A qualitative assessment of disease and non-battle injuries in Ukraine since the Russian invasion

Background: Disease and non-battle injuries (DNBI) often account for more military casualties than those from combat wounds. The February 2022 Russian invasion of Ukraine has severely limited access to care in areas with increasing patient care needs beyond combat injuries. The expansion of the draft resulted in an older military population susceptible to musculoskeletal injuries, while trench warfare and harsh winters create conditions conducive to cold weather injuries and infectious diseases. This study aims to assess the prevalence and scope of DNBI in Ukraine. Methods: We conducted qualitative key informant interviews with Ukrainian military and civilian health care workers from June 2023-February 2024 using an expanded version of the Global Trauma System Evaluation Tool which had components focusing on DNBI. Thematic content analysis was used to derive key themes related to DNBI from interviews. Results: We conducted 36 key informant interviews. Respondents described the wide range of DNBI that Ukrainian soldiers are experiencing. Infectious disease, cold weather injuries, musculoskeletal injuries, sexual assault, and mental health emerged as prevalent concerns. Respondents described the critical shortage of resources and the high burden on military hospitals as barriers to the delivery of adequate care for DNBI. Conclusions: DNBI in Ukraine are directly related to the physical environment and the age and fitness of the military population. The troop shortage has resulted in soldiers with chronic illnesses returning to duty, while the physical environment limits prevention measures for weather-related injuries and infectious diseases. The complex healthcare challenges created by these factors highlight the importance of a military health system with the capacity to provide service members with the full spectrum of care beyond combat injuries.