inflation range for Ukraine (14–16% year-on-year), with additional upward adjustments for cost-sensitive lines such as fuel, equipment, and rentals, which partners report are frequently subject to rapid vendor repricing windows of only three days. Overheads and support costs vary according to organization size and follow standard partner administrative ranges allowed by donors. 

Monitoring Priorities  

  • Track partner 5W reporting, rotations, and delivery of minimum service packages across frontline areas, evacuation routes/transit centers, strike locations, and IDP hosting hromadas, aligned with Health Cluster coordination systems. 
  • Ensure continuity of patient flow across the displacement pathway, from frontline evacuation (SP2), through transit centers, to partners providing care in IDP hromadas (SP4), including triage, referrals, transport, counter-referrals, and follow-up with local health services. 
  • Use the HRPR tool to monitor essential medicines, diagnostics, equipment, and emergency supplies, ensuring visibility and continuity across all SPs. 
  • Maintain coordination and accountability mechanisms, including alignment with TC/CC schedules, service mapping, communication channels, incident reporting, and follow-up with collective/transit site managers and authorities. 
  • Oversee implementation of the digital inter-cluster referral tool (CVA for Health TT, Protection Cluster, CWG), for partner adherence and reviewing referral flows, case resolution for recipients moving across sectors and SPs (SP1-SP4). 
  • Physical monitoring of partner projects for alignment with the strategy of the Health Cluster and to ensure health system disruption is avoided. 
  • Monitor attacks on healthcare for advocacy purposes, and to continue protecting the health workforce and patients at high risk. Monitoring also helps to ensure inform updated preparedness and response plans in line with the evolving situation.

Linkages and Coordination 

The Health Cluster collaborates closely with other clusters, including Protection (GBV, CP) and Shelter/NFI (CCCM), to align lifesaving health services with access constraints, evacuations, and multisectoral needs. Coordination with government line ministries (MoH, DoH, CDM, DoSP) and oblast/hromada authorities ensures aligned referral pathways, MMU deployment, and continuity of essential services. Partners work with local authorities to support frontline PHC, emergency medical services, and health services at evacuation reception points (transit centers and hromadas). The Cluster engages early recovery, transition, and development actors, local health authorities, and WHO’s health programs and health finance teams to sequence Bucket 2 transitional activities, link financing pathways, and support a costed, system-integrated shift over 12–36 months. 

Cluster Transition  

Can transition only if the cost is accounted for and financed accordingly. (Transitional / Co-delivered - 12–36 months). Requires the National Health Service Unit (NHSU)/oblast/hromada integration and support: 

  • Harmonized national MMU model (SP1, SP4): currently fragmented across partners and government (e.g., Ukraposhta). 
  • Staffing incentives/salary top-ups (SP1, SP3): must transition to NHSU/oblast/hromada financing. 
  • Preparedness & prepositioning systems (SP3): surge capacity, emergency kits, trauma supply stockpiles, energy supplies. 
  • Training models linked to universities with CME credit (SP1, SP3). 

Transition lever: Move from partner-led ad-hoc delivery to a standardized, costed response integrated with NHSU contracting and oblast/hromada budgets. 

Key Resources and References