The World Health Organization warned Monday that the Ukrainian health care system is facing “unprecedented challenges” as the country marks the third year of defending against Russia’s invasion.

Ukrainians have suffered a decline in physical and mental health with a need for mental health care, trauma care and rehabilitation, according to the global health agency.

Thousands of people have been injured, and both children and adults are experiencing serious medical conditions and psychological trauma, studies have shown.

“Being a doctor in wartime means returning home after each shift, wishing the war had never happened and praying for its swift end,” Olha Zavyalova, an emergency physician and surgeon from the Dnipro region in southeastern Ukraine, said in a statement.

“People are exhausted — both the patients and the health care workers. Yet, as medical professionals, we do not have the luxury of being tired. Our patients need us to keep going and we must push through the fatigue to continue delivering the care they deserve,” Zavyalova said.

An October 2024 assessment from the WHO European Region found that 68% of Ukrainians reported a decline in health compared to before the war. Mental health concerns were the most prevalent health issue, reported by 46% of those surveyed, the WHO found.

This was followed by mental health disorders — such as anxiety and depression — reported by 41% of those surveyed, and neurological disorders reported by 38%.

Access to health and medical care continues to be a struggle, with one in four people reporting a decrease in access to medical services since the start of the war in February 2022, according to the WHO.

In front-line regions, including the most affected areas, only about 50% of residents have been able to access medical care compared to 57% in the capital, Kyiv, and 60% in the rest of the country, according to the October 2024 report.

Internally displaced people are among the most affected when it comes to lack of medical care. According to the United Nations Refugee Agency, 4 million Ukrainians were internally displaced as of February 2025.

The WHO said 13% of internally displaced people lack access to primary health care facilities compared to 6% of those not displaced, and 9% don’t have access to a family doctor compared to 4% of those not displaced.

The October 2024 WHO report also found the cost of medicines and treatment to be a barrier to accessing care, with 35% postponing medical care due to financial challenges.

Additionally, there is a need for trauma care and rehabilitation, according to the WHO. The agency, citing the Ukrainian Ministry of Health, said that by mid-2024, 100,000 amputations had been performed due to the war. Meanwhile, there is a severe shortage of trauma specialists, prosthetics and rehabilitation services, the WHO said.

The WHO also warned about attacks on the health care system and workers. Since the start of the war, the agency said it has documented at least 2,254 attacks, with 42 attacks so far in 2025 alone, which resulted in 12 injuries and three deaths.

Amid the attacks was damage to the Okhmatdyt Children’s Hospital in Kyiv — one of the most well-respected children’s hospitals in the country — when five Ukrainian cities fell under attack in July 2024, President Volodymyr Zelenskyy said at the time. At least two people were killed in the attack on the hospital, including one female physician, and at least seven children were injured, according to officials.

In November 2022, a newborn baby was killed when a missile strike hit a maternity hospital in the town of Vilniansk in Zaporizhzhia Oblast, the local mayor told ABC News at the time.

The WHO said it’s focused on rebuilding Ukraine’s health care system, including installing primary health care clinics in affected regions and providing critical care including immunizations and mental health care, as well as treating HIV, tuberculosis and antimicrobial resistance.

“Health is the foundation of peace and recovery. Rebuilding health systems means restoring hope, dignity and securing the future,” the WHO wrote in its release.