At the start of summer, the halls of the district hospital in Hola Prystan, a city in Ukraine’s Russian-occupied Kherson region, had become unnervingly silent. Long electricity outages regularly left the building in complete darkness.

Much of its equipment and medical stock had been removed or diverted for military needs, while many trained employees had either fled or stopped working there.

“They even carried away some of the furniture,” says Natalia Sergeevna, a nurse who worked at the hospital for more than 20 years before leaving for Ukrainian-controlled territory in July.

Compared with other facilities under occupation, she says, the hospital was relatively fortunate. Some hospitals had been converted for military purposes, while others had been shut entirely.

Even with scarce resources and unlit wards, patients continued to arrive, Sergeevna says, travelling through the dangerous, mine-strewn areas of occupied Kherson.

“People came with wounds and injuries. They needed cancer specialists, endocrinologists or palliative care. Pregnant women kept coming too,” she says. “But helping them became more difficult every day.”

Over recent months, worsening restrictions and shortages have further weakened healthcare services in several Russian-occupied areas.

In June, the UN Human Rights Monitoring Mission in Ukraine warned that circumstances in Oleshky and Hola Prystan, where Sergeevna had worked, were becoming critical. Thousands of residents, it said, lacked food, clean water and essential medicines.

The mission reported that ambulances were no longer visiting homes, that care was reserved for only the most severe emergencies, and that some people died while trying to evacuate.

Sergeevna says she remained for as long as she could because she hoped the area would be liberated. By summer, however, the situation was impossible to endure. “There is almost no capacity for surgery now. Even simple procedures, such as removing polyps, cannot be done.

“Earlier this year, we were carrying out a Caesarean section when the patient began bleeding from her uterus. There was no blood for a transfusion because supplies had been sent to the Russian soldiers,” she says.

Another major barrier is the forced distribution of Russian documents in occupied areas. Medical treatment can be denied to people without Russian compulsory health insurance, which is generally available only to those holding a Russian passport.

“They treat you terribly if you are Ukrainian. They say we have no rights and tell us directly that we are nobody,” says Marina*, who lives in a town occupied by Russian forces. In 2023, she developed complications during pregnancy and went into premature labour.

“The baby was breech and I needed an emergency Caesarean. I was in terrible pain,” she says. “But it was 11.30 at night and the curfew had begun. We tried to leave, but they fired at us.”

Marina says her husband and a neighbour cared for her through an agonising night. Once the curfew ended, they rushed to the local clinic. “There was no obstetrician, no pregnancy specialist, nobody able to help. In the end, I had a Caesarean with help from my neighbour, who was a nurse. Thankfully, both my baby and I survived.

“Under normal conditions, this complication would have been detected. But there were no tests, no medical specialists left in our town, not even an ultrasound machine, so there was no way to diagnose it,” she says.

Sergeevna recalls another case from earlier this year in which staff had to treat a patient suffering from endometriosis without anaesthetic.

“She was bleeding when she arrived. There was no anaesthesia and not even electricity. The nurse used the flashlight on her phone during the procedure because there was simply no alternative.”

Reliable data is unavailable, but groups observing the area report an apparent increase in maternal and child deaths, along with lasting health consequences. Access to contraception and abortion care has also reportedly become more difficult.

Sergeevna says women have been affected especially severely. She had treated patients experiencing serious mental health problems linked to the absence of medical support and the violence they had endured, including rape and sexual exploitation.

She remembers an 18-year-old patient whose torso had been cut with the letter “Z”. During treatment, Sergeevna realised that the young woman had also been raped. “That was not the reason she came to us. She was too ashamed to say it. She came because the wound had become swollen and infected, and she could no longer bear the pain.”

With few doctors remaining and supplies running out, Sergeevna and her colleagues could only clean and stitch the injury. “There was nothing more we could offer. We had no means to test her for sexually transmitted infections or give her contraceptives. We could not even arrange psychological support.”

* Name has been changed