The figures are overwhelming: Ukrainian civilian infrastructure, particularly healthcare facilities, continues to suffer regular damage as a result of Russia's armed aggression and relentless bombardment. In more than three years of war, the Russian aggressor has damaged 1,984 healthcare facilities and destroyed 301. To date, 667 facilities have been fully restored, 320 have been partially restored, but 50 that were rebuilt have been damaged again. More than 500 healthcare workers have been killed. On the front lines, medical personnel courageously stand by the combatants and risk their lives every day. Behind the lines, healthcare workers, especially nurses, devote themselves day and night to caring for the civilian population as well as wounded soldiers. Adding to these difficulties is the Ukrainian government's neoliberal policy of optimising the health service, which has led to hospital closures, unfair dismissals, delays in salary payments and disregard for labour rights. The medical union Be like we are is one of the most active organisations in supporting healthcare workers and defending their rights. Oksana Slobodiana, president of Be like we are, kindly agreed to answer our questions.

Patrick Le Tréhondat

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After three years of war, what is the situation of medical staff on the front line and behind the scenes?

After three years of large-scale war, the situation for medical personnel in Ukraine remains difficult. At the front and in areas close to the fighting, doctors are working in extremely challenging conditions: constant evacuations under bombardment, staff shortages, and constant risks to their lives. The specialities most in demand are anaesthesia, surgery, intensive care, emergency medical assistance, and rehabilitation. Some of the burden is offset by volunteers and accelerated training in tactical medicine, but the shortage problem cannot be completely solved. In the rear areas, the situation is different but equally problematic. Hospitals suffer from a lack of funding, network optimisation and the closure of departments, often resulting in the closure of entire facilities. Doctors are forced to work beyond their hours, taking on multiple shifts, which leads to massive burnout, stress, anxiety and depression. The staffing crisis is being felt across the country. Some healthcare workers have left to work abroad, while others are forced to seek employment outside their speciality in order to survive. There is also a shortage of young professionals.

Hospitals continue to close, as in Poltava, despite protests from the population and patients. Medical staff still face great difficulties in their work. Do you think the situation has worsened?

Yes, we can say that it has worsened. Because instead of expanding access to healthcare during wartime, we are seeing the opposite happen. This demotivates healthcare workers and deepens the population's mistrust of the healthcare system.

There is also the problem of excessive drug prices. The Public Service for Production and Consumption has received 1,156 complaints about inflated prices in pharmacies. What do you think about this situation and what are the causes? What solutions do you see?

The main reason is the lack of state control over pricing and the monopolisation of the pharmaceutical market. In times of war, companies often take advantage of the chaos. The solution can only come from controls and fines for pharmacies that charge excessive prices. It would also be necessary to create transparent price registers and online platforms to enable comparison.

The Be like we are union is growing significantly. Can you tell us about it?

Yes, despite the difficulties, our medical movement is expanding its network of support for healthcare workers. This includes legal consultations — our organisation helps doctors and nursing staff in cases of unfair dismissal, late payment of wages and other violations of their rights. We also organise educational seminars where we train medical staff to defend their own labour rights and resist abuse by hospital administrations. We publicly discuss many painful issues at press conferences and round tables. We conduct sociological surveys that clearly highlight the problems faced by healthcare workers (especially nurses), such as excessive workloads, contempt from management, burnout and a lack of psychological support. Thanks to this open work, we are seeing growing trust in Be Like We Are among healthcare workers in different regions of Ukraine.

But you face opposition. Caregivers are prevented in various ways from joining your movement. What is this situation like?

Unfortunately, in some hospitals, management puts pressure on those who want to join our movement. They are told that they could have problems with their jobs, and are threatened with dismissal or pay cuts. It's the classic "don't rock the boat" scenario. But we are fighting precisely against this atmosphere of fear.

What are the most important demands of Be Like We Are in the current situation?

Today, Be like we are has several key demands that reflect the real needs of healthcare workers in wartime. First and foremost is the transparent calculation and timely payment of salaries and bonuses. Healthcare workers must receive the funds promised by the state, without delay or bureaucratic obstacles. Equally essential are the guarantee of safety and the creation of decent working conditions in areas close to the front line: healthcare workers risk their lives every day and their work must be supported by adequate protective equipment, reasonable working hours and assistance. Our organisation also opposes the closure of hospitals during wartime, as reducing the healthcare network at a critical time jeopardises the population's access to treatment.

On 15 August, Be like we are organised a conference in Odessa for healthcare workers on defending their labour rights during martial law. During this meeting, you stated that you wanted to: "ensure transparency in the calculation of bonuses - oblige hospital management to publicly report to staff on the funding received and its distribution" and "develop an independent mechanism to monitor compliance with the regulations governing the remuneration of healthcare workers in areas close to the front line". How do you envisage these monitoring mechanisms being implemented in practice? Monitoring by the medical staff themselves?

Transparent and fair calculation of bonuses for medical staff is only possible if effective control mechanisms are put in place, with the collective agreement playing a key role. We believe that this document should not be a mere formality, but a living instrument that defines the rules of the game within the hospital. This document must clearly set out the collective's rights to receive reports on financing, the distribution of funds and the terms and conditions for the payment of bonuses. A two-tier control system could be applied. The first tier is internal, with the creation in each establishment of an independent commission composed of representatives of medical staff, mandated by the collective agreement to demand public reports from the administration and carry out regular checks. The second level is external, with the establishment of an independent supervisory board, bringing together trade unions and civil society organisations. Its mission would be to compare management reports with actual payments in order to prevent any manipulation. It is precisely the combination of these two levels that will make control not merely formal, but truly effective, and will ensure that the collective agreement guarantees transparency and fairness in relations between the administration and medical staff.