Olha Golubovska, infectious disease (ID) doctor, Professor, MD, PhD, Honored Doctor of Ukraine

As an infectious disease doctor, I have observed the same pattern for years: infectious diseases are forgotten — right up until the moment something goes wrong. As long as things appear relatively stable, infectious disease wards are downsized, hospitals are closed, and specialists are redirected into other fields. Yet as soon as a serious threat emerges, there is a sudden realization that the system must be urgently rebuilt, reinforced, and restored.

One would think the COVID-19 pandemic had taught us this lesson. We remember well how Ukraine faced it: without a Chief Sanitary Doctor, with a largely dismantled system of sanitary and epidemiological surveillance, and with no clear transfer of responsibility for epidemiological control. Only when the crisis became real did efforts begin to rapidly reverse course — positions were reinstated, structures rebuilt. It is a telling example, underscoring a simple truth: short-sightedness in healthcare always comes at a high cost.

Reforms must have a clear objective — improving the quality of medical care. For me, as a physician, that metric is straightforward: how many patients we actually cure of serious diseases. The number of test tubes purchased, machines installed, or ventilators acquired cannot serve as a meaningful indicator of quality. Yet, unfortunately, such measures are often presented today as primary markers of success.

We must recognize that Ukraine is now in a profound social crisis. This is a reality we cannot ignore. The well-established concept of social determinants of health shows that healthcare itself accounts for only about 20% of health outcomes. The rest — 80% — depends on living conditions, nutrition, poverty, environment, and social support. This makes patient-centered social support essential, not just important.

A simple example: we have effectively dismantled a significant portion of tuberculosis care facilities, yet failed to establish a system of social support for patients undergoing treatment. Modern TB therapies can be highly effective, but only if patients adhere to them consistently. Without adherence, treatment fails. Moreover, such patients become sources of infection, potentially spreading multidrug-resistant tuberculosis. Someone must oversee this process; patients need structured support. Instead, they are often discharged “under family supervision.” But families may be absent or lack the means to provide such care.

In wartime, these challenges become even more acute. This is especially true for internally displaced persons living with chronic illnesses, tuberculosis, or mental health disorders. These individuals are doubly invisible: they have lost not only their homes, but also their hospitals and the communities that once knew and supported them. In many cases, reforms have resulted in such patients being discharged from inpatient care without any follow-up plan. We often do not even know what has happened to them — or how many lives may have been lost.

Before undertaking any reforms, we must answer a set of fundamental questions: What is our actual population? How many hospitals are functioning? How many have closed? What are the current rates of morbidity and mortality across diseases? Since 2019, we have been promised a comprehensive audit of the healthcare system — yet it has not materialized. Without reliable data, no system can be effectively planned. Until we truly understand what we have, we should focus less on dismantling and more on preserving what still works.

I work in a hospital setting and witness the consequences of these decisions daily. Recently, a patient died. It began with something as simple as ear pain. She sought medical attention but was told to return in two weeks. By the time her husband found her unconscious, she had already developed severe meningoencephalitis. For a physician, the hardest thing is not when a patient dies from an incurable disease, or when medicine reaches its limits, but when a life is lost simply because timely care was not accessible.

Medicine will always involve a human factor. But when limited access to care becomes systemic, it is no longer an accident — it is a matter of public policy. And that is something I have never accepted, do not accept, and will never accept.