Report from Ukraine – Between War and Resilience

Unbroken Center, ©La Chaine de l’Espoir

First Mission in Ukraine with Olivier, Director of Operations

We arrived on July 21 from Rzeszów, Poland. With the airspace closed, the journey continued by car: a ten-hour drive, with a first night in Lviv. This slow and complex logistics already says much about the war: entering Ukraine is to share, even for a moment, the daily constraints of an entire country.

The context is heavy. On the night of the 21st, Kyiv was hit by a massive attack: over 420 drones and around twenty missiles, some hitting a daycare, a metro station, and residential areas. Ten days later, a new wave caused up to 18 deaths and more than 150 injuries. Our mission took place between these two assaults, like a fragile parenthesis. During our stay, a few nighttime alerts were enough to remind us of the constant underlying anxiety weighing on residents.

Kyiv: a tense but vibrant capital

What struck me was the calm of Ukrainians. Everywhere, the war is present: interrupted nights, sudden awakenings, worry for loved ones. Many are sleep-deprived, yet no one complains. This silent dignity commands respect.

And yet, life goes on. In Lviv, restaurants and bars remain lively until curfew. In Kyiv, families stroll in parks, and young people linger outdoors in the evenings. An almost festive vitality, as if a collective refusal to fully succumb to war. This strength is rooted in history. Since 1991, civil society has continuously resisted. In 2014, the Maidan was a decisive rupture: Ukrainians rose against a pro-Russian president who had reneged on his promise to sign the association agreement with the European Union—a sovereign act and an irrevocable choice for Europe.

Civic engagement remains: the demonstrations

This spirit endures. During my mission, the population—a highly mobilized youth—took to the streets to oppose a plan to bring the anti-corruption body under government control. Massive and determined mobilization forced the measure to be withdrawn. Even in war, democracy is lived daily here, both in the streets and within institutions.

Maidan: memory and grief

Today, Maidan is also a place of mourning. On one of the lawns, thousands of small blue-and-yellow flags have been planted, tightly packed. Each bears the photo of a soldier fallen in combat.
I stop in front of these faces, sometimes so young they could be my own children. Behind each flag is a life cut short, a grieving family, an interrupted story. This field of bright colors has become a symbolic cemetery: a silent tribute to the price Ukraine pays every day for its independence.

Maidan Memorial, ©La Chaine de l’Espoir

Exemplary Ukrainian colleagues

In Kyiv, I met the local team of La Chaîne de l’Espoir. Their dedication gives our work a particular dimension: it is not only about external assistance but a shared struggle.

Polina, a pediatric surgeon, left Canada to return in the early days of the war. Mykhailo, an orthopedic surgeon, travels to Kharkiv every weekend, near the front line, to operate with his colleagues. For over three years, he has not taken a vacation. Their energy and determination embody the mission better than any speech. La Chaîne de l’Espoir lives through them.

Institutional meetings in Kyiv

Our days were also filled with numerous meetings: Ministry of Health, Expertise France, AFD, French Embassy, OCHA, and the manager of the Humanitarian Fund for Ukraine. These encounters are essential for strengthening partnerships and preparing new projects.

Deputy Minister of Health and Anouchka Finker, ©La Chaine de l’Espoir

A healthcare system weakened by war

Discussions confirmed that the war exposes the flaws of an already fragile hospital system. Three major challenges emerge:

  • Infections: Patients often arrive too late, after prolonged tourniquet use, without proper antibiotics. Wounds become infected, often with multi-resistant strains; many amputations could have been avoided. Observations from evaluations conducted by La Chaîne de l’Espoir are being incorporated into our projects.

  • Avoidable amputations: Too many patients lose limbs due to delayed stabilization or transfer to specialized hospitals.

  • Biomedical equipment: In many hospitals, essential equipment remains unused due to lack of maintenance, spare parts, or trained technicians. This paradox—available but unusable equipment—is a system Achilles’ heel. We address it by training local staff and restoring vital equipment.

Damage Control training, ©La Chaine de l’Espoir

Return to Lviv: Damage Control and reconstruction

In Lviv, we visited the Husome center, where six surgeons undergo intensive Damage Control training. One day of theory, followed by one day of practice. Under anesthesia, pigs are used following strict ethical protocols. Surgeons must diagnose and stabilize injuries to the bladder, liver, lungs, and heart.

Damage Control teaches how to stabilize a patient and buy time before transfer to a better-equipped hospital. These trainings, designed by Professor François Pons—a volunteer surgeon with La Chaîne de l’Espoir, former military, and former director of the Val-de-Grâce School—are now in high demand. Their impact is immediate on the ground: they save lives. To date, nearly 270 Ukrainian surgeons have been trained by La Chaîne de l’Espoir in this method, significantly strengthening surgical capacities in wartime.

St Pantelimon Hospital and the memory of heroes

At St Pantelimon Hospital, the corridors are adorned with portraits of doctors, including Dr. Stéphane Romano, a French volunteer surgeon with La Chaîne de l’Espoir. His commitment alongside local medical staff has earned him the status of a true hero. His photo reminds us of the impact a single doctor can have.

St Pantelimon is also one of the largest medical facilities in western Ukraine, with the country’s largest intensive care unit (nearly 100 beds), a 700 m² state-of-the-art sterilization unit, and a cutting-edge transplant center capable of complex procedures thanks to an immunogenetics lab and advanced technologies. A pillar of Ukraine’s health system, marked by war yet looking toward the future.

Unbroken: reconstruction after injury

Finally, we visited the Unbroken center, a showcase of Ukrainian resilience. Next-generation prosthetics, exoskeletons, medical robotics: everything supports rehabilitation. Patients, often very young, relearn to walk, live, and rebuild themselves. The contrast is striking: on one hand, avoidable amputations due to delayed care; on the other, innovation giving hope.

Conclusion

Three priorities emerge from this mission:

  1. Train surgeons in Damage Control to save more lives.

  2. Provide faster, better care to prevent infections and unnecessary amputations.

  3. Strengthen biomedical capacities by training technicians to restore hospital equipment.

Beyond projects, I retain the image of a dignified and resilient people, and of my Ukrainian colleagues who fight every day, not only to save lives but to defend the future of their country.

Anouchka Finker

Anouchka Finker - CEO @ La Chaine de l'Espoir | LinkedInAnouchka Finker has been CEO of La Chaîne de l’Espoir since 2019. She has over twenty years of international experience in strategic management and partnership development in multicultural environments, both in the private and humanitarian sectors.

As head of La Chaîne de l’Espoir, she leads the work of a 240-staff international medical organization active in around twenty countries. The NGO focuses on improving access to healthcare for the most vulnerable populations, especially children and women, while sustainably strengthening health systems, with particular attention to surgery. She works closely with local partners to provide lasting solutions and meet needs in crisis contexts.

La Chaîne de l’Espoir 

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“The World to Come as Seen by the CIA”

Éditions des Équateurs, Robert, Diane; United States, Office of the Director of National Intelligence; United States, Central Intelligence Agency

What perspectives can humanitarians draw from the CIA’s latest forward-looking report?

On May 28, the French translation of the latest CIA report intended for the U.S. administration was published in France by Éditions Équateurs Documents. The report, published under the title “The World to Come as Seen by the CIA – Analyses, Facts, and Figures”, offers humanitarians—always alert and seeking foresight regarding tectonic shifts, crisis arcs, fault lines, and the major trends of “concrete geopolitics” that condition our actions—an opportunity to examine their own perspectives, drawing from the data and interpretations of the main U.S. intelligence agency, which in Europe often carries a negative image.

Before delving into the most significant analyses of the report, it is important to highlight two major “biases”:

  1. The report is conceived, written, and structured solely from the perspective of U.S. interests and “extreme and critical” threats to them. It is likely that a similar report produced by French intelligence, while pointing out the same unavoidable phenomena, would highlight others, create a partially different threat hierarchy, and perhaps provide a more nuanced or complex vision.

  2. The report is designed for the current U.S. administration—i.e., the Trump administration. Between the lines, one can detect a vision aligned with, and anticipating, the ideological assumptions and worldview of that administration. Similarly, the absence of a mention of a phenomenon (climate change, for example, as we will return to) is itself indicative of the threat posed by the refusal of the world’s leading power to address that issue.

With that said, the presentation of global perspectives by the world’s leading power cannot leave one indifferent; above all, it cannot “leave the world indifferent,” since U.S. perceptions, in turn, shape the world.

Structurally, the French edition comprises three distinct parts: the report titled Annual Threat Assessment of the U.S. Intelligence Community, the transcript of a U.S. Senate hearing on current global threats, and finally a section Analysis, Facts, and Figures concerning nine countries/states selected, presumably, as significant.

CIA Headquarters, Langley, VA

Let us examine, in a non-exhaustive way, the report’s most decisive analyses regarding “extreme and critical” threats to U.S. interests and attempt to discern their consequences or factors for humanitarians in their present and future work.

The first threat cited in the report as affecting U.S. interests (a priority confirmed in the Senate hearing) is organized crime and drug cartels responsible for the massive influx of drugs into the U.S. (notably fentanyl, which has caused widespread deaths), human trafficking, and illegal immigration. While a serious and real threat, this priority is largely influenced by the ideological focus of the current U.S. administration on immigration and related crime (drug inflow, prostitution, and migrant influx often viewed as inseparable). For humanitarians, this political orientation toward border closure and deportation suggests the need to implement or expand programs for the Caminentes (“those who journey”): migrants stranded in Central America or forcibly returned without resources or shelter. The coming years may see a growing population of men, women, and children left with nothing, either there or here, who will require assistance—from daily survival to education.

A persistent threat emphasized by the report is the continuation or increase of terrorism risk. In Asia and the Middle East (except Yemen), ISIS is identified as the primary actor capable of resurging—even without territory—taking advantage of any regional or local instability (e.g., in Syria), expanding as in Somalia or West Africa where it rivals Al-Qaeda networks, and inspiring local initiatives in Europe or Russia. ISIS-Khorasan in Central Asia is described as particularly aggressive, seeking to exploit “high-vulnerability travel routes.” In West Africa and the Sahel-Saharan belt, regional Al-Qaeda affiliates will increasingly destabilize states like Mali, Burkina Faso, and Niger (and further toward the Gulf of Guinea), with growing attacks on urban centers and diminishing government control. The report highlights the coordination between active Al-Qaeda affiliates in Yemen (AQAP) and Somalia (Shabab) with the Houthis, facilitating access to more sophisticated weapons and possible coordination to strike Western interests and commercial traffic. For humanitarians, already aware of this threat, the report reinforces the need to anticipate risks along local or cross-border routes, isolated settlements, and logistics chains. Western-origin humanitarians will increasingly be threatened and targeted where these organizations expand, and access to the most remote populations may be risky, contested, or blocked.

China is presented as a source of both regional (expansionist policy in the South China Sea, de facto annexation of islands and islets, military encirclement and harassment of Taiwan) and global threats. U.S. analysts anticipate a coherent “galaxy” of major risks from China’s deliberately aggressive actions: disruption of supply routes and logistics chains used by Western countries, threats to critical infrastructure (energy, security, health, transportation, banking networks, etc.), and information, communication, and internet systems; covert use of AI to manipulate data and open-source information (similarly cited for Russia); and data exfiltration from Western internal or external networks. Humanitarians, who position emergency stocks abroad and ship supplies worldwide, must consider the vulnerability of their logistics chains. Likewise, humanitarian organizations increasingly produce and rely on borderless digital information—data, communications, mapping. To what extent are our systems immune to intrusion, exfiltration, or manipulation?

The Chinese threat is compounded by Russia, which poses risks to Western satellite networks and related communications systems. Humanitarians must question their increasing dependence on vulnerable satellite links. Notably, the report does not mention the risk of Russia cutting undersea internet cables, despite NATO taking it seriously—perhaps intentionally downplaying Russian culpability.

SCO Summit, Shanghai 2025 ©X_Narendramodi

Regarding Ukraine, U.S. analysts do not foresee an imminent collapse along the contact line. Their assessment can be summarized: “The longer the war continues in Ukraine, the more Ukraine will lose.” The report notes Russia’s current military advantage and capacity to continue its campaign longer than Kyiv. Compared to the French former Chief of Staff’s caution that victory favors the adversary who can endure slightly longer, the CIA report highlights the growing risk of large-scale conflict between NATO allies and Russia, including potential nuclear weapons use. While the humanitarian role in a nuclear conflict is theoretical, humanitarians must consider what their role—or absence thereof—would be in a high-intensity, widespread European conflict, where operational procedures, safety guidelines, and logistics could collapse. The potential scale of displacement and humanitarian need would far exceed current capacities, placing humanitarian organizations among the first victims of high-intensity war in the West.

In the Middle East, written before recent Israeli-U.S. strikes on Iranian nuclear and military installations, the report lists expected critical threats: attacks on Israel and U.S. facilities, blockages of energy, trade, and logistics routes by Iran or its proxy in Yemen (Houthis). Regarding Syria, the report underscores volatility after Bashar al-Assad’s fall and the risk of ISIS resurgence. For humanitarians, vigilant in the region, this is a reminder: worsening political and military volatility, attacks on minorities (Alawites, Druze), interventions affecting Rojava, or renewed Turkish action would jeopardize access to isolated or displaced populations.

© UNICEF Ashley Gilbertson

As noted, what a report omits can be as telling as what it includes: climate change. During the Senate hearing, Tulsi Gabbard, Director of National Intelligence, was directly questioned about its absence. Her response—that the report focuses on the most extreme and critical national security threats—implies to humanitarians that the U.S. is unlikely to fund adaptation or resilience programs for vulnerable populations. Consequently, humanitarian needs related to climate change may exceed expectations and capacities. By contrast, French think tanks, such as Institut Montaigne, acknowledge climate’s centrality to policy planning by 2040.

The final section covers nine countries, revealing symbolic and strategic choices. Notably, Denmark, Greenland (separately treated), and Canada are included. Two cases stand out: Syria—marked as “head of state: vacant,” highlighting U.S. ambiguity regarding figures like Ahmed al-Charaa/Al Joulani—and Turkey, whose dossier underscores the massive refugee intake, highlighting the complex humanitarian challenge of new arrivals, return policies, or mass movements toward Europe.

Conclusion

High-intensity Russia-NATO conflict where humanitarian actors would have limited role; growing instability in the Middle East, West Africa, the Sahel-Saharan belt, and Central Asia; threats to supply chains; ongoing risks to information and communication systems; possible data manipulation; U.S. disregard of climate-related humanitarian impacts; and massive unmet humanitarian needs. While the CIA report may be oriented, sometimes simplistic or unnuanced, one fact is clear: humanitarians face pervasive danger and must act—or reinvent themselves—to remain relevant.

Pierre Brunet

Writer and Humanitarian

Pierre Brunet is a novelist and member of the Board of Directors of the NGO SOLIDARITES INTERNATIONAL. He became involved in humanitarian work in Rwanda in 1994, then in Bosnia in 1995, and has since returned to the field (Afghanistan in 2003, the Calais jungle in 2016, migrant camps in Greece and Macedonia in 2016, Iraq and north-eastern Syria in 2019, Ukraine in 2023). . Pierre Brunet’s novels are published by Calmann-Lévy: Barnum in 2006, JAB in 2008, Fenicia in 2014 and Le triangle d’incertitude in 2017. A former journalist, Pierre Brunet regularly publishes analytical articles, opinion pieces and columns.

 

 

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