As we mark the third anniversary of the Russian invasion of Ukraine, the repercussions of the conflict extend significantly beyond the battlefield. The war has resulted in substantial civilian casualties, with the United Nations reporting 40,838 casualties, including 12,456 fatalities, and has displaced millions, leading to an urgent humanitarian crisis affecting approximately 17.6 million individuals in Ukraine.

The Ukrainian healthcare system, previously a symbol of resilience, has been severely strained, facing unprecedented challenges. The World Health Organization has documented over 2,215 attacks on healthcare facilities, resulting in 205 deaths and 699 injuries. These attacks, coupled with security concerns and shortages of medical supplies and personnel, have hindered access to essential medical care, particularly for stroke prevention and treatment. Notably, despite a reduced population, acute stroke admissions in 2023 increased by 13% compared to 2021, driven by poorly managed risk factors and the impacts of displacement.

In response to these challenges, the European Stroke Organisation (ESO) established a Task Force for Ukraine (TF4UKR) in March 2022, aimed at supporting stroke patients and healthcare professionals. The TF4UKR has implemented various initiatives, including waiving membership fees, facilitating the movement of Ukrainian stroke physicians to European institutions, offering grants for professionals to engage with stroke units across Europe, and organizing a stroke conference in Liviv in September 2024.

Collaborative efforts among professional stroke societies, the Ukrainian Ministry of Health, and international organisations have led to significant advancements in stroke care during the conflict. National medical standards have been developed, and improvements in the rates of intravenous thrombolysis and mechanical thrombectomy have been observed: thrombolysis and mechanical thrombectomy in ischemic stroke have risen, last year exceeding 10% and 2%, respectively.

Furthermore, with support from the World Bank, Ukraine secured a substantial loan to invest in state-of-the-art medical equipment, including approximately 200 CT scanners, dozens of MRI machines and angiographic suites. These proactive measures laid a strong establishment for stroke treatment, ensuring that essential infrastructure and pathways were in place. Despite the challenges that followed, these initiatives continued to evolve, driving meaningful improvements in stroke care delivery across the country.

The ESO’s ongoing commitment to supporting Ukrainian stroke patients exemplifies a broader European solidarity, highlighting the need for continued attention to the healthcare challenges faced by vulnerable populations amid the ongoing crisis. As we reflect on this anniversary, it is crucial to recognise the profound human cost of the war, particularly for those affected by strokes, while also acknowledging the hope and resilience fostered by international collaboration and support.

This month marks the second anniversary of the war in Ukraine. This is a devastating crisis for Ukraine and for Europe. Large part of the population fled the country seeking refuge in neighboring and far countries, mostly women and children. Leaving the most intense conflict zones, survivors were pushed into degraded living conditions, which presented a unique strain upon the healthcare system, that found no parallel in recent history of Europe.

According to the United Nations Office for Human Rights, 27,768 civilian casualties (9,806 fatalities and 17,962 injured) were reported between February 24, 2022, and October 8 2023. An estimated 17.6 million people in Ukraine require urgent humanitarian support, over 6 million Ukrainian residents became internally displaced persons, and 6.3 million refugees from Ukraine were recorded globally, most of whom (5.9 million) reside in Europe.

With respect to stroke care, the health and wellbeing of the Ukrainian population was heavily affected. Access to thrombolysis and thrombectomy, stroke units, and to services for secondary prevention rehabilitation and palliative care has been affected in conflict regions, especially for vulnerable patients such as stroke survivors and their families.  Before the conflict Ukraine was among the top five countries in Europe for stroke incidence, morbidity, and mortality: each year, there are 100–110,000 primary and 40–50,000 recurrent cases of stroke. Because of this high burden, stroke remains a priority for the Ukrainian Ministry of Health and National Health System. Investments in new equipment allowed all Ukrainian regions to offer mechanical thrombectomy (MT) to acute ischemic stroke patients. The MT rate is 1.5%, whereas access to thrombolysis is 10%. In 2024 new policies were issued to ensure improved access and quality of inpatient rehabilitation, increasing the number of days (up to 112) covered by the NHS.

In 2022, the European Stroke Organisation (ESO) established the Task Force for Ukraine (TF4UKR) chaired by Dr. Francesca Romana Pezzella (Italy) and Dr. Yuriy Flomin (Ukraine) to provide a dedicated team providing a continuous channel for the Ukrainian stroke community to network effectively with European national Societies, healthcare professionals and the WHO.

The ESO TF4UKR organized educational and communication events and funded grants in favor of Ukrainian stroke professionals. Among the main activities conducted in the last 2 years are: 1) supporting Ukrainian stroke physicians to relocate to other European institutions; 2) offering grants to Ukrainian Neurologists to visit Stroke Units in other European countries in 2023; 3) building educational forums, including virtual educational event series; 4) forming collaborations with WHO and other European Institutions, such as the University of Oslo, the Danish Stroke Society and Stroke Support Organization, to address gaps in stroke care, using mapping services and providing equipment. ESO’s solidarity with the Ukrainian stroke community remains steadfast. We trust that this collaboration will reinforce the link between our communities and provide opportunities for growth and recovery of Ukrainian stroke healthcare systems.