Hospitals need to be prepared for war – report

Ambulances parked near a hospital in Kyiv, Ukraine

Hospitals need to learn lessons from Ukraine and Syria as they increasingly become targets for military activity during times of conflict, according to research carried out by Anglia Ruskin University (ARU) and published by the World Health Organisation (WHO).

The 96-page guidance document for underground shelters in hospitals, informed by research led by Dr Nebil Achour, is the first of its kind ever published and is based on the experiences of 617 Ukrainian hospitals during the ongoing war and other international health facilities in warzones.

The research draws on lessons learned from the conflict in Ukraine as well as Syria, and cites an urgent need for renovations, structural upgrades and adherence to standards in hospitals across the world.

Since the start of the conflict in February 2022, the World Health Organization (WHO) has documented more than 2,300 attacks on health care facilities across Ukraine, severely disrupting the delivery of services and endangering the lives of patients and staff.

Despite the shelling, damaged infrastructure, and lack of essential equipment, health professionals have continued to provide care under emergency conditions.

Many hospitals have been forced to repurpose older underground shelters, many built during the Cold War, as makeshift health-care facilities to continue serving the population amidst the conflict.

While the majority (82%) of hospitals in Ukraine have shelters, approximately 70% of hospitals have 20 or fewer beds in their shelters, therefore giving them very limited capacity and ability to deal with mass casualties.

A quarter of shelters had modifications such as new ventilation systems, water and power supply networks, and showers and toilets. A total of 57% reported minor modifications such as flooring, painting and furniture, and 19% did not report any work at all.

Findings suggest that there are many difficulties facing the renovation and improvement of shelters, such as shortage of human resources, time, know-how and finance.

Irina Stanislavovna Tkachenko, medical director at Mykolaiv Regional Children’s Clinical Hospital, stated in the report: “One of our biggest challenges has been converting our old Soviet-era basements into makeshift shelters. These shelters were not originally intended for such use, so we had to quickly adapt them – cleaning out debris, installing water supplies, and creating spaces for incubators and medical equipment.

“The situation became even more complicated when people from the nearby community sought refuge during air raids. While we couldn’t turn them away, we simply didn’t have enough room to accommodate everyone.”

Iryna Dyuzhnyk, Deputy Director of General Affairs at Children’s Hospital #5 in Zaporizhzhia, said: “When the war began, we quickly realized that while we had a functioning shelter, it was not in a condition to handle the demands of this situation. We had to act swiftly.

“With support from international partners and funds allocated by our city council, we were able to transform it into a fully autonomous anti-radiation shelter. Now, it’s supported by a diesel-powered generator, a ventilation system, patient rooms, an operating theatre, sanitary facilities and a stockpile of necessary medical supplies.”

The WHO report provides actionable steps and a detailed checklist for repurposing existing structures and operating shelters to maintain health services during challenges such as structural damage, infectious diseases, cases of radiation poisoning and significant increase in patient numbers.