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Earlier this month, I visited our partners in Lviv, Ukraine.
Over the past year, I have immersed myself in Ukraine’s healthcare system, the challenges facing its people, and the extraordinary work of Direct Relief’s partners through briefings, reports, and conversations with colleagues and healthcare leaders. But it was my first time visiting the country.
The visit offered something only being there in person could: the opportunity to listen, observe, and learn directly from the people living and leading through these challenges every day.
What I encountered was something so much more impactful than I expected.
Alongside the realities of conflict, I saw healthcare leaders expanding services, training future providers, investing in mental health and rehabilitation, and strengthening institutions designed to serve their communities for decades to come.
Across every organization we visited, I saw the same steadfast determination: not simply to respond to today’s challenges, but to continue building for tomorrow.
The Work of Preparedness
Even underground, the focus remains the same: caring for patients.
At St. Nicholas Children’s Hospital, our visit was interrupted by an air raid alert. As staff calmly guided patients, families, and visitors downstairs, we entered the hospital’s basement shelter.
Along the walls were rows of child-sized hospital beds, already positioned and ready for patients.
Standing in the shelter, looking at the rows of neatly arranged beds ready to receive children when the next siren sounded, I found myself unable to reconcile what I was seeing in front of me.
How have we come to this?
How has something so unimaginable become routine, woven into the daily rhythms of life here at a children’s hospital?
Parents are already facing some of the most difficult moments imaginable when a child is admitted to the hospital. They are worrying about diagnoses, treatments, surgeries, and recovery. Yet here, families and healthcare providers must also prepare for the possibility that care will need to continue underground.
The clinicians explained that when an alert comes, they must quickly determine which children can safely be moved downstairs and which are too critically ill to leave their rooms.
Which children are stable enough to move? Which must remain where they are? How do you maintain continuity of care while preparing for the possibility of an incoming attack?
These are questions no healthcare system should ever have to answer.
And yet they do. Repeatedly.
What struck me was not only the reality of those decisions, but the calm professionalism with which they were made. The systems were in place. The teams knew their roles. Care continued.
Preparedness is often invisible until the moment it becomes essential.
The work required to maintain continuity of care during a crisis begins long before the crisis itself.
In many ways, that commitment to continuity became one of the defining themes of the visit. Across the organizations we visited, leaders were not only protecting care today, but strengthening the systems that will support care tomorrow.
The Future They Are Building (and Meeting the Future President)
Even amid extraordinary challenges, the future is taking shape in the hopes and ambitions of young people like Nazar, pictured here with his mother.
Among the many patients we met was Nazar, a 12-year-old boy recovering from a heart transplant.
Nazar had previously battled cancer, and the treatments that helped save his life ultimately weakened his heart, leaving him in need of a transplant. His doctors feared they were within 48 hours of losing him when they received word that a donor heart had become available.
It is difficult to comprehend what a child should have to endure at such a young age. Harder still to imagine that journey unfolding amid the uncertainty and disruption of an ongoing war.
And yet Nazar’s story was not defined by hardship.
It was defined by possibility.
When I asked him what he wanted to be when he grows up, his answer was immediate.
“The President of Ukraine.”
Throughout our time in Lviv, we met healthcare professionals focused on helping patients recover, families move forward, and communities rebuild. Nazar reflected the same determination we saw everywhere we went.
His answer captured something larger about what we would continue to see across Ukraine. Even amid extraordinary challenges, people continue investing in what comes next.
Building What Comes Next
With Andriy Sadovyi, Mayor of Lviv, Ukraine.
The visible effects of conflict are easy to recognize. Damaged buildings, disrupted communities, and patients recovering from injury tell part of the story.
Less visible is the work required to strengthen a healthcare system while living through those challenges.
Across Lviv, we met leaders focused not only on meeting today’s needs, but on preparing for tomorrow’s.
At the Lviv Regional Clinical Perinatal Center, teams continue providing maternal and newborn care while adapting to the realities of air raid alerts and ongoing uncertainty. The Ukraine Midwives Union trains first responders on delivering babies in air raid shelters and emergency situations. At UNBROKEN, specialists are helping patients recover from profound physical and psychological trauma while simultaneously advancing rehabilitation medicine, mental health services, education, and workforce development.
Throughout the city, we saw investments in medical education, specialized clinical care, new facilities, and expanded services designed to meet the needs of patients for years to come.
These efforts are not separate from the response.
They are an essential part of it.
Strong health systems cannot simply withstand crisis. They must continue to learn, adapt, and evolve through it.
That is exactly what is happening across Ukraine today.
Healthcare leaders are responding to immediate needs while simultaneously investing in the people, infrastructure, and expertise that will shape the country’s future.
In many ways, that may be the most powerful form of resilience: continuing to build even amid profound uncertainty.
The Importance of Long-Term Partnership
Looking over medications that have recently arrived in Ukraine.
Direct Relief was supporting healthcare partners in Ukraine before the current conflict began, and we remain steadfast in that commitment today.
Since 2022, Direct Relief and its donors have provided $2.5 billion in medical aid and support to healthcare providers across Ukraine. Those resources have helped expand access to care, strengthen specialized services, support medical education and training, and ensure patients continue receiving treatment under extraordinarily difficult circumstances.
While financial support and medical resources matter, they are only part of the story.
The most important work is being led by Ukrainian healthcare professionals themselves.
Our role is to listen, learn, and support the expertise, leadership, and determination that already exist within the communities we serve.
The visit reinforced something I have come to believe more strongly over the past year.
Strong health systems aren’t built in a single moment of crisis. They are built over time through trusted local leadership, sustained investment, careful preparation, and a commitment to keep moving forward despite extraordinary challenges.
As Ukraine enters its fifth year of war, the needs remain significant even as global attention has shifted.
Lviv was a powerful reminder of why long-term partnership matters.
Throughout the visit, I met leaders who understood that the future cannot be put on hold until conditions improve. Patients still need care. Students still need training. Communities still need strong institutions. Progress must continue, even amid uncertainty.
That commitment was evident everywhere we went.
Ukrainians are not waiting for the future to arrive.
