How Conflict Ravages A Health Care System

From The Publisher Health AffairsVol. 44, No. 9: Insights About The Opioid Crisis How Conflict Ravages A Health Care SystemRabih Torbay AffiliationsRabih Torbay is president and CEO of Project HOPE in Washington, D.C. The author thanks Scott Latta for his help in writing and editing this article.PUBLISHED:September 2025Open Accesshttps://doi.org/10.1377/hlthaff.2025.00944AboutSectionsView PDFPermissions ShareShare onFacebookXLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSHealth professionalsSystems of careViolenceNursesGlobal health Earlier this year, I visited Ukraine for the first time since 2022. The last time I was there was just weeks after Russia's full-scale invasion, and I still remember the red crosses hastily spray-painted onto hospitals in Irpin, which didn't protect them from shelling. I saw land mines outside a children's hospital in Bucha and met a doctor who dodged sniper fire to dig a mass grave, where he laid sixty-seven bodies to rest. Rabih TorbayPhotograph by Project HOPE The brazen attacks on Ukraine's health workers left me speechless. Three years later, it is clear just how widespread the damage is, and how long the road to recovery will be. There are more countries engaged in conflict today than at any point since World War II. According to the Global Peace Index 2024, published by the Institute for Economics and Peace, ninety-two countries are engaged in conflicts outside their borders. This is a disastrous trend for the world's health, as health systems suffer catastrophic damage wherever conflict takes root. Ukraine is a sobering example of how devastating conflict can be. The World Health Organization has tracked more than 2,500 attacks on Ukraine's health care system since the full-scale invasion began. Hospitals, clinics, ambulances, and equipment have been destroyed, cutting off care to entire communities. The United Nations reports that more than ten million Ukrainians are displaced, including nearly seven million refugees, whose status makes medical care significantly harder to access. Other costs are harder to see. Vital medical services such as cancer screenings and laboratory testing have been put on hold. The risks for gender-based violence, infectious diseases, and chronic health conditions are all elevated. Health workers are burned out, and many have retired or left the country. Hundreds of them have been killed. Multiply these impacts across the dozens of countries in conflict today, and you get a sense of how perilous this moment is for the world's health. Every day, health care workers in places such as Colombia, Ethiopia, Gaza, Haiti, and Sudan go to work facing life-threatening conditions. They deserve better, and so do the people they serve. They deserve medicines, equipment, facilities, and mental health support. But most of all, they deserve peace. Fortunately, I also saw the best of humanity during my time in Ukraine. I saw how proud doctors and nurses were to be able to do their work. I met a doctor whose son was captured by Russian forces, and others who had been displaced numerous times. They carried on, and I carried their resilience with me. I also saw the power of humanitarian aid and how vital US foreign assistance is. Project HOPE has rebuilt sixteen damaged or destroyed facilities in Ukraine, improving care for more than 143,000 people. Our team has launched sixty-four mobile medical units, trained 12,000 health workers, and supplied nine ambulances that can transport 23,000 patients. We should not have to. Health workers should not be targets. This is a precarious moment for the world's health. We have a choice: Do we accept this as the way it has to be and ask our doctors, nurses, surgeons, pharmacists, and ambulance drivers to pay the cost? Or do we commit to building a better world—a world without violence, where health professionals can go to work without fear of not coming home? Peace, above all, must be our priority. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 September 2025 InformationThis open access article is distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) license.PDF download