Ukraine, 1,000 days on: civilians are still the primary victims of armed violence

The whole of Ukraine is still under threat from air raids, with the east and south of the country particularly hard hit by bombing and shelling.

A surge in bomb attacks since last July

The surge in bomb attacks, particularly since last July, is causing an ever-growing number of casualties. As an example, 208 people were killed and 1,220 were injured last September. In that same month, 45% of the victims were over the age of 60.  

Thousands of people in Ukraine currently have no electricity, gas or water, and little access to food. Because of the constant bombardments, these people are effectively cut off from the world, in areas that are difficult to access and close to the front line. With the onset of winter, there are fears of a sharp rise in humanitarian needs, particularly as numerous energy installations have been damaged or destroyed. In September alone, 30 bomb attacks on energy infrastructure were recorded.

“At least 27,449 civilians have been killed or injured since February 2022, the vast majority in bombings of urban areas. The commemoration of these 1,000 days of large-scale war coincides with the 2nd anniversary of the signing of the EWIPA Political Declaration, which calls on states to do their utmost to protect civilians from the consequences of bombing in populated areas. Concrete measures must be urgently taken to stop the use of the most destructive and indiscriminate weapons, which are costing thousands of civilians their lives, and to ensure that survivors have access to all the services they need. Therefore, it is essential that humanitarians are granted safe and unhindered access to all areas where people are in need, particularly near the front lines or in areas contaminated by mines or explosive remnants of war where thousands of people, often older, live isolated and abandoned," explains Célia Faure, head of advocacy in Ukraine.

Breakdown in access to healthcare

In areas to the east and south, near the front lines and therefore difficult to reach, the war has made access to healthcare virtually impossible. According to a WHO report published in August 2024, almost 2,000 health facilities have been damaged or destroyed in the bombardments.

This lack of access to healthcare also affects displaced people, who number at least 4 million according to figures provided by the Ukrainian authorities.

“Older people and people with disabilities are the hardest hit, as many of them have had to leave their homes and move to other parts of Ukraine where the facilities are not adapted to their situation and where they have limited access to health services and support from caregivers”, explains Roman Shinkarenko, HI’s Protection Project Manager based in Dnipro, Ukraine.

Our teams are also seeing an increase in serious health problems such as diabetes, strokes and cancer, diseases that are not given priority for treatment because of the overcrowding in hospitals dealing with war casualties and the absence of therapeutic options.

“In the newly accessible areas, HI is also seeing a reduction in public transport services, which is limiting mobility, particularly for people with disabilities,” says Illia Demianyk, Protection Project Manager at HI in Kharkiv, Ukraine.

HI’s response: HI provides physical and functional rehabilitation services to people with disabilities, injuries and chronic illnesses. These include many people displaced by the conflict and living in areas where access to healthcare is very difficult. Nearly 13,000 rehabilitation sessions have been carried out for 4,100 people in Ukraine since 2022 (figures as of October 2024).

A climate of deep uncertainty

Many people are also in need of psychological support. In addition to the accumulation of acute stress and trauma caused by forced displacement, bereavement and separation, all civilians are living in a climate of uncertainty. How can they look ahead or build a future when they don't know what will happen to them from one minute to the next?

"Psychologically, people have had to learn to adapt, but guidelines and safety rules can help them to do so in a context of bombing and bomb warnings.... However, everyone is living in a climate of uncertainty... Our teams of psychologists have identified various ‘coping strategies’ used by the people affected, such as increased alcohol consumption or taking over-the-counter medication, which endangers their health. People affected by the war are more inclined to isolate themselves, to pass their negative emotions on to others, and to have a negative attitude to life," explains Diana Turchyn, HI's mental health and psychosocial support technical adviser in Kharkiv, Ukraine.

HI’s response: HI is organizing support groups with communities affected by the war to help them cope with the trauma that they are experiencing (accumulated stress, separation, forced displacement, grief, etc.) share their feelings, forge links and strengthen their resilience. 2,585 group and individual sessions have been delivered to 7,262 people since 2022 (figures as of October 2024).

The “invisible” threat of unexploded ordnance (UXO) contamination

In addition to the devastating effects on civilian lives, the regular shelling and bombing and the high risk of contamination by explosive munitions are limiting humanitarian access and creating an “invisible threat” for the communities. In the face of these dangers, some civilians no longer dare to travel around, have stopped working their land and have drastically reduced their leisure activities.

HI’s response: HI is organizing awareness-raising sessions on the risks associated with anti-personnel mines and explosive remnants of war, as well as sessions on preparedness and protection against bombings for children, adults and NGO staff. The aim is to reduce accidents and increase the resilience of local populations, displaced people and humanitarian aid workers affected by explosive ordnance.

Accumulation of vulnerabilities

Children, older people and people with disabilities, particularly women and girls, are disproportionately affected by the conflict and face greater risks. Since the escalation of the conflict, women have had limited access to specialized services (legal aid, medical services), especially for cases of gender-based violence. This is particularly the case in rural areas, as services are concentrated in towns. Women’s socio-economic situation has also been weakened by the fact that many men have been deployed to the front line, leaving them to manage their households and children on their own. Moreover, due to population movements and the general mental health situation, the risk of gender-based violence remains high.

HI has been present in Ukraine since February 2022, providing essential and inclusive humanitarian aid to war-affected people through a multi-sectoral response ranging from physical rehabilitation and psychosocial support to explosive ordnance awareness and population protection. Our teams also deliver humanitarian goods and essential hygiene items to conflict-affected populations and provide financial assistance to help meet the most urgent needs.