Aneta Mihaylova is a Health Officer with Project HOPE in southern Ukraine and a practicing general surgeon who made a conscious decision to remain in the country after Russia’s full-scale invasion. Of Ukrainian and Bulgarian heritage, she chose to stay close to her community, combining frontline surgical work with humanitarian coordination at a time when Ukraine’s health system was coming under unprecedented strain.

For nearly three years, Mihaylova has occupied a rare dual role—inside operating rooms and inside coordination meetings—bridging clinical medicine, crisis communication, and health system support. Her work spans emergency trauma response, continuity of care for non-communicable diseases, mental health programming, medical training, and evidence-based advocacy with local authorities and international donors. In parallel, she is completing a master’s degree in health care management, strengthening her ability to navigate the fragile intersection of medical practice, administration, and humanitarian logistics in wartime.

Her perspective is shaped not only by Ukraine’s experience but also by comparative crisis settings. In early 2025, she traveled to the Gaza Strip in the Occupied Palestinian Territory to exchange experience with health workers operating under protracted conflict conditions. The visit reinforced a shared reality: across geographies, health professionals face similar pressures—damaged infrastructure, displaced populations, staff shortages—and the same determination to keep systems functioning.

Since February 2022, Ukraine’s health sector has endured more than 2,254 documented attacks on health care facilities, according to the World Health Organization. In this interview, Mihaylova reflects on how needs have evolved from immediate trauma care to more complex, hybrid demands: rehabilitation and prosthetics for war-related injuries, continuity of chronic disease treatment for displaced populations, and expanded psychosocial support for patients and providers alike. She also explains the ethical principles that guide humanitarian storytelling—ongoing consent, privacy-first safeguards, and the refusal to retraumatize vulnerable people for visibility. As an example of responsible advocacy translating into tangible results, she highlights the reconstructed rehabilitation department at Mykolaiv Regional Clinical Hospital, where documented patient needs helped shape an accessible, modern facility now serving hundreds each year.

Scott Douglas Jacobsen: Since February 2022, how have health and humanitarian needs in Ukraine evolved, particularly in front-line regions?

Aneta Mihaylova: Since February 2022, health and humanitarian needs in Ukraine have shifted from immediate emergency response to a complex mix of chronic, psychological, and long-term systemic challenges, particularly in eastern, southern, and northeastern front-line regions.

In the early months, priorities were trauma care, evacuation, the deployment of emergency supplies, and keeping hospitals operational during direct attacks. Today, the needs have shifted toward long-term care, with a greater demand for specialized medical care, physical rehabilitation, and prosthetics for war-related injuries. In response, Project HOPE launched an initiative last year in collaboration with rehab4u to strengthen Ukraine’s rehabilitation ecosystem and advance the social inclusion of persons with disabilities and civilian war victims.

Millions of displaced people rely heavily on primary healthcare clinics that were never designed to serve such large populations. Access to care for non-communicable diseases — cardiovascular conditions, diabetes, and cancer — has become a major challenge, driven by infrastructure damage, disrupted supply chains, and loss of medical personnel. Interruptions in chronic care pose serious long-term risks.

At the same time, the health system itself is under attack, with more than 2,254 attacks on health care facilities since February 2022 as verified by the WHO. Providers have relocated, been mobilized, or experienced repeat trauma. Health facilities operate with reduced staffing, an unstable power supply, and ongoing security threats. What once would have been “routine” care now requires extensive coordination, flexibility, and external support just to maintain continuity.

Today’s needs are less visible than in 2022 — but no less urgent. The evolution has been one of acute crisis → protracted strain → hybrid needs, with repeated attacks on civil infrastructure, especially the energy, water, and heating supply system, compounding the challenges.

Alongside what Project HOPE already does— including Mobile and Local Medical Units, ambulance services, expanded pharmaceutical and equipment donations, and comprehensive staff training (BLS, ALS, TDTR, EPALS, and tailored courses for doctors and nurses) — Project HOPE is preparing to support winterization efforts. This will provide facilities with critical winter supplies and fuel to ensure continuity of care during the most difficult months.

 

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Jacobsen: As both a surgeon and a humanitarian coordinator, how do you navigate the tension between bearing witness to suffering and protecting patients’ privacy and dignity?

Mihaylova: This balance is at the heart of humanitarian work.

We meet people at their most vulnerable moments, and many of us — including myself — are trained in Psychological First Aid, which ensures that every interaction is safe, respectful, and grounded in empathy. The way a story is told can either protect a person or expose them to further harm.

A few principles guide us include: Consent is ongoing, not a one-time form. A person can stop at any moment. We never push anyone to relive trauma. If a story can be told without graphic detail, we choose the gentlest version. We focus on resilience, needs, and solutions — not suffering. We avoid identifying details if there is any risk to a person’s safety.

Ultimately, storytelling is not about data points or impact metrics. It is about human beings. Protecting their dignity always comes before visibility or publicity.

Jacobsen: Can you describe a specific case in which responsible storytelling—grounded in consent and evidence—directly contributed to improved patient care?

Mihaylova: One powerful example comes from our work with secondary care facilities in southern Ukraine. Last year, the rehabilitation department at the Mykolaiv Regional Clinical Hospital reopened following a full reconstruction, which directly improved care for hundreds of patients.

Before the renovation, people recovering from neurological, traumatic, or musculoskeletal conditions had very limited access to modern, barrier-free rehabilitation. Patients raised these concerns with the hospital and regional health authorities, and our team heard the same issues during field visits. The gaps were clear, but what made the difference was documenting those needs responsibly—grounding the story in evidence, listening to patients, and ensuring we weren’t exposing anyone to risk.

By working with the Department of Health and the Ministry of Health’s Restoration Office, we translated those lived experiences into a data-backed case for reconstruction. That storytelling helped the hospital and regional authorities prioritize the rehabilitation department and design it around real, practical needs: wide, accessible corridors and doorways, adapted bathrooms, multifunctional beds, dedicated therapy spaces, and rooms for psychological support.

The result is a facility that now provides free, high-quality rehabilitation to approximately 800 patients annually. And for people recovering from life-altering injuries, that means more than a better building — it means dignity, access, and a real chance at long-term recovery.

To me, it shows how responsible storytelling can drive change: when you elevate the right voices, ground them in evidence, and pair them with strong partnerships, you can help turn identified needs into tangible improvements for patients.

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Jacobsen: When determining which frontline realities to elevate to donors, policymakers, or the broader public, what criteria guide your decision-making?

Mihaylova: In the field, we prioritize stories that reflect clear, evidence-based needs or demonstrate impact, while always ensuring the privacy and safety of the individuals involved. When deciding which stories to share with donors, policymakers, or the wider public, we carefully balance the potential to raise awareness with our responsibility to protect individuals, maintain program integrity, and follow the principle of ‘do no harm.’

Some stories help donors understand funding gaps. Others help policymakers recognize system-level needs. And others help the public connect with the human reality of the war.

I believe the right story is the one that strengthens program decisions, deepens community understanding, and improves the care we can provide to the people we serve

Jacobsen: Thank you very much for your time and for sharing your insights.