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OUR WEEKLY NEWSLETTER ON UKRAINE'S RECONSTRUCTION
26 JUNE 2024
Newsletter 24
Eastern Circles Membership
The next full-version Newsletters will be available for members only, we invite you to join the Eastern Circles community. Membership includes:

- Access to the newsletter on the evolution of Ukraine’s alliances, institutions, and elites

- Access to conference reports, recordings, and/or slides

- Access to post-conference closed networking events

- Access to exclusive dinners with the speakers


WARTIME REFORMS AND INSTITUTIONS. KEY ACTORS
On July 8, Russia launched a series of attacks on Ukrainian cities, including Kyiv, Dnipro, Kryvyi Rih, Sloviansk, and Kramatorsk. These attacks struck civilian infrastructure, most cynically the Okhmatdyt Children's Hospital in Kyiv destroyed by an X-101/555 cruise missile. Later Iskander striked a private maternity hospital on the Left Bank suggesting that children's institutions were targeted on purpose.

Russia's motives for targeting civilians:

There are two possible explanations for Russia's deliberate targeting of civilian infrastructure, especially a children's hospital:

  • Destabilizing Ukrainian society: By inflicting immense suffering on civilians, Russia aims to erode Ukrainian morale and cohesion. This strategy hopes to pressure President Zelenskyy towards peace talks, capitalizing on potential public fatigue and frustration. Following the attack, some Ukrainian commercialized influencers (bloggers Yulia Verba, Vlada Rogovenko, Julia Tenkaieva) echoed this sentiment, urging an end to the war "at any cost." This messaging weakens public trust in Ukrainian leadership and sows discord within the population, creating fertile ground for further Russian manipulation.

  • Triggering mass exodus: Russia's destruction of critical infrastructure, including hospitals, goes beyond immediate damage. It disrupts the ability of Ukrainian cities, even those far from the front lines, to function and provide basic services. This devastation could trigger a significant new wave of Ukrainian refugees fleeing to Europe, placing a strain on both Ukrainian and European economies.
Overall, Russia's attacks on civilian targets, particularly a children's hospital, represent a barbaric escalation of the conflict. These actions aim to break the Ukrainian resolve through fear and desperation.
Source: libkos
Unbroken – A Rehabilitation System In A Public Hospital
In April, Eastern Circles went on a study trip to Ukraine, with a group of our Media Fellows – experienced French journalists – with a goal of sharpening our understanding of the processes and changes taking place in Ukrainian society during the war. All in all, we spent a week in the country in April, travelling from Lviv, to Kyiv and Chernihiv, meeting businessmen, politicians, journalists, lawyers, doctors and activists at all levels.
The first place we went to on Monday morning was “Unbroken” hospital in Lviv. As our cab approached the hospital, we were surprised with what we saw. Twice. The first glimpse of the main building revealed an old façade of a multi-story, soviet-style, shabby-looking, L-shaped grey-brown concrete structure, which looked unimpressive to say the least. Where is the modern healthcare center we have heard and read about so much?

When we entered it was all inside: renewed buildings, equipment, and a totally new concept from a basic-care hospital it was 4 years ago, before the arrival of the new management. In those four years, Unbroken transformed into Ukraine’s national rehabilitation center, the largest medical complex, a leader in transplantation and cardio surgery.

“We have half a million patients: about 129,000 internally displaced patients, about 15,000 patients with mine-blast trauma. Because this war is a modern war, because it involves drone reconnaissance and the use of heavy artillery, most of the injuries are mine-blast trauma with amputation of lower limbs and less often upper limbs.”

Even before February 2022, Unbroken has started working on prosthetics and developing rehabilitation services. But they had to expand their activities and learn new skills when they started receiving thousands of patients in the first months of war in evacuation trains with heavy injuries at unprecedented scale. Good contacts with Western hospitals allowed to forward some of the heavily injured to Europe. But partners reached capacity a couple of months into the full-scale invasion.

“We were looking for more premises from the start, to help people,” says during a meeting with our group Unbroken Deputy Director Volodymyr Fedoriv. “It was cooperation with the Lviv city mayor which led to the decision to build a powerful rehabilitation center on the basis of the First Territorial Medical Association to provide a full cycle of necessary medical care. This is how Unbroken was born.”

Besides, the principles of treating a combat injury are fundamentally different from the principles of treating an injury sustained in everyday life. To learn how to treat war injuries, Unbroken rehabilitation center partnered with hospitals across Europe and the US to develop training programs for its staff and doctors from other Ukrainian hospitals in a full spectrum of care, turning a medical association into a powerful medical and training hub with unique experience.
“We have gained experience from the world, and we gain experimental experience, and the doors of our hospital are open for any surgeon, any traumatologist, reconstructive surgeon, rehabilitation specialist, prosthetist from Ukraine to adopt the experience we have already gained.”

Over the last 2.5 years it has become a comprehensive rehabilitation healthcare system, consisting of 2 hospitals, 1 children's hospital, 2 maternity hospitals, and 2 rehabilitation centers – altogether employing 4500 medical personnel. Within this system, each specialized hospital has its own rehabilitation department: “Each of our hospitals has rehabilitation departments. St Luke's has a separate rehabilitation department for children's and children's rehabilitation units,” explains Oleg Bilyanskyi, Head of Unbroken Rehabilitation Center. Furthermore, psychologists and psychiatrists are crucial in the rehabilitation process, working with patients from prosthetists, physiotherapists, general surgery, reconstructive surgery, neurosurgery, traumatology, cardio-vascular and other departments. The same methodology of comprehensive approach to rehabilitation is applied across different services.

Rehabilitation starts with an inspection and diagnostics of an incoming patient by a cross-sector team of doctors, who then map out different stages of treatment, including psychological, neuropsychological, physical, reconstructive surgery, prosthetics, lost vision rehabilitation, for example. Each type of rehabilitation will have a dedicated team, members of which will work with different patients in a cross-discipline rehabilitation team. The patient is at the center of the system, and the goal of each team is to reach the highest quality of life for each patient.

Psychological rehabilitation runs through all parts of this system. The areas of expertise by specialized doctors in Unbroken psychiatric center differ from child psychology to working with victims of rape (most of them men coming out of Russian occupation or captivity, in addition to numerous women and children), with people who lost their limbs, people brain damage due to multiple contusions, to people who look whole from the outside, yet carry bleeding scars on the inside. PTSD is a red thread running through the various types of psychological trauma inflicted by war. Thus, “when a woman whose face was blown off by an explosion or destroyed in a fire comes to the hospital, it is not just about reconstructive surgery and putting something in place of a face. It’s about working with her all through the process, so she does not kill herself after looking into a mirror at home after she is discharged,” says the Head of Unbroken Psychiatry Department Ulyana Bereznyak.

How long a rehabilitation may take depends on every individual and his or her family, and their acceptance levels of this new situation. There are patients who can be discharged from the hospital after 14 days of rehabilitation treatment with major improvement, and those who have to stay up to one year with slow and patched progress. Some patients need repeated stages of rehabilitation, with work for decades, if not more, after the war, as physical functions degrade or psychological treatment reaches its limits. To prepare for the future, based on the recent experience, Unbroken is forming institutions for training, response planning, and anticipation of complications up to a year in advance.

Unbroken Rehabilitation Center is registered as an NGO. 80% of its funding come from the state authorities and from Lviv city. Among the state actors, the Ministry of Social Policy is the most important for their rehabilitation program. The remaining 20% of funds came from donations by over a thousand partners, including cities (Freiburg, Warsaw, etc.), private companies (e.g., Ikea) and NGOs (e.g., Red Cross) assisting war victims.

Source: Unbroken social networks
Prosthetics

There are two types of prostheses: mechanical, more suitable for basic tasks like picking up, carrying objects, while bionic, also called biomimetic, or post-integration prosthetics are more appropriate for precision movements and allows patients to feel surfaces and manipulate objects. Post-integration prosthetics are actively developing in Ukraine, including within Ubroken, which the war has led to becoming a national leader in transplantation, with emphasis on oseo-integrated prosthetics:

“What made us unique was that we supplied more than 30 bionic upper limb prostheses. Bionic prostheses are a high-tech product that scans muscle impulses and converts these impulses into bionic prostheses. These bionic prostheses scan muscles and convert them into bionic prostheses,” explains Fedoriv.

Since early 2022, Unbroken installed 500 mechanical and over 30 bionic prosthetics.

In addition to partnering with countries with most advanced prosthetics expertise, like America, Germany and Denmark, Ukrainian native production is emerging. One of Unbroken suppliers is Esperbionics, a Ukrainian start-up making biomimetic prosthesis, with good reviews from patients at much lower prices than a same-quality foreign products.


Source: Eastern Circles
Who pays for prosthetics in Ukraine

A state program by the Ministry of Social Policy has developed a powerful structure of compensation for prosthetics covering the cost of good quality mechanical prosthetics (8 000 euros on average). The state does not cover a biological prosthesis however (which average 30 000 euros per unit), and Unbroken tries to help by organizing fundraisers with partner foundations to help families find the money. Ukrainian NGOs, such as Dobro.UA, fundraise for prostheses.

The Unbroken rehabilitation center houses a small in-house prosthetics manufacturing lab and with the help of Lviv city opened a new factory in May, with production capacity of over 1000 prosthetics a year. The focus of the new factory is on training and manufacturing of components with 3D printing. Unbroken is currently raising funds for 3D metal printers.

This growth happened from a low start, as before the war the hospital which has become Unbroken had no focus on prosthetics, and Ukraine as a whole had a couple of dozen specialists, and only few upper limb prosthetics doctors. Medical schools did not have specialized departments either. Today, after the country’s healthcare system confronted the war-scale demand to treat thousands of patients with lost limbs, medical schools opened a specialty in the sector, increasing the number of graduates in this discipline and requalification training programs for practicing doctors. Now Unbroken alone employs 14 prosthetic specialists and an experimental team that knows how to work with combat injuries. Unbroken has also set up international partnerships with foreign hospitals in the USA, Denmark, Germany and France, among others, who accepted to train Ukrainian doctors abroad and send their experts to Ukrainians at home.

The way Unbroken administration sees their mission today is to create programs to train more prosthetic specialists across the country, turning their hospital into an expertise and training hub for other doctors across Ukraine.
Due to the scale and intensity of the war, the demand for prosthetics remains overwhelmingly higher than supply, and it is growing across the country, with long waiting times due to limited manufacturing capacity and funding remaining key challenges for patients.

“As of today, even the satisfactory rehabilitation needs are not yet met. The number of civilian patients, of civilian injuries from the war, is quite high,” concludes Oleh Bilyanskyi.

Source: Unbroken social networks
Challenges

Among the main challenges, like in other hospitals across the country, are personnel shortage, stretched education system, struggling to meet the spiking demand for specialists, increased workload for doctors who face higher work and academic loads with fewer specialists. They cope with earlier and more active medical student involvement in rehabilitation work and training more doctors.


Ministerial ousting: a strategy or a strategic mistake

If we recall a few months earlier, National Security and Defence Council of Ukraine Secretary Oleksiy Danilov, the Minister of Reconstruction of Ukraine Oleksandr Kubrakow, Deputy Minister of Infrastructure of Ukraine Mustafa Naem, and others were dismissed. It becomes obvious that Zelensky’s team has launched a major reset, which the president announced when he dismissed Valeriy Zaluzhnyi as Commander-in-Chief of the Armed Forces of Ukraine. What does it mean for Ukraine’s future?

Elite rotation during the war is a risky decision that puts on the stake two major aspects: the functions and performance of the institutions, and the trust of the partners and society. Despite that, Volodymyr Zelensky isn’t Columb of “high-level staff rotation” strategy during the war. The other famous person, Napoleon Bonaparte did a constant rotation of army leaders, ensuring new leadership and motivated officers to prove themselves. However, it also led to competition and rivalries among marshals, hindering cooperation during critical campaigns. In other words, officers left the scene too quickly, taking with them urgent crucial experiences.

Globally speaking, such a rotation strategy leads to two possible paths: removing potential opponents, bringing new executive power, and creating a high uncertainty that deprives some elites of access to previously received benefits. Coming back from Napoleon to Zelensky, Ukraine is right in between two paths. Ukraine is navigating between them due to a trend emerging where high-level political appointments in Ukraine are heavily influenced by personal connections to President Zelensky, potentially leading to overreliance on individual performance and charisma in choice of new leaders of institutions rather than demand of established institutions. To better understand the situation, let’s zoom into the example of the replacement of the Minister of Reconstruction of Ukraine Oleksandr Kubrakov.

Source: strana.ua
Oleksandr Kubrakov is known as a close to Zelensky trusted “manager” proving his qualification as Minister of Infrastructure of Ukraine (2021), and Vice Prime Minister for the Restoration of Ukraine - Minister of Development of Communities, Territories and Infrastructure (from December 1, 2022 to May 2024). The closeness to Zelensky is justified by his performance and wartime intersectional agility: Establishing logistics and supply of fuel, weapons, and humanitarian supplies at the beginning of a full-scale Russian invasion; Finding alternative ways to export agricultural products after Russia withdrew from the grain deal; Unblocking freight traffic on the border with Poland during the truckers' protests; Working closely with Western partners, especially the United States, to attract targeted loans and grants for Ukraine's reconstruction projects. In May 2024 without official reasoning Oleksandr Kubrakov was dismissed. The hypothesis media giving as reasons are insufficient performance of the Ministry of Reconstruction, corruption scandals around it, Kubrakov's too close ties to donors, conflict with the President's office, etc.

So which is the price of such a radical strategy of Minister replacement? On the one hand, it costs the actual "nullification" of two funds on which the Ministry of Recovery relied - the Road Fund and the Fund for Elimination of the Consequences of Armed Aggression, and breaks a trust with international donors. On the other hand, the Ministry of Economy and the Ministry of Strategic Industry received 29 and 49 additional billion hryvnias to their budgets from the cancelled funds of the Ministry of Reconstruction.

To conclude, in addition to “high-level staff rotation” in Zelenskyy's team, there is also a tendency to change the prioritization of ministries: from reconstruction to the development of the military-industrial complex and the economy. It remains to be seen what Zelenskyy's Napoleonic tactics will lead to.


International Cooperation with Ukraine June 2024
June was a month of significant bilateral agreements for Ukraine
  • The Global Peace Summit was held in Switzerland, with over 100 countries and international organizations participating.
  • Agreement was reached on three key points of the Ukrainian Peace Formula: nuclear security, food security, the exchange of all prisoners of war, and the return of all civilians.
  • Ukraine has already signed 20 security agreements with allies, including the EU and the US. According to these agreements, the UA partners plan to provide Ukraine with total military support of $60 billion annually over the next 4 years.
Ukraine will receive an additional $50 billion from our allies this year, thanks to the use of proceeds from frozen Russian sovereign assets in the West. This decision was made at the G7 summit.

Key agreements in the financial sphere:
  1. Ukraine and the US signed an agreement that will allow our country to receive almost $7.9 billion in financial support this year.
  2. Ukraine signed an agreement with the EU on financing under the Ukraine Facility for the next 4 years. Yesterday we received €1.9 billion from our European partners under this program.
  3. After the meeting of the IMF Board of Directors Ukraine (June 28th) expects to receive $2.2 billion.
Thanks to all these agreements with the EU, IMF, US, World Bank, G7 countries and other allies, the Ukrainian government has an understanding of financing the budget for the next year.

One more historic event - the official start of negotiations on Ukraine's accession to the European Union. Ukraine expects that next month the European Commission will begin bilateral meetings, during which Ukraine will present the state of approximation of national legislation to EU legislation in each negotiation chapter.
Ukraine Recovery Conference – June 2024
During the Ukraine Recovery Conference-2024, international agreements and assistance worth more than €16 billion were signed and announced. The conference was held in Berlin on June 11-12, 2024. In particular, during the International Recovery Conference, the following agreements were signed and assistance announced:

  • A number of companies have expressed their willingness to enter the Ukrainian market and help build 1 GW of generating capacity in the future. The volume of potential investments could amount to 500-700 million euros
  • Guarantee and grant agreements under the investment component of the Ukraine Facility program - EUR 1.4 billion
  • US Energy Assistance Package - USD 824 million
  • Launch of the SME Resilience Alliance for Ukraine - EUR 7 billion commitment
  • Skills Alliance retraining program - over EUR 700 million
  • Additional funding for humanitarian land demining - USD 35 million
  • 14 agreements between Ukrainian and German and international business partners - over EUR 560 million
  • Risk insurance agreements - over USD 350 million
In total, 110 international agreements were signed during the conference.

In addition, during the conference, the Ministry of Economy presented the Investment Guide, which includes 95 investment projects requiring about $27 billion in financing. USD of financing. It also presented European integration documents, including the SME Development Strategy and the National Energy and Climate Plan.

The Business Advisory Council was also launched to help improve the investment climate in Ukraine. It includes almost two dozen CEOs of leading global companies and business associations from different countries.

A security agreement between Ukraine and Poland – June 2024
The security agreement with Poland consists of ten chapters covering political, military, economic, and other support, as well as bilateral cooperation in the event of a future threat of aggression.

Among the key provisions of the document is Poland's commitment to provide several packages of military assistance by the end of 2024 and to continue such support for 10 years of the agreement. Warsaw will also consider providing Ukraine with at least an additional MiG-29 squadron (at least 14 fighters).

The document, for the first time among the bilateral security agreements already signed, provides for the possibility of intercepting missiles and drones in the airspace of our country fired in the direction of Poland.

In addition, the bilateral document for the first time provides for the creation of a "Ukrainian Legion" within which personnel of the Ukrainian security and defense forces will be trained in Poland.

The security agreement with Poland is the twenty-first one signed since the beginning of the year.

Military Aid For Ukraine March-May 2024
The US military assistance package: a farewell prize?

The biggest news of this spring was the US allocation of the $61 billion to Ukraine. A closer look at the main priorities of this package are outlined in the Ukraine Security
Supplemental Appropriations Act of 2024, and are directed toward the development of the US military industry in the US and the support of the US forces in Europe, with 42% of the total going toward weapons and ammunition supplies to Ukraine.
1) The biggest priority is the transfer of weapons and munition ($25.7Bn), either from the existing US stockpiles under the presidential drawdown authority, through grants and loans to Ukraine and its allies for buying US weapons, or through the direct funding for ramping up US production of weapons and ammunition.
2) The second most important item is training and intelligence ($17Bn).
3) A structural loan (not a grant) for financial support of Ukraine’s essential government services, like law enforcement ($7.9Bn).
4) O&M cost of the US military forces in Europe ($7.3Bn).
5) Humanitarian aid ($1.6Bn), which includes Europe, Eurasia, Central Asia, and support for Ukrainian refugees in the US.


The international support for Ukraine continues to grow in both scale and diversity, reflecting a unified commitment to bolstering Ukraine's defense against ongoing threats.

The following trends emerge from recent aid packages:

Significant contributions from major allies:
  • Germany leads with a substantial €28 billion package, providing a wide range of military equipment and support.
  • The United States continues to play a pivotal role, with multiple aid packages totaling over $1.275 billion in recent months, including precision strike rockets, artillery rounds, air defense systems, and tactical vehicles.
Focus on immediate defense needs:
  • Many countries, including Spain, Denmark, Australia, and France, are supplying specific military equipment such as tanks, missiles, artillery, and speedboats to address Ukraine's immediate battlefield requirements.
  • Lithuania and Latvia are providing targeted aid with reconnaissance drones and anti-aircraft systems to enhance tactical operations.
Emphasis on air defense and artillery:
  • Countries like France and Italy are supplying advanced air defense systems like the SAMP/T and Aster missiles to protect Ukrainian airspace.
  • Belgium, Canada, and Denmark are contributing significantly to artillery and air defense munitions, ensuring sustained firepower.
Support for domestic production and maintenance:
  • Some aid focuses on enabling Ukraine to build and maintain its own defense infrastructure. Denmark's "ZBROYARI: Manufacturing Freedom" project and Belgium's funding for F-16 maintenance are examples of such initiatives.
Humanitarian and economic aid:
  • Alongside military support, humanitarian aid and economic support continue to flow, with countries like Finland and Kosovo contributing to broader efforts including soldier rehabilitation and civilian support.
Long-term Strategic Assistance:
  • Sweden and South Korea have committed significant long-term support, with $7.01 billion and $2.3 billion respectively, aimed at sustaining Ukraine's defense capabilities over several years.
Overall, the aid packages reflect a comprehensive approach to supporting Ukraine, blending immediate military needs with long-term strategic assistance and domestic capacity building. The trend is clear: international allies are increasingly focused on not just meeting Ukraine's current defense needs, but also ensuring its future security and stability.



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