Ukraine: "It is possible to manage and control hospitals”


Patrick Le Tréhondat

August 25, 2023

According to a report dated 10 August 2023 by the Ukrainian Health Centre, since the  start of the large-scale Russian invasion, more than 1,000 attacks on healthcare infrastructure have been recorded. The Ukrainian healthcare system - medical staff, medical facilities and other healthcare infrastructure - has suffered approximately two attacks per day since the start of Russia's full-scale invasion on 24 February 2022. N As a result of these attacks, 148 medical workers have been killed and, as a result of 414 attacks, hospitals and ambulatory care centres have been damaged or destroyed.  Oksana Slobodiana, a member of the independent trade union Be like Nina explains that "the situation is extremely tragic. Our nursing staff are often forced to neglect their own safety in order to save patients' lives. Today, we are paying particular attention to those who have remained in the combat zone. Our organisation provides them with financial aid (as part of a project with Medico International, as well as psychological and legal support. Health workers who have decided to leave the front-line towns for safer ones are not left without help either.

So far, we have been able to provide them with accommodation, food, hygiene products and medicines until the end of the year. Here, they are adapting and finding work". This dramatic situation is compounded by the disorderly management of the Ukrainian hospital system, the result in particular of a reform carried out before 24 February 2023, which entrusted the management of health centres to local authorities. Corruption is endemic in the Ukrainian hospital system.

For example, on the morning of 10 August, searches were carried out at Zhytomyr hospital. The spokesman for the national police explained this police operation as follows: "Today, the national police are investigating the hospital in Zhytomyr, as well as people who may be involved in illegal activities. Investigative action is being taken as part of criminal proceedings for fraud with funds allocated to finance the provision of medical services." According to investigators, hospital officials organised a scheme  to illegally obtain budget funds from the National Health Service of Ukraine. "All hospitals must be controlled!!!" said a nurse on the union's social network Be like Nina. Another investigation is underway at the Ivano-Frankivsk hospital into a UAH 4.5 million fraud. At a time when the health system is vital, nurses have not been paid their salaries, or at best only part of them, for many months. Their working conditions are deteriorating, and when they protest they are subjected to bullying. In the previous issue of Soutien à l'Ukraine résistante, we reported on the demonstration on 15 July by nurses from four hospitals in Kryvyi Rih who were demanding payment of what they were owed. On 27 July, Be like Nina organised a rally outside the Ministry of Health in Kyiv to voice the grievances of health workers. In the pouring rain, the trade unionists had to wait on the pavement, despite threats from the police, who reminded them that any gathering on the public highway was forbidden under martial law. A representative of the ministry then deigned to come down to see them and left after a tense exchange. At the end of the afternoon, however, the Ministry announced that it would agree to receive a delegation from the union in September. For Oksana, this "rally under the windows of the Ministry of Health was not formally a rally, because during martial law they are forbidden. We simply came to remind ourselves of the existing problems in the health sector. Despite the fact that the war has been going on in the country for two years and that the funds allocated to the health sector are very low, health workers need to be paid a decent wage on time. Can you imagine what would happen to the country if they started leaving en masse ? The authorities should not allow that to happen. We are now actively working to unite all care workers in Ukraine. We are helping them to set up independent unions on the ground, and we are talking about their rights. Together, we are preparing written appeals to representatives of the authorities, informing them of our problems and proposing options for resolving them. We also make appointments with officials, with whom we wish to discuss face-to-face anything we are not happy with. I would like to point out that we have created a convergence of medical staff in Ukraine, which includes the most active unions in various regions. Together, we will be knocking on the doors of government offices to prevent the destruction of healthcare and medical staff jobs in Ukraine."

According to Oksana, "the most effective way to respond to this crisis is to create independent trade unions that can and will clearly understand the situation and control everything from the inside. After all, who knows the situation of their hospital, its capacity and administration better than the employees themselves? So managing and controlling hospitals is possible if we start by electing the director by the staff themselves. In addition, members of management must be accountable even after they have been dismissed, so that the union will be able to control all [judicial] processes. Finally, the most important thing is transparent accounting, which clearly shows how much money has been received and what it has been spent on".