Introduction
The Russian invasion of Ukraine, which began on February 24, 2022, has caused a serious humanitarian crisis. During the 1st year of the war, approximately 8 million refugees fled their country and more than 1.5 million were registered in Poland for Temporary Protection or similar national protection schemes [1]. Due to the war, the Ukrainian healthcare system has collapsed which has had a resulting high impact and strain on healthcare services within neighbouring countries. The very high number of refugees who came to Poland has increased the burden on the health care system, including palliative care, and reduced the system’s capacity to provide services. The difficulties faced by the Polish health care system stem from the complex range of problems being experienced by Ukrainian refugees comprising medical issues including physical conditions (some of the refugees were somatically affected), and mental conditions (depression, anxiety, stress and post-traumatic stress disorder) as well as social problems, language barriers, lack of medical records and inadequate staffing of health care settings [2–5]. Ethical approval was not required for this research.
Palliative care in Ukraine
In Ukraine, annually at least 500 000 people with incurable illnesses require palliative care [6]. To meet this need, there are in total 66 palliative care services accessible to adults. Of these, 76% are inpatient palliative care units within hospitals. Only 7 inpatient hospices are available to patients nationwide. When considering paediatric care services, there are 3 inpatient hospices (stand-alone facilities), 6 home programmes and 3 hospital programmes [7, 8]. Overall, a total of 1 500 beds are available to provide palliative care in Ukraine (34.1 beds/million inhabitants), which meets approximately 1/3 of the requirements recommended by the European Association of Palliative Care [9]. The majority of palliative care beds are located in the following regions: Ivano-Frankivsk, Poltava, Chernihiv, Volyn, Kyiv and Kharkiv [10].
During the last 10 years, the Ukrainian system of palliative care has undergone significant changes, including the creation of new inpatient care facilities, strategies for the improvement of home care, the development of outpatient services and the implementation of legislation for better access to opioids [10–12]. Despite these changes, more than 80% of patients still do not receive sufficient pain therapy due to physician hesitancy around prescribing and inadequate access to opioids [13].
Palliative care in Poland
Poland is a leading country in the provision of high-quality palliative care in Central and Eastern Europe [12]. According to the EAPC ATLAS 2019, there were 587 palliative care services available for adults (180 inpatient care facilities, 404 home care settings, and 3 supportive palliative care teams in hospitals) and 74 for children (8 hospices and 66 home care programmes) [7]. In Poland, palliative care is mainly financed by the public healthcare insurance system, and it is free of charge for patients. Currently, approximately 100 000 adults and more than 2 000 children receive specialised palliative care annually (according to data obtained by authors from the National Health Fund for the year 2021), and most are cancer patients [14]. The majority of patients will receive timely specialist palliative care, however, there are still seriously ill people who die whilst waiting to be admitted to these services [15]. This is caused by a lack of resourcing, namely insufficient financing and an inadequate number of healthcare professionals. There are over 600 physicians in Poland who specialise in palliative medicine, but there is a need to double the staff numbers. Furthermore, there is limited access to specialised palliative care within Polish hospitals [16].
Consequences of the war on the healthcare system in Ukraine
As of July 6, 2022, according to data from the Ministry of Health, since February 24, 817 medical facilities were partially destroyed, and another 122 were destroyed. After the Russian invasion, all healthcare institutions (including palliative care facilities), especially those located on or near the front line and temporarily occupied territories, have faced numerous problems in providing their patients with necessary medicines, food and care items. Compounding this problem is also the limited access to trained healthcare professionals, medicines and services [17]. Many general practitioners have left Ukraine or joined the ranks of the Armed Forces of Ukraine, which has resulted in a lack of prescribers. There is no state funding and patients have been forced to purchase extremely expensive medicines. Pharmacies have been experiencing significant problems with the supply of medicines, especially to the occupied territories; and pharmaceutical manufacturers of analgesics located in the front-line zones are not working at full capacity.
The importance of the provision of suitable medical care for palliative patients was emphasized through the implementation of the Ministry of Health order No. 474 dated 12.03.2022 citing: “Issues receiving humanitarian and charitable aid in conditions of martial law”. This order regulates the distribution of opioid drugs between healthcare facilities as a humanitarian or charitable service [18].
Currently, palliative care is needed not only by civilians but also by military personnel, as they are also diagnosed with incurable diseases, and face post-traumatic stress disorder and severe consequences after injuries, limb amputations, etc. In response, Ukrainian health institutions increased the number of inpatient beds as much as possible and many opened a palliative care department during the war and are successfully caring for their patients. For instance, the hospital in the Odesa region opened a palliative care department, and the Medical centre “Dobrobut” opened a palliative care centre in Kyiv.
Polish palliative care response during the war
During the first days of the war, several hospices from Poland initiated the prompt admission of palliative care patients (mainly children with their families) evacuated from Ukraine. Support for this special group of refugees was rapidly provided by hospice and palliative care centres, non-governmental and public organizations, local authorities and individual citizens. Both qualified staff and volunteers were deployed. In addition, many Polish palliative care settings stated on their websites their willingness to assist and provide humanitarian aid for individuals and healthcare facilities in Ukraine. There was a huge need for health professionals who speak Ukrainian for psychosocial support and patient communication with Polish hospice teams, and these calls for volunteers were also advertised on these websites. During the following weeks of the war, rescue convoys were organised to evacuate patients from Ukrainian hospices. Furthermore, a special medical train was arranged to safely transport seriously ill children and their families to Poland [19].
Detailed data identifying the number of Ukrainian palliative care patients admitted to Polish hospices is constantly changing. Within the first month, 12 hospices reported on their websites that 30 Ukrainian patients had received specialized palliative care (mainly in inpatient hospices and home hospices). One hospice reported, that since the beginning of the war, 10 young patients with 30 family members had obtained help. It is important to note that the degree of social support for families that have been delivered extends beyond the standard level of palliative care and included assistance in finding accommodation as well as the provision of basic supplies and essential items.
On March 12, 2022, the Polish Parliament implemented a new law entitled: “The Act on assistance to citizens of Ukraine in connection with armed conflict on the territory of that country”, which ensures all Ukrainians who fled to Poland after 24 February 2022 access to social benefits and the Polish public healthcare system. Based on the Act, all aforementioned individuals are guaranteed public health services, including hospice and palliative care, to the same standard of conditions as Polish citizens. These services are financed by the Polish national budget [20]. During the first year of the war, more than 1.5 million refugees were eligible to access healthcare services in Poland [1].
The Russian invasion of Ukraine had a significant impact on the suffering of Ukrainian palliative care patients, requiring immediate humanitarian action. The rapid response from Polish palliative care centres and the prompt access to palliative care services for Ukrainian refugees provided these patients with dignity, by meeting their basic needs, and allowed them to experience some level of peace in a deeply troubling time.
Article information and declarations
Conflict of interest
All authors declare no conflict of interest.
Funding
The study has no funding.
