In 1940, less than a year into World War II, Germany forced Britain and its allies to retreat to the beaches of Dunkirk in France, where they were rapidly penned in. Britain immediately coordinated an evacuation of the allied armies across the English Channel — a response led not by gargantuan warships but by hundreds of privately owned “little ships” that could rescue troops on the beaches. It was a precise response to a desperate need.
Ukraine is experiencing daily Dunkirk moments with Russia’s relentless destruction of civilian infrastructure, including energy and water supplies and health care facilities. While reliable, up-to-date information on the human consequences of Russia’s invasion remains elusive, we know it is extremely high — more than 16,000 civilian casualties, including roughly 6,500 deaths since the conflict began in February.
A portion of these illnesses, injuries and deaths are likely linked to civilians’ increased vulnerability to communicable diseases, environmental catastrophes, malnutrition, gender-based violence, loss of access to health care, and other medical casualties that occur secondarily to the war — known in disaster medicine as the “kill twice effect.”
Russia’s violation of international human rights laws in its attacks on health care facilities and providers exacerbates these collateral losses and injuries.
Similar to the Dunkirk evacuation, large numbers of private, non-governmental organizations (NGOs) have responded to the dire needs of Ukrainians, using proverbial rescue boats to deliver precision-guided humanitarian and medical aid. These collective efforts bridge gaps in access to care, much like those “little ships” of private Britons did during “Operation Dynamo” at Dunkirk.
As with many crises, problem-solving has mandated navigation of complex, interwoven systems and processes, applying novel partnerships between public and private sectors, policymakers, concerned citizens, and leaders across multiple disciplines. Local, national and international communities have come together under a common flag to hold Russia accountable for its barbarism and to provide the support so urgently needed by Ukrainians.
A significant portion of the success in providing shelter, food, water, medicines, health care and education is attributable to the collective efforts of hundreds, perhaps thousands, of grassroots organizations working in concert with millions of Ukrainians to counter the humanitarian and medical crises. It is through direct, personal communication, as well as existing and new relationships, that these targeted efforts achieve their aims.
According to Humanitarian Outcomes, a British-based research firm that gathers data to inform evidenced-based solutions, successful delivery of aid and support in Ukraine has been driven by 150 previously existing and 1,700 newly formed Ukrainian local aid groups. The organic, agile nature of these methods enables flexibility of response on the ground in Ukraine to meet both broad and specific needs. Such collaboratives have accomplished their endeavors on shoestring budgets, at best.
In contrast, many large international NGOs have received a tremendous influx of dollars and donations to support Ukraine. However, they lack (or lacked), especially early on, the networks of internal connections and delivery routes to facilitate purchasing and supplying appropriate aid with the same precision of many small, organically formed groups. Humanitarian Outcomes explains that the corporate-type NGOs are constrained by financial regulations that dictate some of the ways in which they are allowed (or not allowed) to allocate funds.
Small NGOs, big impact
Collectively, the authors here represent small, independently run NGOs networked together in the overarching mission to support Ukrainians with much needed health care during this crisis. We have been able to offer nimble responses to the emerging, evolving needs of Ukrainians within their country and of those forced to flee.
Two of the NGOs, Health Tech Without Borders (HTWB) and TeleHelp Ukraine, leverage technological innovations spurred by the COVID-19 pandemic to mobilize world-class clinicians from across the globe to provide free telehealth services to Ukrainians. In combination, HTWB and TeleHelp Ukraine offer the full spectrum of medical care, from primary care to sub-specialty support, via telemedicine. HTWB has completed more than 65,000 telehealth consults; TeleHelp Ukraine has completed more than 200 mental health and sub-specialty appointments.
Others galvanize new and existing relationships to determine and fulfill medical supply and educational needs. The Heal Ukraine Group, or HUG, represents a consortium of Harvard Medical School Faculty physicians and scientists who have come together to address the needs of clinicians and scientists on the frontlines of the war in Ukraine. HUG team members convene voluntarily; collectively, the HUG cooperative has delivered tens of thousands of lifesaving surgical supplies and medical equipment, ranging from portable ultrasounds, cardiac monitors and mechanical ventilators to wound vacuum therapy units, boxes of surgical staples and sutures, and surgical head lamps. HUG-allied experts have facilitated direct trauma and other training to more than 500 Ukrainian clinicians.
To achieve these targeted goals, driven by regular communication with clinicians on the ground and the Ukrainian Ministry of Health (MOH), HUG partners with several small NGOs that predated the war but have shifted focus and become razor-sharp in determining and delivering supplies and care that are most needed. Global Medical Knowledge Alliance (GMKA), founded by two Ukrainian-American surgeons and key members of the HUG team, along with Autism Unity and HTWB, represent three of HUG’s critical collaborators.
Ukraine’s health care future
Russia’s lawless invasion of Ukraine, like all senseless war, represents the worst of humanity in its attempts to eradicate a country and its people. Russian missile attacks on Ukraine’s civilian infrastructure reinforce the urgent need to continue fortifying Ukraine’s health care system at all levels.
Encouraging communication and networking of activities between numerous NGOs will foster the sharing of best practices to help effectuate the parallel goals, address persistent gaps and overcome barriers. Such collaborations will act as a force-multiplier and accelerate the provision of equipment and services. The intent is for NGOs to continuously learn from and bolster each other’s efforts in this extraordinarily challenging arena.
Many “little ship” NGOs stand at a tipping point, however. Nine months into the war with no end in sight, small NGOs need help — from uninterrupted volunteerism to stable financial giving — to fulfill their missions and provide steady medical aid for Ukrainians. Individuals, corporations and large NGOs can play a crucial role.
We urgelarge international NGOs and agencies to apply their standing to facilitate connection between legitimate grassroots groups with validated impacts and to provide resources to enable smaller, community-based organizations to continue effective management of their support for Ukraine’s health care system.
Jarone Lee, M.D., M.P.H., is vice chair of Critical Care, Division of Trauma, Emergency Surgery, Surgical Critical Care, at Massachusetts General Hospital and associate professor at Harvard Medical School. He is a co-founder of Health Tech Without Borders (HTWB) and a member of the Heal Ukraine Group (HUG).
Aditya Narayan is a second-year medical student and Knight-Hennessy Scholar at Stanford School of Medicine. He is director of implementation and evaluation at TeleHelp Ukraine.
Jacqueline A. Hart, M.D., is director of the Bassuk Center in Massachusetts, a founding member of the Heal Ukraine Group (HUG), and involved with the HUG-Harvard medical Scholars at Risk (SAR) initiative. Dr. Hart partners with community organizations to provide housing, health care and trauma-related services to populations in greatest need, including families and children experiencing housing instability, immigrants, refugees and asylum seekers.
Mark C. Poznansky, M.D., PhD., FIDSA, is director of the Vaccine and Immunotherapy Center, Infectious Diseases Division, of Massachusetts General Hospital, a professor of medicine at Harvard Medical School and co-founder of Heal Ukraine Group