HEALTHCARE IN WARTIME: INSTITUTIONAL CAPACITY  OF THE STATE AS A FACTOR OF NATIONAL SECURITY

Olha Sokurenko

doi:10.23856/7127

Olha Sokurenko Mykhailo Dragomanov National University of Ukraine https://orcid.org/0009-0007-8423-6860

Keywords: governance, public policy, crisis management, healthcare system, national resilience, institutional reform, decentralization, human capital

Abstract

The article explores the institutional capacity of the healthcare system during wartime as a critical dimension of national security, with a particular focus on Ukraine’s experience in the context of Russia’s full-scale military aggression. It emphasizes that healthcare is no longer solely a social or humanitarian sphere but a vital political instrument for maintaining state resilience in crises. The author examines the role of medical institutions in sustaining logistical, psychological, and operational support for the civilian population and armed forces alike, high- lighting the politicization of healthcare in hybrid warfare, including through disinformation and psychological attacks.Drawing comparative insights from Israel and Georgia, the article illustrates how institutional flexibility, intersectoral coordination, and public trust enable healthcare systems to adapt to wartime conditions. In Ukraine, despite some legislative and administrative efforts, the healthcare system faces numerous challenges: insufficient staffing, lack of legal frameworks for military medicine, fragmentation of governance, weak decentralization mechanisms, and poor integration of mental health services. The author stresses the need for a comprehensive framework law on medical security, expanded public-private partnerships, modern digital platforms for healthcare management, and reform of medical education and human resources policy.The article argues that only through institutional reform, strategic leadership, and strengthened accountability can healthcare become a sustainable element of national security policy in wartime.

References

1. ACAPS. (2023). Vplyv konfliktu na systemu okhorony zdorovia ta aktsentuvannia uvahy na konkretnykh potrebakh [Impact of conflict on the health system and focus on specific needs]. ACAPS. https://www.acaps.org/fileadmin/Data_Product/Additional_resources/20231004_ACAPS_thematic_report_Ukraine_impact_of_the_conflict_on_healthcare_system_and_spot-light_on_specific_needs_Ukrainian.pdf [in Ukrainian]
2. Bondarenko-Zelinska, N., Boryslavska, M., & Zelinskyi, A. (2021). Pro pravo na okhoronu zdorovia sotsialʹno vrazlyvykh hrup naselennia [On the right to health protection of socially vulnerable groups of the population]. University Scientific Notes, (82), 157–190. https://doi.org/10.37491/unz.82.13 [in Ukrainian]
3. Minenko, Y. (2023). Vplyv rosiisʹkoi propahandy na suspilʹno-derzhavnu stabilʹnistʹ Ukrainy: analiz metodiv ta naslidkiv [The impact of Russian propaganda on Ukraine’s socio-state stability: Analysis of methods and consequences]. Naukovi pratsi Mizhrieghionalʹnoi Akademii upravlinnia personalom. Politychni nauky ta publichne upravlinnia, 3(69), 47–51. https://doi.org/10.32689/2523-4625-2023-3(69)-6 [in Ukrainian]
4. OECD. (2025). Upravlinnia novymy krytychnymy ryzykamy. Keis-stadii ta porivnialʹnyi analiz krain [Managing emerging critical risks. Case studies and cross-country synthe- sis report]. OECD. Retrieved from https://www.oecd.org/en/publications/managing-emerging-critical-risks_1f9858ea-en/full-report/country-case-study-israel_0726674d.html
5. Nitzan, D., Mendlovic, J., & Ash, N. (2024). Izrailsʹka systema travmatolohii v umovakh viiny – polityka ta upravlinnia [The Israeli trauma system during wartime – policy and man- agement]. Israel Journal of Health Policy Research. BioMed Central. Retrieved from https://ijhpr.biomedcentral.com/articles/10.1186/s13584-024-00623-x
6. Levi, B., Davidovitch, N., & Dopelt, K. (2021). Na sluzhbi suspilstvu? Medychni asotsiatsii yak ahenty sotsialʹnykh zmin – naslidky dlia medychnoi polityky ta osvity v Izraili [In service of the society? Medical associations as agents of social change – implications for health policy and education in Israel]. Healthcare, 9(10), 1264. https://doi.org/10.3390/healthcare 9101264
7. World Bank Group. (2010). Hruzynsʹka spilʹna otsinka potreb u postkonfliktnyi period otrymuie nahradu Svitovoho banku [Georgia post-conflict joint needs assessment wins a World Bank prize]. World Bank. Retrieved from https://www.worldbank.org/en/news/press-release/2010/03/31/georgia-post-conflict-joint-needs-assessment-wins-a-world-bank-prize
8. World Bank Group. (2025). Upravlinnia pryvatnym sektorm okhorony zdorovia v Hruzii [Governance of the private health sector in Georgia]. World Bank. Retrieved from https://iris.who.int/bitstream/handle/10665/381681/WHO-EURO-2025-11941-51713-79128-eng.pdf?sequence=1
9. Kovalchuk, V. B. (2023). Osoblyvosti pravovoho rehuliuvannia funktsionuvannia orhaniv mistsevoho samovriaduvannia v period voiennoho stanu v Ukraini [Peculiarities of legal regulation of local self-government bodies during martial law in Ukraine]. Ukrainskyi chasopys konstytutsiinoho prava, (4), 37–46. [in Ukrainian]
10. Karamushka, L. (2022). Psykhichne zdorovia personalu orhanizatsii v umovakh viiny: osnovni vyiavy ta resursy [Mental health of organizational personnel during the war: Key man-ifestations and resources]. Scientific notes of the University "KROK", 67, 124–133. https:// doi.org/10.31732/2663-2209-2022-67-124-133 [in Ukrainian]
11. Pravo na zakhyst. (2021). Analiz Stratehii intehratsii VPO ta vprovadzhennia serednos- trokovykh rishenʹ shchodo vnutrishnoho peremishchennia na period do 2024 roku [Analysis of the Strategy for IDP integration and implementation of medium-term solutions on internal displacement until 2024]. Pravo na zakhyst. Retrieved from https://archive.r2p.org.ua/strategi-ya-integracziyi-vpo-analiz [in Ukrainian]
12. NISD. (2024). Tendentsii rozvytku systemy okhorony zdorovia v umovakh detsentralizatsii [Trends in the development of the healthcare system under decentralization]. NISD. Retrieved from https://niss.gov.ua/doslidzhennya/sotsialna-polityka/tendentsiyi-rozvytku-systemy-ok-horony-zdorovya-v-umovakh [in Ukrainian]
13. Romashka, S. (2025). Finansuvannia okhorony zdorovia v Ukraini pid chas povnomasshtabnoi viiny ta prohnoz na pisliavoiennyi period [Healthcare financing in Ukraine during the fullscale war and forecast for the post-war period]. https://doi.org/10.5281/zenodo.14922016 [in Ukrainian]
14. Zakon Ukrainy Pro vnesennia zmin do deiakykh zakonodavchykh aktiv Ukrainy shchodo pidvyshchennia dostupnosti medychnoi ta reabilitatsiinoi dopomohy u period dii voiennoho stanu: pryiniatyi 29 lyp. 2022 roku № 2494-IX [Law of Ukraine on amendments to certain legislative acts to improve access to medical and rehabilitation care during martial law, from July 29, 2022, № 2494-IX]. (2022, July 29). Retrieved from https://zakon.rada.gov.ua/laws/show/2494-20#Text [in Ukrainian].
15. Zakon Ukrainy Pro vnesennia zmin do deiakykh zakonodavchykh aktiv Ukrainy shchodo udoskonalennia nadannia medychnoi dopomohy: pryiniatyi 1 lyp. 2022 roku № 2347-IX [Law of Ukraine on amendments to certain legislative acts to improve the provision of medical care, from July 1, 2022, № 2347-IX]. (2022, July 1). Retrieved from https://zakon.rada.gov.ua/laws/show/2347-20#Text [in Ukrainian].
16. Alliance for Public Health. (2025). Yak zabezpechuietsia stiikistʹ v okhoroni zdorovia Ukrainy pid chas viiny [How resilience in Ukraine’s healthcare is ensured during the war]. Alliance for Public Health. Retrieved from https://aph.org.ua/uk/novyny/yak-zabezpechuyet-sya-stijkist-v-ohoroni-zdorov-ya-ukrayini-pid-chas-vijni-2 [in Ukrainian].
17. Shevchuk, R. (2022). Analiz problem reformuvannia systemy okhorony zdorovia v Ukraini [Analysis of the problems of healthcare system reform in Ukraine]. Vcheni zapysky TNU imeni V. I. Vernadskoho. Seriia: Publichne upravlinnia ta administruvannia, (6), 178–183. https://doi.org/10.32782/tnu-2663-6468/2022.6/28 [in Ukrainian].
18. Ivanchov, P. (2020). Problemy reformuvannia systemy okhorony zdorovia v Ukraini: insty- tutsiinyi aspekt [Problems of healthcare system reform in Ukraine: Institutional aspect]. Aktualni problemy ekonomiky, 228(6), 133–145. Retrieved from https://eco-science.net/wp-content/uploads/2021/08/6.20._topic_Ivanchov-P.V.133-145.pdf [in Ukrainian].
19. Pravylo, O. (2024). Pravove rehuliuvannia okhorony zdorovia v Ukraini [Legal regulation of healthcare in Ukraine]. Elektronne naukove vydannia "Analitychno-porivnialʹne pravoznavstvo", (3), 390–395. https://doi.org/10.24144/2788-6018.2024.03.67 [in Ukrainian].
20. Dzvinchuk, D., & Baran, M. (2020). Zastosuvannia dialogichnoi modeli zmin u protsesi reformuvannia systemy okhorony zdorovia v Ukraini na pervynnomu rivni [Application of the dialogical model of change in the process of healthcare reform in Ukraine at the primary level]. Public administration and regional development, (7), 89–108. https://doi.org/10.34132/pard2020.07.04 [in Ukrainian].
21. Liakhovych, H. I., & Vakun, O. V. (2025). Kadrova polityka v zakladakh systemy okhorony zdorovia: zarubizhnyi dosvid ta problemy v Ukraini [Personnel policy in healthcare institutions: Foreign experience and problems in Ukraine]. Investytsiyi: praktyka ta dosvid, (2), 39–45. https://doi.org/10.32702/2306-6814.2025.2.39 [in Ukrainian].