“I Have Nightmares About Explosions”: War Fatigue Among Ukrainian Healthcare Workers

Photo via Reuters

SARA MEDINA: Ukraine has suffered from a severe humanitarian crisis worsened by targeted attacks on healthcare since Russia’s invasion in February 2022. Coupled with lasting effects of the COVID-19 pandemic, the war has devastated the mental and physical wellbeing of healthcare workers.

Imagine you are a young nurse tending to an elderly patient who has been infected with COVID-19. You are about to leave the patient’s room when you suddenly hear an explosion. Your ears begin ringing, and though you cannot hear anything, your patient is visibly distressed and short of breath. You see your colleagues running around the halls frantically, unsure of their next step. You are frozen, hoping you are in a nightmare. Your patient is bedridden. The hospital is being bombed. Should you stay with your patient? Should you leave? How do you leave?

Since Russia's invasion of Ukraine, there have been 1,940 attacks on healthcare facilities. This is the highest number reported of any humanitarian crisis in history. In 2024 alone, 34 deaths and over 200 injuries of healthcare workers and patients were confirmed.

The conflict originated in 2014 with Russia’s annexation of Crimea, a peninsula off the southern coast of Ukraine. Armed conflict erupted between Russian-backed forces and the Ukrainian military. Attempts at negotiations began in 2015 with the Minsk Accords, but were largely unsuccessful. 

In February 2022, satellite images showed the largest deployment of Russian troops to Ukraine since the Cold War. Following failed negotiations, Russian President Vladimir Putin initiated a complete land, sea, and air invasion of Ukraine. Many, including United States President Joe Biden, called the invasion “unprovoked and unjustified.”

Since the beginning of the invasion, Ukrainian civilians have reported war crimes such as execution, torture, and rape. The war has been characterized by targeted attacks on civilians, including residential complexes, theaters, and of particular concern, hospitals. 

The largest recent attack on healthcare was on Okhmadyt Children’s Hospital in Kyiv on Jul. 8, ending in the evacuation of 600 patients and the death of four children. The missile attack also destroyed much of the hospital’s infrastructure. The attack is a grim reminder of the need to control the conflict and its violation of human rights. In the words of the hospital’s director, bombing a hospital filled with sick children is “not just a war crime, it is far beyond the limits of humanity.” 

Today, conditions for health workers are more uncertain than ever. Many are not only scarred by the atrocities they have seen during wartime, such as the attack on Okhmadyt, but also drained from the COVID-19 pandemic which overlapped with the war in 2022. In the face of these exhausting conditions, mental health and burnout among health workers have been of large concern.

A report from the International Rescue Committee (IRC) in October surveyed healthcare workers in Ukraine and found that 1 in 5 workers were experiencing negative effects of war-related stress. These effects include post-traumatic stress disorder, depression, anxiety, and substance use disorders. One respondent wrote, “I have nightmares about explosions…and then I wake up…and I don’t know if it was a dream or a real explosion.” 

Qualitative findings of the survey also suggested that healthcare workers prioritized the wellbeing of their patients over their personal wellbeing. Furthermore, nearly 1 in 3 healthcare workers can only sometimes or rarely manage their feelings in a healthy way. 

Burnout, depression, and anxiety among healthcare workers have been shown to have a direct impact on error likelihood and patient care. A 2002 study conducted on a sample of internal medicine residents found that residents who met the criteria for burnout (75%) were two to three times more likely to report “suboptimal patient care practices.” Another study showed that out of all incidents where symptoms of stress negatively impacted patient care, 7% were critical mistakes and two resulted in patient death. 

The Ministry of Health of Ukraine has been quite responsive to the mental health concerns of healthcare workers, as both the war and COVID-19 have placed a psychological strain on many other subgroups of the population as well. Since the war began, new mental health programs targeting health workers, teachers, and other professionals have been proposed and implemented. The ministry has also made efforts to destigmatize mental health and to encourage individuals to seek care. 

Though this manages the effects of the conflict, as long as it persists, health workers are still in danger. Fearing death and feeling ominous is only natural. Over 65% of young medical doctors in Ukraine are not optimistic about the future. Though mental health care can relieve some of their stress and its effect on patient care, the root of their concerns must be addressed.

The humanitarian and military effort in Ukraine remains tremendously underfunded, and important international players like the United States appear to be shifting away from providing more aid. On Oct. 29, Congressman Clay Higgins (R-LA) introduced legislation to redirect dollars from the Ukraine supplemental funding package to disaster relief in the US. Higgins stated, “I work for the American citizenry, not Ukraine,” a view shared by many politicians who are conservative on foreign policy. 

Foreign policy on global humanitarian crises is an ethical dilemma. While the priority of the US government should always be its own citizens, moral conscience and international law blur this concept. As a member of the United Nations, the US technically has an obligation to uphold universal human rights. At the same time, there is the question of whether it is morally wrong to allow evident violations of human rights to occur when the US does have the power and influence to end them. However, those like Higgins would argue that it is more morally wrong to send funds overseas when there is still suffering at home. 

In the face of conflict after conflict arising in the past two years, the war in Ukraine has become overshadowed and forgotten by many. In particular, the voices of healthcare workers who transitioned from a global pandemic into a large-scale invasion have not been heard. Raising awareness about this aspect of the war and using our power as global citizens to effect change is crucial to alleviate the immense burden on healthcare workers and ensure the livelihood of Ukrainian civilians.

Sara Medina is a sophomore majoring in Global Health and minoring in Government, interested in the impact of world politics on population health. She is from Southborough, Massachusetts.