Building integrated ambulatory care in conflict settings: lessons from Ukraine

Issue/problem

During war, healthcare delivery often focuses on trauma stabilization and evacuation, while ambulatory care, continuity of care, infectious disease prevention and long-term service organization remain underdeveloped. High patient flows, fragmented records and workforce shortages increase delays and inefficient use of limited resources.

Description of the problem

During the full-scale war in Ukraine, First Separate Medical Battalion developed an integrated ambulatory care model serving an active frontline area of approximately 100 kilometers. The model introduced structured outpatient pathways beyond emergency response. The unit provides daily outpatient services for approximately 100–150 individuals, including primary care, specialist consultations, dental care, podiatry, diagnostics, laboratory services, infectious disease screening and preventive care. To improve efficiency, the battalion developed “Sisyphus,” a proprietary digital system that manages patient flow, collects operational and clinical data, tracks service utilization and specialist workload, and supports data-informed planning. The model was built through hybrid resource mobilization combining internal expertise, charitable fundraising, private donations, repurposed infrastructure and partnerships.

Results

The model improved access to structured outpatient care during wartime, reduced congestion and strengthened operational planning. The model also strengthened continuity of care for individuals requiring non-emergency consultations in a highly unstable environment. It also showed that patient-centred design, including organized scheduling and improved waiting spaces, can improve healthcare experiences during war.

Lessons

Health systems operating during war should not be limited to emergency response alone. Integrated ambulatory services, low-cost digital tools and flexible financing can strengthen continuity of care and resilience in fragile settings.

Key messages

• Health systems operating during war require investment not only in emergency response but also in continuity of care and outpatient services.

• Hybrid financing, digital tools, and patient-centered design can strengthen health system resilience in conflict-affected settings.