If you were to ask any neurologist to describe the ideal environment for managing Multiple Sclerosis (MS), they would describe a life of predictability: low stress, regular sleep, and consistent medication schedules. The myelin sheath—the protective coating around our nerves—is fragile. It demands calm.
War is the antithesis of calm. War is cortisol spiking at the sound of an air raid siren at 3:00 AM. War is the chaos of displacement.
As we stand here in January 2025, looking back at the four years since the full-scale invasion, we must abandon the comforting narrative of “adaptation.” One does not simply adapt to the destruction of the nervous system. For the MS community in Ukraine, this period has not been about adjusting to a “new normal”; it has been a chronicle of loss, rapid disease progression, and a terrifying surge in new diagnoses.
The Domestic Front: A Health Crisis, Not Just a Logistics Challenge
For the patients who remained in Ukraine, the reality has been far grimmer than the international headlines suggest. While the world marveled at Ukrainian resilience, inside the country, the health of the MS community was deteriorating at an unprecedented rate.
The primary cause of this decline was the collapse of stability. We saw a massive wave of internal displacement from the East and South—regions like Kharkiv, Donetsk, and Zaporizhzhia. Patients did not just lose their homes; they lost their “medical anchors.” The bond between an MS patient and their neurologist is built over years. When patients were forced to flee to western regions, that bond was severed. Medical histories were lost in the rubble, and the continuity of care—crucial for managing a chronic disease—was shattered.
The physical environment became an enemy. The relentless attacks on energy infrastructure meant that for long periods, patients lived without heat or light. For a person with MS, extreme cold increases spasticity and pain, while the inability to use elevators in high-rise buildings during blackouts turned apartments into prisons. This physical immobility accelerated disability progression (EDSS scores) significantly faster than in peacetime.
But the most alarming trend we see in 2024 is the sheer volume of new patients. The chronic, unyielding stress of constant shelling and air raids acted as a powerful trigger. We are now witnessing a sharp spike in the incidence of MS among young people who, under peaceful circumstances, might never have developed the disease. The war didn’t just hurt existing patients; it created thousands of new ones, overwhelming a medical system already strained by the drain of professionals to the frontlines or abroad.
The Refugee Experience: Displaced Care and Silent Struggles
For the millions who fled to the EU, the UK, the US, and Canada, the challenges were less kinetic but equally debilitating. They traded the danger of missiles for the danger of bureaucracy.
In 2025, we can admit that while the global reception was warm, the medical transition was cold and jagged. The first hurdle was the “paper trail.” Many Ukrainian patients arrived in Germany, Poland, or France with nothing, but a backpack and a diagnosis written in Cyrillic. The European standard for disability recognition often did not align with Ukraine’s MSEC (Medical and Social Expert Commission) system. Patients found themselves in bureaucratic limbo, unable to access insurance or social support because they couldn’t “prove” their disability fast enough.
Then came the issue of “therapeutic switching.” Medical protocols vary wildly across borders. A patient stabilized on a specific high-efficacy DMT in Ukraine might find that the specific drug is not the first-line protocol in their host country or is simply not reimbursed by the local insurance. We saw forced switches— changing from brand-name medications to biosimilars, or to entirely different classes of drugs—simply due to administrative rigidity. For an MS patient, washing out one drug to start another is a period of extreme vulnerability.
However, the deepest wounds were often invisible. Mental health strain compounded neurological risk. Language barriers isolated patients from both doctors and peers. Subtle symptoms — cognitive fatigue, neuropathic pain, mood changes — were often underreported or misunderstood. The loss of community, cultural context, and identity deepened depression and worsened symptom perception. MS does not exist in isolation from the nervous system’s emotional circuitry; loneliness itself can exacerbate fatigue, spasticity, and cognitive dysfunction.
The Digital Lifeline
Yet, amidst this deterioration, we found tools to survive. When the physical roads were blocked, we built digital bridges.
Ukraine’s rapid digitization of healthcare prior to the war—specifically the “eHealth” system—became a critical lifeline. When patients couldn’t physically reach a neurologist, telemedicine stepped in. Electronic prescriptions allow patients to pick up medication in different regions without needing a new paper chart. We saw consultations conducted via encrypted messengers and video calls, with doctors reviewing MRIs sent via cloud storage.
Global solidarity also played a role. International partnerships allowed for “humanitarian corridors” specifically for pharmaceuticals. Western pharmaceutical companies and patient advocacy groups worked with the Ukrainian Ministry of Health to ensure that humanitarian shipments of DMTs pushed through.
The Cost of Survival
Today, in 2025, the data is undeniable. The war has accelerated the progression of Multiple Sclerosis for an entire generation of Ukrainians. We are seeing higher disability scores and a younger demographic of new patients than ever before.
They are not just patients; they are witnesses to the devastating impact of modern warfare on chronic health. Their story is a warning: when peace is shattered, the body’s own defenses often shatter with it. Ukrainian patients continue to fight—not because they have adapted, but because they have no other choice.
About the Author: Mariia Usatenko is a patient advocate, Deputy Head of NGO “UCMS”, based in the Chicago area. She has been coordinating support for Ukrainian MS patients since 2019.
