Ukraine
Palliative care built from NGO and donor roots inside a reformed national purchaser system, and a rare published case of pain relief under full-scale war.
8 domains reviewed · 8 high-confidence · 0 dated estimates · 9 material gaps
WHO region: Europe. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 8 of 9
- Hospice: 3 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 16
- Newest source 2026
Lessons from Ukraine
- Paying mobile palliative teams through a national purchaser can widen home access, but only if base rates reflect real costs.197,195
- Where opioid access is already low, conflict makes pain relief worse. Controlled-medicine supply belongs in emergency preparedness.194,196
- When palliative education depends on NGO courses, clinicians stay undertrained. Formal postgraduate training for primary care doctors is a structural need.195,198
- In wartime, volunteer patient networks using social media and hotlines can guide displaced patients through referral and evacuation when official channels are overwhelmed.194
- Flexible opioid agonist dosing, including unsupervised doses, and easy transfer for displaced patients help keep people in treatment during war.711,712
- Methadone can be delivered in primary care with guideline-concordant care and retention similar to specialty clinics.713
Palliative care
Is morphine available in Ukraine?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
Before the war, opioid access for palliative care met only a small share of national need, and painkillers were not supplied in full volume. War conditions have worsened pain relief.194,196
How did oral morphine availability change after the 2022 invasion?
Help answer it:Search PubMedHow does Ukraine regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
Advocacy evaluations report that laws and policies limiting palliative care were reformed and that palliative care medicines were available by the mid-2010s. Both are written by staff of the funders and advocates involved, and neither names the specific instruments.199,274
Which laws or ministerial orders changed opioid stocking, prescribing and dispensing, and when?
Help answer it:Search PubMedWho can prescribe morphine in Ukraine?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
May family doctors or other non-specialists prescribe strong opioids?
Help answer it:Search PubMedHow does palliative care reach patients in Ukraine?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
Palliative and hospice care began through NGOs with international donor grants. Family doctors carried home care where no mobile team service existed. The war has damaged community services and home care is often unavailable.195,194,198
Who pays for palliative care in Ukraine?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
The national purchaser pays mobile palliative teams at base rates judged below actual costs, and many services carry high out-of-pocket payments. In wartime the health system depends on international grants and loans.197,195,194
How much palliative care depends on national purchaser contracts versus donors and out-of-pocket payment?
Help answer it:Search PubMedHow are palliative care clinicians trained in Ukraine?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
Undergraduate and postgraduate palliative education is described as unsatisfactory, and clinicians learn mainly through NGO courses. Family doctors report an urgent need for training.195,198
Is palliative medicine a recognized specialty, and who certifies it?
Help answer it:Search PubMedHow does Ukraine prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Before the 2022 invasion, opioid analgesic use for palliative care averaged 120 mg morphine equivalent per patient with serious illness, meeting 7% of national need. Ukraine runs a national opioid agonist maintenance program; in a registry cohort of 17,211 patients, 29.3% stopped treatment in the first two years of full-scale war, with displacement the main driver and unsupervised dosing protective.194,711,712
Has the wartime expansion of ePrescription changed community access to oral morphine for palliative patients, and is take-home naloxone available outside NGO programs?
Help answer it:Search PubMedHow do children get palliative care in Ukraine?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
The pediatric oncology foundation Tabletochki runs palliative care programs and helps arrange medical evacuation for children with cancer. A legal review reports that children's rights to palliative care at home, to consent to care, and to confidentiality are violated in practice.194,714
How many children in Ukraine receive palliative care each year, and are oral morphine formulations for children available?
Help answer it:Search PubMedHow is palliative care delivered during crises in Ukraine?
Secondary and community palliative services have been severely affected by infrastructure damage, staff evacuation and mass displacement, and disrupted treatment caused some curable cancers to progress to needing palliative care. Home and community palliative care is often unavailable to older people with serious illness, and internally displaced people had the highest risk of losing opioid agonist treatment.194,711
How is palliative care, including opioid supply, delivered to internally displaced patients and in frontline regions?
Help answer it:Search PubMedHospice care in Ukraine
How the hospice model works here, who can use it, who pays and who it reaches. Covered 3 of 4.
What does hospice care look like in Ukraine?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Ukrainian sources use the combined term palliative and hospice care, and a legal review treats hospice care as a component of palliative care. The first Ukrainian hospice was an institution for cancer patients in Lviv. In a Kyiv survey, mobile teams and home-based services were the most requested forms of this care.196,313,314
When was the Lviv hospice founded, and how many inpatient hospices now operate under state, municipal or charitable ownership?
Help answer it:Search PubMedWho can get hospice care in Ukraine?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
What diagnosis or prognosis rules and referral routes govern admission to Ukrainian hospice departments?
Help answer it:Search PubMedWho pays for hospice care in Ukraine?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
In a 2011 survey, all Ukrainian respondents named full-time hospices and palliative care units as the main place of care, and 80% said this care was only partly publicly funded. A 2024 modeling study of mobile palliative teams paid by the National Health Service of Ukraine, grouped by the authors under palliative and hospice care, used a base rate of 69,326.04 UAH and judged the tariffs below actual costs.369,197
What does the current NHSU package pay for inpatient hospice beds, and how much do hospices still rely on charity or local budgets?
Help answer it:Search PubMedHow many people reach hospice in Ukraine?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
A 2019 legal review reports an insufficient number of palliative and hospice departments and incomplete provision of free palliative care. A 2020 survey reported too few inpatient beds for palliative patients and no mobile team service, which left home care to family doctors.196,198
How has wartime damage since 2022 changed the number and location of Ukrainian hospice beds?
Help answer it:Search PubMedWhat fills the gap in Ukraine
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
Home and community-based palliative care is often unavailable, and caregivers are mainly family members who face emotional strain; older adults and caregivers were reported to cope through acceptance, spirituality and self-reliance. Before the war, opioid supply met only 7% of national palliative need.194
National evidence- Volunteers and compassionate communities
During the war, the Kyiv-based volunteer network Inspiration Family used social media to guide displaced cancer patients through referral and evacuation and helped over 100 patients receive treatment abroad in the first 3 months. The NGO Athena runs a patient hotline and peer-support Facebook group, and the foundation Tabletochki runs paediatric palliative care programmes.194
Mixed scope- Community health workers and home-based care
In remote villages of Donetsk region, the NGO EMERGENCY employs locally recruited community health workers who make door-to-door visits, monitor chronic disease treatment, and arrange home-based care for bedridden people, linked to nurse-led clinics. This is a program description by the implementing NGO.521
Single-site evidenceSelf-reportedFamily physicians in primary care provide general palliative care at home; in Uzhhorod, fatigue and pain were the main symptoms among 219 such patients. A pre-2022 analysis reported that the absence of mobile palliative teams required family doctors to provide this care at home with limited training.522,198
Mixed scope
Sources cited here
- 194Karavska A, Kizub D, Kovalchuk N, et al.
Cancer care in wartime Ukraine: disruption, resilience and recovery. BMJ Oncology 2026;5(1):e000943. Very limited pre-war opioid access for palliative care; war worsened pain relief and damaged community services; health system dependent on international grants and loans. Full text read.
- 196Shevchuk O, Trofymenko V, Martynovskyi V, et al.
Realization of the human right to palliative care in Ukraine: problems and legal issues (review). Georgian Medical News 2019;(289):168-173. Painkillers, including narcotic drugs, not provided in full volume. Abstract read. National-journal review; lower certainty.
- 199Lohman D, Amon JJ.
Evaluating a Human Rights-Based Advocacy Approach to Expanding Access to Pain Medicines and Palliative Care: Global Advocacy and Case Studies from India, Kenya, and Ukraine. Health and Human Rights 2015;17(2):149-165. Advocacy contributed to reform of laws, policies and practices in all three countries. Abstract read.
- 274Lohman D, Abidjanova N, Amiryan D, et al.
Progress update: development of palliative care from 2017 to 2020 in five countries in Eurasia. Journal of Pain and Symptom Management 2022;64(2):100-109. Armenia, Georgia, Moldova, Tajikistan, Ukraine; policies, medicines and training in place by the mid-2010s. Authors are Open Society staff evaluating their own funding. Abstract read.
- 195Paal P, Brandstötter C, Bükki J, et al.
One-week multidisciplinary post-graduate palliative care training: an outcome-based program evaluation. BMC Medical Education 2020;20(1):276. Palliative care began through NGOs with international donor grants; high out-of-pocket payments; training mainly through NGO courses. Full text read.
- 198Mykhalchuk VM, Goida NG, Tsarenko AV.
Professional postgraduate training of family doctors: an important part and condition of the optimal palliative and hospice care system implementation in Ukraine. Wiadomosci Lekarskie 2020;73(5):925-930. Family doctors lacked palliative knowledge; no mobile team service at the time. Abstract read. National-journal study; lower certainty.
- 197Tsarenko AV, Kovtun OO, Maksymova ZV.
Modelling business processes in palliative care management: ways to optimise resource management. Wiadomosci Lekarskie 2024;77(11):2271-2276. National Health Service of Ukraine base rates for mobile palliative teams judged below actual costs. Abstract read. National-journal study; lower certainty.
- 711Ivasiy R, Madden LM, Meteliuk A, et al.
War-related displacement, conflict intensity, and treatment delivery factors in opioid agonist maintenance treatment discontinuation following Russia's invasion of Ukraine: a national cohort study. Lancet Reg Health Eur 2026;69:101831. National registry cohort of 17,211 people on opioid agonist maintenance treatment in 252 government clinics in Ukraine, 2022 to 2024; displacement and war intensity drove discontinuation, and optimal and unsupervised dosing were protective. NIDA funded; independent academic study. Abstract read.
- 712Pykalo I, Filippovych M, Zeziulin O, et al.
Holding the line: Provider and patient perspectives on Medications for Opioid Use Disorder continuity during the war in Ukraine. PLoS One 2026;21(2):e0341182. Qualitative study of 10 displaced patients and 7 providers in three western and central Ukrainian cities on keeping medications for opioid use disorder going during war. Small sample, three cities. Abstract read.
- 714Shevchuk OM, Shevchuk AM, Holovash OO, et al.
Protection of сhildren's rights to access palliative medical services: Legal problems. Wiad Lek 2025;78(6):1078-1082. Legal analysis of Ukrainian law on children's rights to palliative care, including home care, consent and confidentiality. Theoretical and legislative review, no patient data. Abstract read.
- 313Bilynsky BT, Shparyk YV, Mryglotsky MM, et al.
70th anniversary of the Lviv scientific school of oncology. Exp Oncol 2016;38(1):60-2. Historical article by Lviv oncologists that credits Lviv with the first Ukrainian hospice for oncological patients; institutional self-history, no founding date given. Abstract read.
- 314Tsarenko AV, Chaikovska VV, Goida NG, et al.
THE AVAILABILITY AND QUALITY OF PALLIATIVE AND HOSPICE CARE ENSURING IN THE COVID-19 PANDEMIC CONTEXT. Wiad Lek 2022;75(5 pt 1):1112-1117. Survey-based study of outpatient palliative and hospice care and Kyiv mobile teams; several authors are affiliated with the Ukrainian Palliative and Hospice Care League (advocacy organization). Abstract read.
- 369Mardofel A.
[Analysis of current conditions concerning development of palliative care in three selected countries of the former Eastern Bloc]. Pol Merkur Lekarski 2013;35(206):89-93. Survey of 95 medical staff in Belarus, Kazakhstan and Ukraine in 2011 plus official documents; per-country sample sizes not given in the abstract; author affiliated with a Polish hospice association. Polish article, English abstract read.
- 713Machavariani E, Esserman D, Dumchev K, et al.
Integrating Methadone Services Into Primary Care in Ukraine: Two-Year Outcomes From a Randomized Trial. Ann Intern Med 2025;179(2):177-186. Randomized trial of 1459 adults in 13 Ukrainian cities; methadone in primary care gave higher guideline-concordant care scores with similar retention to specialty clinics. NIDA funded. Abstract read.
- 521Lupica Spagnolo D, Colpo E, Peretti M, et al.
A Field Report from War-Torn Remote Villages in South-Eastern Ukraine: Enhancing Healthcare Access Through a Community-Oriented Primary Care Model. J Prev Med Hyg 2025;66(3):E421-E427. Field report by the NGO EMERGENCY on its own community health worker model in remote villages of Donetsk region (self-report). Abstract read.
- 522Detsyk OZ, Bratsyun OP, Babich РM.
QUALITY OF LIFE OF PATIENTS RECEIVING HOME-BASED PALLIATIVE CARE FROM FAMILY PHYSICIANS AND MOBILE PALLIATIVE CARE TEAM. Wiad Lek 2020;73(8):1681-1689. Quality-of-life study of 219 patients receiving general palliative care from family physicians in Uzhhorod and a mobile team subgroup. Abstract read.