Lynn Lieberman Lawry

Introduction: The Russian invasion of Ukraine in February 2022, following the conflict in 2014, resulted in indiscriminate shelling, systematic torture and conflict-related sexual violence (CRSV), suggesting possible war crimes and crimes against humanity (WCCAH). This study explores the experiences of Ukrainian veterans and former prisoners of war (POWs) since 2014 to systematically document reported abuses and inform accountability. Methods: We conducted a series of semistructured key informant interviews (KIIs) of 40 Ukrainian veterans and former POWs (20 male, 20 female) from the 2014 and 2022 invasions between August and November 2025. The KII instrument contained 32 open-ended questions covering demographics, abuses, psychological impact and justice. Data analysis involved qualitative thematic analysis with quantitative descriptors from coded interviews. Results: Participants reported numerous abuses consistent with previously documented WCCAH including attacks on civilian infrastructure; systemic torture, beatings, electrocution, starvation, denied medical care, deliberate targeting of Ukrainian nationality, unlawful killings of civilians and hors de combat; and CRSV targeting both male and female captives and civilians. Internally, female veterans reported facing discrimination, restrictive roles and military sexual assault. Self-reported trauma symptoms consistent with post-traumatic stress disorder, anxiety, depression, sleep disturbances and moral injury were cited as major consequences of the wars. Conclusions: Reported incidents appear deliberate and widespread and may constitute violations consistent with WCCAH. Psychosocial barriers undermine protection and prevention efforts for justice. Stigma, particularly for male survivors of CRSV, and fear of harming loved ones still in captivity obstruct evidence-gathering and truth-telling. Self-reporting of severe trauma symptomatology necessitates an immediate humanitarian response prioritising recovery of veterans and former POWs through structured, accessible, long-term psychological and psychiatric services. Restrictive roles, discrimination and military sexual assault reveal a need to establish mechanisms that combat internal sexual violence and reinforce professional military hierarchy.

Introduction: Since the full-scale Russian invasion of Ukraine in February 2022, the Ukrainian Women, Peace and Security National Action Plan (NAP) has become extremely important in creating conditions for the participation of both women and men in conflict resolution, peacebuilding, recovery, in addressing security challenges and systemic responses to conflict-related violence including sexual violence, in alignment with United Nations Security Council Resolution (UNSCR) 1325. NAPs are more effective when they have broad population acceptance. This paper introduces a structured method for evaluating progress towards the NAP via measurement of public opinion and creates baseline measures for that progress. Methods: We conducted a population-based, cross-sectional household quantitative study in 20 of 24 oblasts in Ukraine during a 2-month period from 01 May to 29 June 2025 to assess public opinion related to the progress of Ukraine’s NAP across four pillars consistent with UNSCR 1325 to include participation, protection, prevention, and rehabilitation and recovery, which relate to indicators in the Ukrainian NAP. Results: Of the 4385 households surveyed, respondents from 4228 households completed the study (96%). The majority of the NAP indicators assessed were either met or somewhat met. Only one of the indicators scored low enough to be considered ‘not met’. However, there were significant differences in agreement levels between sex and between civilians and former military. Conclusions: Despite the ongoing conflict, Ukraine continues to make significant progress towards its NAP goals, which are vital for long-term recovery, reintegration and resilience. Moving forward, shifting mindsets, particularly among males, to support female leadership and peacebuilding roles will be essential to securing lasting peace.

Introduction: Recent global events including the Russian invasion of Ukraine have caused major disruptions to medical supply chains, highlighting the fragility of just-in-time logistics models and the risks posed by overreliance on foreign manufacturing capabilities. The transition from peacetime to crisis—and from crisis to full-scale conflict—demands rapid escalations in supply of pharmaceuticals. The objective of this research was to develop a consensus-driven list of high priority critical medicines as a basis for the creation of a North Atlantic Treaty Organization (NATO) pharmaceutical stockpile. Materials and Methods: This Delphi Panel completed work started by the NATO Center of Excellence for Military Medicine to identify critical medications in July 2024. The panel involved collecting feedback across two rounds of voting from a group of subject-matter experts with background in combat casualty care and pharmaceuticals, with the goal of rating a list of critical medications on three factors on a Likert scale of 1 (low) to 9 (high): overall priority, use above baseline, and availability of alternatives. Median scores and tertiles were calculated to rate the medications in order of priority based on the aggregate statistics. Results were presented and finalized at a NATO-sponsored workshop in Poland as the final round of the Delphi in May 2025. Results: The first round of the Delphi, conducted in February 2025, was a virtual, asynchronous voting round where 28 respondents participated rating and refining the initial list of 107 medications. Based on these results, 26 medications were determined high priority for stockpiling and 20 were removed from consideration. The second round took place in March 2025, and consisted of synchronous, virtual voting on the 61 medications of “uncertain priority” in the previous round. As a result, two additional medications were added to the high priority category for inclusion in stockpiles, with the final list presented for discussion in person during Round 3 containing a total of 28 critical medicines rated “high priority.” Additionally, Rounds 2 and 3 resulted in discussion of alternative medications not included in the list, such as treatments for CBRNE exposures and viable alternatives for listed medications. Conclusions: Ensuring availability of critical medicines during military operations and humanitarian emergencies supports the health and operational readiness of military personnel and the well-being of civilians affected by crises. By developing a systematic approach for prioritizing pharmaceuticals, this project addresses gaps in medication availability for NATO that could otherwise hinder effective response to emergencies.

Introduction: The ongoing war between Russia and Ukraine represents the return of large-scale combat operations to Europe for the first time since 1945 and the largest sustained conventional armed conflict in Europe of the 21st century. The current war has led to the rapid escalation of a mental health crisis with predictions of between 10 and 15 million Ukrainians ultimately needing professional psychological assistance as a result of the current hostilities. Materials and Methods: We conducted qualitative key informant interviews (KII) during the ongoing conflict using a Ukraine Trauma System Assessment Tool (TSAT) to understand the experiences of the health and trauma system in Ukraine with respect to mental health disorders and care delivery for these conditions in the time period following the Russian Federation invasion. Results: Between September 2023 and February 2024, 36 civilian and military healthcare or healthcare-adjacent participants were interviewed, including 22 (61%) males and 13 (36%) females. Mental health conditions are seen as having a detrimental impact on service members in Ukraine. Respondents reported frequent presentations of post-traumatic stress disorder (PTSD), anxiety, depression, sleep disturbance, and traumatic brain injury, described varied treatment practices including psychotherapy, pharmacologic support, and telemedicine, and highlighted persistent gaps in access to care. Participants also emphasized the importance of rehabilitation and noted that untreated mental health conditions adversely affected readiness and return-to-duty rates. Conclusions: The ongoing conflict in Ukraine has precipitated a significant mental health crisis, impacting both civilians and military personnel. Comprehensive mental health services for PTSD, anxiety, depression, traumatic brain injury (TBI), and other related disorders among Ukrainians are needed. Integration of mental health care into rehabilitation settings, development of expanded community mental health service, and the embedding of psychiatrists and psychologists within military units are necessary to effectively address these needs.

Introduction: The full-scale Russian invasion in February 2022 severely impacted the organizational structure of Ukraine’s healthcare system. The devastation wrought by the Russian aggression requires the Ministry of Health to find ways to address the most pressing healthcare issues and limit impacts on the health of the population. We summarize a series of papers that assessed the challenges to the health and trauma system in Ukraine since the Russian invasion. Materials and Methods: We performed a framework synthesis of 10 manuscripts using data from a qualitative study of Ukraine’s health and trauma systems. We synthesized the findings using the Doctrine, Organization, Training and Education, Materiel, Leadership, Personnel, Facilities, Policy (DOTMLPF-PI) framework developed by the DoD to assess system efficiency and effectiveness and includes NATO’s domain of Interoperability. Results: The assessment of Ukraine’s military medical system under large-scale combat operations (LSCO) revealed key systemic limitations across the DOTMLPFP-PI domains—particularly training category (27), materiel (19), doctrine (18), policy (17), and interoperability (17). The overall assessment reveals a health system under severe strain, operating within outdated frameworks that are misaligned with modern warfare realities. Conclusions: This work generated a comprehensive set of recommendations that, if implemented, would enhance the effectiveness of Ukraine’s military medical system in both the current conflict and into the future. The recommendations are also broadly applicable to other state-actors and their military-health systems, particularly in the context of the evolving realities of modern LSCO.

The February 2022 Russian invasion in Ukraine delayed healthcare reforms. The conflict has led to disruption of medical supply chains and a rapid need for integration between military and civilian entities. This study aims to assess the organization and logistics of the Ukrainian trauma system since the Russian invasion. Qualitative key informant interviews were conducted among Ukrainian military and civilian health care workers using a Ukraine Trauma System Assessment Tool from September 2023 to February 2024. Thematic content analysis was used to derive key themes related to medical logistics and organizational leadership from interviews. Thematic saturation was reached after 36 key informant interviews. Respondents described the roles of the Ministry of Health and Ministry of Defense, as well as the collaboration and integration between military and civilian trauma systems with medical logistics as a key area of focus. Respondents discussed on-going efforts to develop a centralized logistics system to better coordinate supplies and overcome current bureaucratic and communication challenges. The organizational structure and the logistics of the trauma care system in Ukraine are integral to the facilitation of healthcare delivery among both the civilian and military health systems. While rapid coordination has supported triage and increased the efficiency of resources, barriers are still recognized by healthcare personnel including disruptions in the medical supply chain, unpreparedness for large-scale combat operations, inadequate training, outdated equipment, and attacks on infrastructure.

Introduction: Ukraine’s health and trauma care system has been devastated by the Russian Federation’s invasion in 2022. Previous research shared insight of returned volunteers into changes in the system; however, as the war continues there is the need to understand how the observations of United States (U.S.) volunteers and Ukrainians working in healthcare in Ukraine may differ regarding perceptions of the trauma system’s current strengths and challenges. Materials and Methods: We conducted structured interviews with U.S. healthcare or healthcare-adjacent returned volunteers and Ukrainian healthcare workers using the Ukraine Trauma System Assessment Tool Study Region Observation (TSAT SRO) Tool. Mean scores were calculated for each trauma system domain among both Ukrainian and U.S. groups. t-tests were used to determine if there were any statistical differences between these means among the 2 groups. Results: The overall score for the Ukraine trauma system combining scores from U.S. volunteers and Ukrainians was 1.89 out of a possible 3.00. The domains with the highest combined scores included Prehospital, Chemical, Biological, Radiological, Nuclear, and Explosive (score = 2.33), Prehospital Training (score = 2.25), and Definitive Care Facilities: Blood Product Use (score = 2.38). Domains with the lowest combined scores included Injury Prevention (score = 1.55), Definitive Care Facilities: Disease and Non-Battle Injuries (DNBI) (score = 1.60), and Logistics and Supply (score = 1.55). U.S. volunteers scored every domain lower compared to Ukrainian respondents. All differences between U.S. volunteers and Ukrainian responses were statistically significant except Definitive Care Facilities: Telemedicine, Definitive Care Facilities: Blood Product Use, and Definitive Care Facilities: DNBI. Conclusions: TSAT SRO component scoring from observations of U.S. volunteers and Ukrainian healthcare workers suggests the current Ukrainian trauma system is in development. Domain scores differed between U.S. volunteers and Ukrainians; most were statistically significant, demonstrating the importance of including citizens of a nation versus only foreign healthcare workers in assessing a healthcare or trauma system.

Background: The humanitarian community in South Sudan estimates that 9.4 million people need humanitarian assistance in 2023. Prior data is unlikely to reflect the current health situation of Jonglei state given the influx of internally displaced persons (IDPs) and returnees. Methods: We conducted a cross-sectional, randomly sampled, mixed-methods, population-based household study during a 4-week period in June-July 2023 in ten bomas in four counties of Jonglei, South Sudan. Snowball sampled qualitative interviews were used for triangulation of quantitative data. The study was conducted to understand nutrition and water, sanitation, and hygiene knowledge, attitudes, and practices of IDPs, returnees and the host communities. Results: A total of 859 households consented to the study (586 females and 273 males) with a response rate of 96% among females and 94% among males. Forty-two percent of households identified three or more strategies to prevent starvation or malnutrition. Up to a fifth of households were unable to identify any strategies to prevent starvation or malnutrition with the host community having the highest rate (20.2%) when compared to IDPs (13.4%; p = 0.018) or returnees (10.4%; p = 0.006). Only 34% of respondents could name three warning signs for when a child with diarrhea should be seen by a skilled provider. Only 26% of females exclusively breastfeed. Higher odds of breastfeeding included IDPs (aOR 1.11; 95% CI 1.01 to 1.03; p = 0.038), those educated on breastfeeding (aOR 1.18; 95% CI 1.03 to 1.35; p = 0.015) and those with positive nutrition attitudes (aOR 1.32; 95% CI 1.09 to 1.59; p = 005). Estimated household water usage ranged from 7.9 to 10.1 L/person/day. Based on qualitative triangulation, both nutrition and WASH traditional beliefs hinder adequate nutrition and create barriers to improvements in WASH. Conclusion: Evidence based nutrition interventions should be the priority and include, at a minimum, micronutrient and vitamin supplementation, food fortification and adequate supplemental food for reproductive age females. Immediate and exclusive breastfeeding messaging should be a priority. Improved flood resistant sources for clean water, clean covered water storage container distribution, improved sanitation, oral rehydration solution (ORS) and zinc distribution and education are necessary to decrease diarrheal rates.

Introduction: The ongoing invasion of Ukraine by the Russian Federation represents one of the largest ongoing conventional military engagements in the last 20 years. Since the start of the war, an estimated 210 000 Ukrainian soldiers have been injured or killed as a result of combat. This experience could help prognosticate the nature of large-scale combat operations for modern militaries. The aim of this study was to assess current patterns of injuries among military combatants in Ukraine and identify prevention and mitigation methods. Methods: We conducted a series of key informant interviews during the ongoing conflict using an expanded version of the global trauma system evaluation tool. We focused the analysis on injury patterns and prevention of combat-related injuries. Results: We interviewed 36 participants from June 2023 to February 2024. Respondents described complex polytrauma as representing the injury norm, with prominent battle injuries, including blast wounds to the extremities, traumatic brain injuries and spinal cord trauma. The primary source of injury prevention on the battlefield remains combat body armour. Military commanders and the Ministry of Defence were identified as principal bodies for the authorising equipment and tactical changes. Most respondents stated there was no formal process for using data to inform injury prevention initiatives. Conclusion: The current conflict in Ukraine is characterised by a high prevalence of devastating combat-related injury, with limited measures for battlefield injury prevention. We believe that the provision of additional protective gear could mitigate the severity of some combat-related injuries, while the creation of a trauma registry would provide greater insight into prevention, wounding patterns, treatment and outcomes.