Health system response and recovery in Ukraine after 3 years of war: perspectives of front-line communities and internally displaced persons

Communities affected by war can play a vital role in sustaining and restoring health services, yet their perspectives are under-represented in the evidence base. This study examines the experiences of patients and health personnel in three front-line areas of Ukraine, as well as persons internally displaced due to the full-scale invasion of February 2022. Our findings reveal community perspectives on the effects of war-related insecurity, workforce shortages, and infrastructure damage on health system functions and service availability. Respondents identified health worker shortages - driven by safety risks and resource scarcity - as among the most pressing concerns. Amid these challenges, however, recent health financing reforms, notably the Programme of Medical Guarantees and Affordable Medicines Programme, were often viewed as mitigating factors. Internally displaced persons (IDPs) generally reported positive care-seeking experiences in their host communities, though administrative and information-related barriers continue to limit access for some. Capacity constraints in areas hosting large numbers of IDPs are seen as placing further stress on service availability. Respondents valued the coordinated efforts of humanitarian actors and local authorities in restoring services, helping to maintain trust and social cohesion. Many were sceptical about the feasibility of large-scale reconstruction in the short term, prioritising instead urgent security measures to protect facilities. However, they also acknowledged the importance of defining a long-term recovery strategy, and identified workforce strengthening, integration of humanitarian services, and sustained financial protection as critical priorities.