Sanctions imposed since Russia’s invasion of Ukraine are beginning to affect an already demoralised health system.

Since the start of Russia’s full-scale invasion of Ukraine more than a year ago, western nations have imposed a raft of sanction packages on the country. Although health care has not been included to date, the indirect effects have been felt with drug shortages and other problems reported. Many doctors believe that worse is to come, with little prospect of the war in Ukraine— and sanctions—ending soon.

“The situation will only deteriorate”, one infectious disease specialist in Moscow, who spoke on condition of anonymity, told The Lancet. “If the war continues for a long time, sanctions will go beyond existing sectors and may be imposed directly on drugs and medical equipment.” Russian doctors told The Lancet that the biggest indirect effects of current sanctions have been on the availability of medicines.

Although some shortages have been due to people stockpiling drugs, sanctions have complicated the logistics of and payment for medicine imports, while foreign producers in Russia have either reduced or stopped their operations. Domestic producers have tried to make up the shortfall and imports have switched to other countries more friendly to Russia, such as India and China, but substantial shortages persist.

“International sanctions have affected some medicine supplies, mostly of drugs for rare diseases, that in many cases were previously imported. Russia is trying to get the proportion of medicine domestically produced up to 88%, and for what we do not produce, organisations are appealing to the UN to supply them for patients that need them.”

The import problems increased prices of some drugs, including antibiotics, as well as reportedly led to some clinics halting procedures that rely on imported medicines, including arthroplasty and joint replacement. So far, doctors say that only a relatively small proportion of the population is affected. “In general, Russian hospitals are working as usual”, said the infectious diseases specialist. However, like other doctors who spoke to The Lancet, he said medical staff are growing increasingly worried about the potential effects of the long-term imposition of sanctions.

Since September 2022, medical professionals have been banned from leaving the country in case they are called up to serve as army medics. “Medical staff in Russia view what is happening in Ukraine as abhorrent, but they cannot speak about it. There is so much censorship. They can get jailed for treason just for saying there are shortages of medicines”, said one doctor. “I know many doctors who want to leave Russia—they have the qualifications and experience to work somewhere else—but they cannot go, not just because of the ban, but because they know there would be no one left at home to treat people. This whole situation affects medical workers’ morale and has a greater effect on the health-care system than any sanctions.”1

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References

  1. Holt, E. (2023). Ukraine invasion impacting Russian health care. The Lancet, 401(10382), 1064. https://doi.org/10.1016/s0140-6736(23)00674-8

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