The Doctor’s Dilemma: Rebuilding Trust in Ukraine’s Healthcare Amid War

Oliver Taylor | Europe and Eurasia Fellow

Image sources from Oleksandr Rakushnyak via Flickr.

When Ukrainians first enter a hospital what they may first notice is not the smell of disinfectant, but the sound of a generator. Power cuts have become routine, as Russian missile strikes damage infrastructure, forcing hospitals to rely on emergency electricity just to keep ventilators running.  Beyond these visible disruptions, Ukraine’s hospitals have become an unexpected testing ground for reform. As the war strains the health system, it has also sharpened a deeper question: can trust in public institutions be built not after conflict, but instead during it?  Ukraine’s hospitals demonstrate that trust in government-funded institutions is not a post-conflict luxury, but a prerequisite for democratic resilience—one with implications for Europe and Eurasia, including within their own healthcare systems.

A legacy of mistrust

Even before Russia’s full-scale invasion of Ukraine in March 2022, the country’s healthcare system carried deep scars from the Soviet model. Chronic underfunding, informal payments, and public scepticism shaped everyday interactions between patients and providers. Hospitals were free in name but costly in practice, with patients often expected to pay for supplies or offer gratitude gifts to doctors. These informal transactions flourished in a system where rules were opaque and accountability weak, eroding trust long before the war began.

In 2017, Ukraine began dismantling transactions through its national health reform. The reform introduced digital medical records and created a new National Health Service that reimbursed providers directly for services delivered, rather than allocating funds through rigid budgets or discretionary intermediaries. The impact was not merely administrative—by linking funding to patients rather than infrastructure, the reform clarified entitlements and reduced opportunities for informal gatekeeping. For the first time, citizens could compare hospitals online and access transparent treatment lists, creating modest but meaningful gains in confidence.

The rollout of this digital infrastructure signalled that while still uneven, progress was real. As trust began to grow, however, Russia’s full-scale invasion reversed many gains. Clinics have been bombed, with more than 1,940 health facilities damaged, and thousands of medical workers displaced or killed. In wartime, informal networks have re-emerged as survival mechanisms: cash for medicine, contacts for surgery, favours for transport. Corruption has returned not out of greed, but desperation—placing renewed strain on already fragile public trust in hospitals.

Healthcare under fire

As of mid-2025, the World Health Organization has documented over 2,254 attacks on Ukrainian health facilities since February 2022—the highest number recorded in any modern conflict. Hospitals near the front line in Kharkiv and Zaporizhzhia now operate as hybrid institutions, simultaneously functioning as trauma centres and community shelters while maintaining core medical services under constant threat.

Against this backdrop, Ukraine’s Ministry of Health has continued to prioritise transparency reforms. Digital prescription systems now allow national tracking of antibiotics and other controlled medicines, limiting diversion and misuse. Parallel systems monitor humanitarian medical donations, reducing opportunities for black-market leakage. The paradox is striking: while physical infrastructure is under attack, governance in the health sector has, in some respects, become more accountable than before the war.

An example of this effort is the eHealth platform, which integrates patient data across hospitals and pharmacies. It has enabled remote consultations for displaced Ukrainians and improved coordination between field medics and civilian care. These services remain fragile. Digital infrastructure is vulnerable to outages and attack, technical support depends heavily on international partners, and trust can erode quickly if citizens fear their data is insecure or access is unequal. Even so, in a country once synonymous with informal payments for healthcare, the shift towards digital transparency marks a profound institutional change—one directly tied to rebuilding trust.

The trust test

Still, rebuilding trust in healthcare providers will require more than a software upgrade. A 2024 survey cited in the Organisation for Economic Co-operation and Development integrity review found that only 19 per cent respondents reported that they have confidential or anonymous internal channels to report suspicions of corruption or ethical violations—a figure that has barely improved since 2013.  In contrast, volunteer organisations enjoy near-universal confidence. In cities such as Dnipro and Lviv, community-run medical hubs funded by diaspora donations are often seen as more reliable than public hospitals. For many citizens, healthcare has come to be associated less with the state but more with civil society.

This raises a political question that extends beyond Ukraine: can a government rebuild legitimacy when citizens rely more on volunteers than public institutions? Western donors and the European Union are already treating health-sector transparency as part of accession conditionality, framing it as a litmus test of democratic maturity. Ukraine’s doctors, caught between bureaucratic systems and front-line realities, now embody this tension between institutional reform and lived experience.

What Ukraine means for the rest of the region

Ukraine’s experience matters because it is not unique. Across Europe and Eurasia, particularly in post-Soviet and accession-candidate states, trust in public institutions has become increasingly fragile.  From Moldova to the Western Balkans, health systems remain one of the most intimate points of contact between citizens and the state. When treatment depends on informal payments or local connections, it is not merely a health failure—it is a daily reflection about whose lives the state protects.

In such contexts, hospitals become political institutions. Perceived corruption or inequality in healthcare feeds reform fatigue, hardens resentment towards central government, and creates openings for populist actors who promise order without accountability. In this sense, Ukraine’s health reforms are not simply a sectoral story—they are a case study in how integrity in everyday public services can stabilise democratic life across a volatile neighbourhood, even under the pressures of war.

For the European Union, the lesson is uncomfortable but clear. Institutional rebuilding cannot be neatly sequenced after conflict or crisis. Trust must be cultivated in real time, even as violence continues. If public services collapse into opacity, the democratic damage may outlast the war itself. Conversely, visible integrity in institutions such as hospitals can anchor legitimacy when other pillars of governance are under strain.

Reconstruction and renewal

Ukraine’s doctors are more than clinicians; they are custodians of civic trust. Each diagnosis given accurately and each prescription logged transparently pushes back against decades of cynicism. If the war has laid bare the fragility of life, it has also exposed the fragility of institutions—and the extraordinary people trying to hold both together.

As one Ukrainian medic in Mykolaiv told Reuters, “We fight not just to save bodies, but to prove that this country can heal itself.” In Ukraine’s case, the battle for public trust is being fought not only on the front lines, but in the everyday functioning of hospitals—where democratic legitimacy is quietly made or unmade. The future of Ukrainian healthcare—and perhaps the health of Europe’s democratic neighbourhood—depends not only on victory at the front, but on trust restored in the wards behind it.

Ollie Taylor is the 2026 Europe and Eurasia Fellow for Young Australians in International Affairs (YAIA). He studies Commerce and Biomedical Science at the University of Queensland and has lived across Europe, Asia, and Australia. As a 2025 Westpac Asian Exchange Scholar, he studied cancer biology at the National University of Singapore, undertook Mandarin language training while working in Singapore, and led healthcare-promotion volunteer teams in rural Thailand through Challenges Abroad. He has also backpacked widely across Asia to deepen his regional literacy and cross-cultural understanding.

Ollie previously studied International Relations at the London School of Economics, informing his interest in global governance, health resilience, and cross-regional cooperation. As YAIA’s Europe and Eurasia Fellow, he is committed to strengthening Australia’s engagement with the region and advancing more resilient health systems in less-economically developed rural communities, where development and security challenges intersect most sharply.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect those of Young Australians in International Affairs. All content is original, and no plagiarism has been used in the preparation of this article.