How Ukrainian doctors are trained to respond to air strike threats and what patients should remember

Since the beginning of the full-scale invasion, Ukrainian hospitals have become a target of enemy attacks. The state, local authorities, sponsors, and international partners are making efforts to protect patients and hospital staff during Russian air attacks. Work in this direction is not limited to building shelters – medical facility personnel are trained to act in critical conditions. One such program was launched in Ukraine on the initiative of UNICEF. As part of the project, trainings are conducted that simulate a situation where the hospital itself has become the object of an attack. UNN spoke with the director of the Educational and Scientific Center "Business School of the Bogomolets National Medical University," Doctor of Medical Sciences, Professor Tetiana Vezhnovets, who spoke about this initiative. 

As part of the project, implemented and funded with the assistance of UNICEF, a system for responding to emergencies, namely missile and drone incidents in healthcare facilities, was developed. As part of the implementation, an assessment of the readiness to respond to such emergencies was also conducted for children's hospitals and perinatal centers that joined the program. Trainings for staff were also developed and are being conducted to prepare them for active response in such situations. The Bogomolets National Medical University joined the implementation.

Our task was precisely to develop a methodology, organize a system for responding to emergencies in a healthcare facility, and prepare staff for effective response to missile and drone incidents. That is, in Ukraine, before us, no one specifically dealt with this issue — creating emergency response systems specifically in healthcare facilities regarding missile and drone threats. Although we have been living in a war for the fifth year, and the air danger has become extremely relevant 

But this is not just theoretical work – it has a completely practical significance and is aimed at protecting people's lives and health. Vezhnovets recalled the situation when, after the attack on Okhmatdyt in Kyiv on July 8, 2024, young patients were taken outside – at a time when there was a threat of a repeated missile strike. 

Now, according to her, standard operating procedures for actions have been developed, according to the phases of the incident unfolding. During the development of these procedures, international experience was carefully studied. 

The response systems that exist in the world mostly relate to natural disasters or man-made accidents associated with the mass influx of victims to the facility. Our situation is completely different: the facility itself can become an object that is destroyed or damaged by a missile or drone strike. However, the general global approach to emergency response is definitely applicable here as well: a healthcare facility must have a hospital rapid response team, which, depending on the roles defined by position, will be ready at any moment to perform its functions 

Based on the developed program, the medical university team conducts trainings for doctors. 

We started this activity in July 2025 — then UNICEF and the National Medical University signed a cooperation agreement for the implementation of this project 

Medical facilities, where shelters were equipped with the assistance of UNICEF, joined the project. At the first stage, which lasted from July 2025 to mid-January 2026, such trainings were conducted in four facilities: two in the Chernihiv region (regional children's hospital and maternity hospital), as well as at the Center for Rehabilitation of Mother and Child of the Ministry of Health of Ukraine in Odesa, and a hospital in Zaporizhzhia. The second stage covers 5 hospitals, including the city multidisciplinary clinical hospital for mother and child named after Prof. M.F. Rudnev in Dnipro and the Perinatal Center of Kyiv. 

It was at the Perinatal Center of Kyiv that the training took place just recently. Before the start of the training, the center was visited to assess readiness to respond to threats and the arrangement of shelters. When the level of readiness was assessed as sufficiently high – they moved on to training. 

From two branches of the facility (on Lobanovsky and Predslavenska streets), 5 doctors each were selected, from whom hospital teams will subsequently be formed for rapid response and coordination of actions of all staff. 

The first stage – basic readiness

The hospital must be basically ready for any challenges, including missile and drone incidents. According to Vezhnovets, in particular, the medical facility must have special treatment kits for emergency medical care, humanitarian kits (warm blankets, water for victims), dry rations, a supply of medicines; if it concerns a perinatal center, diapers and nappies are also added to the list. A supply of technical water is also mandatory. 

The second stage – heightened readiness 

When an air raid alert sounds, the healthcare facility moves into a phase of heightened readiness — because, fortunately, an alert does not always end in an incident 

But it is in this phase that the rapid response team begins to prepare for the possibility that something might happen. 

Everyone knows where the kits are; everyone has a card with prescribed actions in case of danger — this is what we taught them 

According to her, in this phase, everyone in the hospital must move to the shelter. A separate protocol of actions exists for patients who are difficult to transport or those who are, for example, being operated on. 

Vezhnovets added that at the capital's Perinatal Center, the shelter includes incubators for supporting the vital functions of the smallest children in complex cases, as well as a delivery room where childbirth or surgical intervention can take place directly in the shelter. 

Thanks to the facility's management, all this is well prepared, and the facility can use these capabilities precisely in emergency situations 

Phase three – incident 

The next phase is the actual strike, the incident. 

Then the response plan is activated: in all healthcare facilities, including the Perinatal Center, according to current regulatory documents, there are emergency response plans that provide for the creation of an emergency response commission. This applies to all facilities classified as critical infrastructure 

Next comes dealing with the consequences of the incident. 

We showed them how to create a triage area for victims – if not everyone managed to go down or someone could not go down due to a critical condition, the State Emergency Service gets involved. Then we explained how to determine how many patients were before the incident, how many are in the shelter, how many did not go down, who needs to be found. All this is counted to ensure no one is lost and assistance is provided in a timely manner. All this is very important, because it is people's lives 

We explained everything using practical cases — participants played out various scenarios in the form of a game, trained, and were captivated by the process. And a lot here depends on the facility's management – the leader's interest plays a significant role. We had one facility that was also supposed to enter the program, but they refused the training. It is very unfortunate 

She also noted that in all facilities where training was conducted, follow-up visits are carried out for monitoring and additional training. By this time, the doctors who participated in the training must develop their own response standards tailored to the needs of the specific facility. 

We do not just teach how to respond to what has already happened, but we teach readiness for what may happen — and then it is much easier to survive the event than to simply react to it post factum. This is the main idea of the entire process 

Based on the developed standards, a manual was published, and an updated edition is currently being prepared for printing. Professor Vezhnovets very much hopes that based on this manual, the Ministry of Health and the Center for Public Health are considering the possibility of creating an official, state-approved methodological guide that any facility — from the largest to the smallest maternity or perinatal center — can use.

The human factor and what should be considered in the future 

Vezhnovets says that during the trainings, they heard from doctors that patients do not want to go to the shelter. 

We emphasized: this is not up for discussion, it is a mandatory function. If you do not get people down to the shelter, further actions lose their meaning. During an incident, it will be difficult to gather the victims, assess how many people need help, and organize all this 

She notes that she increasingly sees shelters in hospitals that are actually being used. Given the enemy's attacks, this is encouraging, as it can save lives and health. 

On the other hand, for example, in Zaporizhzhia – according to colleagues who recently went there for a follow-up monitoring – the alarm sounds almost continuously. It turns out that all the facility's activities would have to be carried out in the shelter. If we look at hospital safety in the long term, they should be built underground. For example, in Israel, all critical care – resuscitation, intensive care units, operating rooms – is located on the lower floors (minus first, minus second, minus third), in a shelter, underground, while ambulatory patients occupy the above-ground part of the building and can go down if necessary 

But until these changes happen – everyone must learn to respond to the threat, both doctors and patients.