Introduction: More than weapons, more than borders

When Europe speaks about security, the conversation usually turns to tanks, missiles, and alliances. But what if the greatest threat to our stability is not a lack of weapons, but the collapse of hospitals?

Ukraine has become the frontline in proving that healthcare is not just a humanitarian necessity – it is security policy. Without functioning hospitals, societies crumble. Civilians flee, soldiers cannot return to battle, and the state itself begins to erode from within.

In this war, hospitals are as critical to resilience as military defenses. To invest in Ukraine’s healthcare system is to invest in the stability of Europe.

Ukraine on the frontline: hospitals under attack

In July 2024, Russia bombed Okhmatdyt Children’s Hospital in Kyiv – Ukraine’s largest pediatric facility. The attack, verified by WHO, shocked the world. Beyond the immediate casualties, it symbolized the deliberate targeting of resilience itself. Destroying a pediatric hospital is not only a war crime – it is an attack on the future of the nation, and a destabilizing act for all of Europe.

Since February 2022, Ukraine’s healthcare system has been under unprecedented assault. According to the WHO Surveillance System for Attacks on Health Care (SSA), more than 1,600 verified attacks on healthcare facilities have been documented – making Ukraine one of the most targeted healthcare systems in modern conflict. Each one does more than destroy buildings – it erodes trust, disrupts treatment, and weakens the resilience of entire communities. 

The WHO Europe update from August 2024 puts the figure even higher: 1,940 attacks since the start of the full-scale war. Every one of these attacks has ripple effects far beyond the frontline.

Hospitals are not just neutral humanitarian spaces. In modern warfare, they are part of the resilience of the state. Destroying them weakens morale, forces displacement, and undermines the social contract between government and citizens.

In Kharkiv, Ukraine’s second-largest city, hospitals continue to operate under bombardment. Doctors at the Zaytsev Institute work daily with advanced trauma and reconstructive cases – many of them soldiers stabilized at military hospitals and then referred for specialist care. The survival of these patients is not just a medical achievement; it is part of Ukraine’s defensive shield.

If Kharkiv’s hospitals fail, hundreds of thousands would be forced to flee westward, placing new strain on neighboring EU countries. Healthcare collapse does not stay local – it destabilizes entire regions.

Healthcare = resilience = security

Security experts often speak of “resilience”: the ability of a society to withstand shocks and continue functioning. In war, healthcare is resilience.

– For soldiers: without hospitals to receive them, frontline units cannot return to duty.

– For civilians: without treatment, chronic conditions turn deadly and trauma becomes permanent disability.

– For the state: without healthcare, public trust erodes and migration accelerates.

The OECD report *Ready for the Next Crisis? Investing in Health System Resilience* shows that societies with weak healthcare systems collapse faster under crises – with severe economic and security consequences. Ukraine illustrates this lesson daily. 

The COVID-19 pandemic proved this point even in advanced economies. When healthcare capacity faltered, whole societies shut down, economies contracted, and politics became polarized. In fragile states, the impact was catastrophic, accelerating poverty, instability, and migration. Ukraine cannot afford such a collapse under wartime conditions – and neither can Europe.

Healthcare is not a sector to be restored after the war. It is part of winning the war itself.

Resilience as Europe’s true defense

NATO’s Strategic Concept (2022) highlights resilience as a central pillar of collective defense. Civil preparedness – including healthcare – is no longer a side issue but an explicit security requirement. The EU’s Strategic Compass (2022) makes the same point: societies can only resist external pressure if essential services, especially healthcare, continue to function. 

This means that every hospital ward kept open in Kharkiv is not only saving lives – it is contributing directly to Europe’s defensive capacity. Resilience is not abstract: it is the daily work of doctors, nurses, and technicians who ensure society does not collapse under stress. Healthcare resilience is therefore Europe’s true defense.

Zaytsev Institute: a referral hub under fire

One of the clearest examples of how healthcare underpins security is the Zaytsev Institute in Kharkiv.

As the region’s top referral hospital, Zaytsev receives patients from across the oblast. Soldiers who have been stabilized at Role 1 points (field stabilization posts) and Role 2 military hospitals are sent there for advanced reconstructive surgery. Civilians injured in missile strikes, traffic accidents, or everyday emergencies also arrive daily. The hospital is a lifeline not just for Kharkiv, but for the entire region.

Deliveries of equipment such as the BOWA Lotus 4 surgical devices have transformed what surgeons can do. In cases of catastrophic internal bleeding, the Lotus 4 allows doctors to cauterize and seal vessels in seconds, often making the difference between life and death.

But surgery is only one part of the system. Zaytsev’s ability to operate depends on elevators that can transport patients between wards, anesthesia machines that allow complex operations, and power supply stability that ensures operating rooms stay lit even during missile strikes. Every piece of equipment delivered is part of Europe’s security shield.

For Europe, Zaytsev is more than a hospital. It is a buffer against collapse. If its operating rooms stay open, Kharkiv’s population stays put. If it fails, hundreds of thousands could be displaced.

Europe’s shared interest

It is tempting to see Ukraine’s hospitals as Ukraine’s problem. But that view ignores the reality: Ukraine is Europe’s shield.

– If hospitals collapse, migration surges into EU states.

– If healthcare systems are corrupted or dysfunctional, democratic trust erodes.

– If Ukraine cannot provide medical care, its ability to sustain defense weakens – and so does Europe’s.

The joint WHO & World Bank report on health financing reforms in Ukraine confirms that sustaining healthcare is not only a humanitarian issue – it prevents large-scale migration and maintains public trust, which are both critical for European stability. 

NATO’s Strategic Concept (2022) and the EU’s Strategic Compass (2022) both emphasize civil preparedness and healthcare as pillars of European resilience. What is happening in Ukraine is therefore not separate from Europe’s future – it is the frontline test of our collective ability to defend ourselves holistically. 

Healthcare is officially recognized as critical infrastructure in both NATO and EU doctrine. This means that investing in hospitals is not optional charity – it is part of security obligations. [ANKAR: NATO]

Migration and displacement

The WHO fact sheet on Refugee and Migrant Health highlights that collapse of healthcare is often a primary driver of displacement. We see the same dynamics being visible in Ukraine: when hospitals are attacked or underfunded, civilians are forced to flee, adding pressure to neighboring EU states. 

Healthcare resilience is therefore not only about saving lives in Ukraine. It is also about stabilizing populations and preventing new refugee crises from destabilizing Europe’s neighbors.

OECD analyses after the pandemic show that healthcare system failure costs billions in lost productivity and social instability. In Germany, economists estimated that every million refugees during the 2015–16 crisis required more than €20 billion annually in support and integration costs. By contrast, maintaining healthcare systems inside Ukraine requires far less – and prevents displacement in the first place. 

From aid to system security

Traditional aid is reactive: buy equipment, deliver, repeat. But in Ukraine, we need more than charity – we need systems.

1 for Ukraine has pioneered a transparent, anti-corruption protocol that tracks every euro from donor to device:

– Ordering and payment directly from manufacturer.

– Signed delivery proof by both supplier and hospital.

– NFC and QR tagging for every device.

– Periodic follow-ups with photo and usage data.

– Public donor portal with archived history.

– Independent verification and sanctions for breaches.

This is not just humanitarian logistics. It is system security. It creates trust, reduces corruption, and ensures that European donations turn into measurable resilience.

By scaling this model – from surgical devices like the BOWA Lotus 4 to ventilators, anesthesia machines, and hospital elevators – we are building a Marshall Plan for healthcare resilience.

Zaytsev Institute in Kharkiv is a concrete example. The Lotus 4 devices already delivered there have enabled surgeons to stop catastrophic bleeding in cases where time is the difference between life and death.

Economic perspective: the cost of collapse

Maintaining healthcare in Ukraine is not only cheaper than dealing with collapse – it is exponentially more cost-effective. The World Bank and OECD estimate that every displaced refugee can cost host societies tens of thousands of euros per year in support, integration, and lost productivity. By contrast, the cost of equipping a hospital in Kharkiv with critical devices may be less than supporting 50 displaced families in Europe for a year. 

In pure numbers, one BOWA Lotus 4 surgical device costs €28,000 and enables 14,600 operations over ten years – or €1.97 per surgery. This efficiency dwarfs the long-term costs of inaction. For every euro spent on sustaining healthcare in Ukraine, Europe saves many more in avoided migration and instability costs.

Expanded patient journeys

To illustrate why equipment matters, consider two expanded patient journeys.

Military: A soldier injured by shrapnel undergoes stabilization at a Role 1 point: external bleeding controlled, fluids administered, tourniquet removed. Evacuated by armored ambulance to a Role 2 military hospital, the soldier is kept alive until referral to Zaytsev. There, advanced tools such as the Lotus 4 allow surgeons to stop internal bleeding, reconstruct tissue, and give the patient a chance not only at survival but at recovery. Without this chain, survival would have ended at the frontline.

Civilian: A child injured in a missile strike is rushed by ambulance to a regional hospital. Without advanced anesthesia equipment, surgeons cannot safely operate. But with modern devices delivered through transparent systems, complex trauma surgery becomes possible. The difference is between permanent disability, evacuation abroad, or a full recovery within Ukraine. These stories demonstrate why healthcare resilience is inseparable from both security and dignity.

EU solidarity and future integration

Looking ahead, Ukraine’s integration into the European Union requires not only democratic and economic reforms, but also healthcare compatibility. The European Health Union initiative, launched during the COVID-19 pandemic, is designed to ensure that all member states can respond jointly to cross-border health threats. For Ukraine to eventually join, its healthcare system must be able to integrate seamlessly into this framework. This means investments made today are not temporary aid – they are strategic alignment. By supporting Ukraine’s healthcare, Europe is building its own resilience. Conversely, if Ukraine’s system fails, Europe inherits instability and migration. Solidarity is therefore not only moral – it is pragmatic security policy.

Lessons from past crises – Why resilience cannot wait

History offers clear evidence of what happens when healthcare resilience is ignored.

Pandemics: During COVID-19, WHO reported that more than 90% of countries experienced disruptions in essential health services. Even advanced economies saw their systems pushed to the brink, with severe political and economic fallout. In fragile states, the collapse of services accelerated poverty, instability, and migration.

Balkans: In the 1990s, the collapse of health systems in parts of the former Yugoslavia contributed to mass displacement and left long-term scars on public health. Rebuilding trust in healthcare took decades, slowing down both recovery and integration into European structures.

Syria: The systematic bombing of hospitals was not collateral damage – it was strategy. Destroying healthcare forced millions to flee, creating one of the largest refugee crises of modern times. Europe continues to feel the political and social consequences.

The lesson is consistent: resilience cannot be built after the crisis. It must be designed and reinforced while the crisis is still ongoing. This is why Ukraine’s healthcare, supported transparently and systematically, is not just aid – it is frontline European security.

Why this matters for Europe

Investing in Ukraine’s hospitals is not charity. It is insurance for Europe’s stability.

– Migration pressure: functioning hospitals reduce refugee flows.

– Security of supply: healthcare keeps soldiers in the field and society functioning.

– Democratic trust: visible, functioning hospitals strengthen confidence in the state.

– Regional stability: Ukraine as a functioning democracy stabilizes its neighbors.

This is why healthcare is security. The logic is simple:

– Secure hospitals = secure people

– Secure people = stable states

– Stable states = a secure Europe

Conclusion: To secure Europe, secure Ukraine’s hospitals

The frontline of European security is not only in trenches – it is in operating rooms. Every ventilator delivered, every surgical device installed, every elevator repaired is part of Europe’s defense system.

To ignore Ukraine’s healthcare is to ignore Europe’s security. To strengthen it is to strengthen Europe itself.

Healthcare is Resilience. Resilience is Security. Healthcare is Security. And it is time Europe treated it that way.

The frontline of European security is not only in trenches – it is in operating rooms. Every ventilator delivered, every surgical device installed, every elevator repaired is part of Europe’s defense system.

To ignore Ukraine’s healthcare is to ignore Europe’s security. To strengthen it is to strengthen Europe itself.

NATO and the EU have both recognized resilience – especially healthcare resilience – as a core pillar of defense. Zaytsev Institute in Kharkiv shows this in practice: when its operating rooms remain functional, hundreds of thousands of people stay in their homes instead of fleeing westward. Each functioning hospital reduces migration pressure, sustains public trust, and reinforces the frontlines. 

Europe must therefore act decisively. Investing in Ukraine’s hospitals is not charity – it is strategy. It is cheaper than managing collapse, more humane than mass displacement, and more effective than reactive crisis response.

Healthcare is Resilience. Resilience is Security. Healthcare is Security. And the sooner Europe fully embraces this principle, the stronger and safer our continent will be.

References

WHO Surveillance System for Attacks on Healthcare (SSA): https://extranet.who.int/ssa/

WHO Europe – Ukraine Emergency: https://www.who.int/europe/emergencies/situations/ukraine-emergency

OECD – Ready for the Next Crisis? Investing in Health System Resilience: https://www.oecd.org/health/ready-for-the-next-crisis-investing-in-health-system-resilience.htm

World Bank – Health Financing Reform in Ukraine: 

NATO Strategic Concept 2022: https://www.nato.int/strategic-concept/

EU Strategic Compass 2022: https://www.eeas.europa.eu/eeas/strategic-compass-security-and-defence_en

European Health Union: https://health.ec.europa.eu/european-health-union_en

UNHCR – Refugee and Migrant Health: https://www.unhcr.org/