A Synthesis of Recommendations to Strengthen Health and Trauma Care in Ukraine Since the Start of the Russian Invasion

Introduction: The full-scale Russian invasion in February 2022 severely impacted the organizational structure of Ukraine’s healthcare system. The devastation wrought by the Russian aggression requires the Ministry of Health to find ways to address the most pressing healthcare issues and limit impacts on the health of the population. We summarize a series of papers that assessed the challenges to the health and trauma system in Ukraine since the Russian invasion. Materials and Methods: We performed a framework synthesis of 10 manuscripts using data from a qualitative study of Ukraine’s health and trauma systems. We synthesized the findings using the Doctrine, Organization, Training and Education, Materiel, Leadership, Personnel, Facilities, Policy (DOTMLPF-PI) framework developed by the DoD to assess system efficiency and effectiveness and includes NATO’s domain of Interoperability. Results: The assessment of Ukraine’s military medical system under large-scale combat operations (LSCO) revealed key systemic limitations across the DOTMLPFP-PI domains—particularly training category (27), materiel (19), doctrine (18), policy (17), and interoperability (17). The overall assessment reveals a health system under severe strain, operating within outdated frameworks that are misaligned with modern warfare realities. Conclusions: This work generated a comprehensive set of recommendations that, if implemented, would enhance the effectiveness of Ukraine’s military medical system in both the current conflict and into the future. The recommendations are also broadly applicable to other state-actors and their military-health systems, particularly in the context of the evolving realities of modern LSCO.