Halyna Vasylivna lives alone in a tiny “Khrushchevka” flat. At 94, she has outlived her sons and her husband, and her grandchildren live outside the city. Her apartment, named after the Soviet leader under whom the five-storey buildings in Kyiv’s Podil district were built, is too far from the bunker so she hides in her pantry during airstrikes. Vasylivna is grateful for her social worker Olya’s visits a few times a week. She wishes she did not live alone. “It’s important to have someone who can listen to you,” she says. Vasylivna is one of 2 million older women in Ukraine who have remained largely invisible to authorities. Most of Ukraine’s elderly people are women – they make up two-thirds of those aged over 65 and 71% of those aged above 75 – partly because Ukraine has the sixth highest proportion of women in the world. These women are reliant on tiny state pensions (Vasylivna’s is about £130 a month), and require support from social services, charities and international institutions. They have become the group most likely to be alone, whether through mobility issues, bereavement or a reluctance to leave familiar surroundings. The lucky few get help; many do not. Ukraine’s health and social care system was already under pressure before Russia invaded in February. Despite progress through reforms, including decentralisation that allowed regional institutions to allocate budgets locally, an overstretched and underfunded health system is again in crisis. Ukraine’s expenditure on healthcare has declined from 7.8% of GDP in 2015 to 7.1% in 2019 (the last available data). The world average was 9.8% in 2019. Now the country is experiencing a humanitarian crisis, with dozens of accounts of rape and murder of Ukrainian elderly women – the biggest group left behind, of those allowed to leave, and least able to escape. In Kyiv’s Holosiyevo district, there are 786 elderly people – 80% of them women like Vasylivna – alone, unable to leave their homes, and without relatives to care for them. Since Russia attacked, the number of social workers in the local centre has collapsed by more than 75%. Those women who remain are mostly elderly themselves, and now have four times as many clients to look after. They work five days a week, earning about £170 a month to supplement their small state pensions. “We need to support both our elderly clients and ourselves,” says 65-year-old social worker Nataliya Bodnar. Social centre manager, Oksana Ruban, says they have faced multiple challenges. “Public transport was closed, the curfew lasted sometimes up to several days, shops closed, too. We had to make sure all of our clients were taken care of by someone – if not relatives or us, at least by neighbours or volunteers. We all worked relentlessly.” The situation for older people is particularly acute in the Donetsk and Luhansk regions where a survey of more than 1,500 over-60s conducted in March revealed the scale of the problem: 99% do not want to leave their homes; 91% need help to get food; 91% are also experiencing extreme cold, with no heating due to electricity cuts; 75% need basic hygiene items; and 34% need urgent medication for chronic illness. These needs are exacerbated by a shortage of vital medicines and Russia destroying healthcare facilities. “I wonder why some young people evacuate their cats and hamsters, but leave their parents behind,” says Roman Vodyanyk, head doctor at Severodonetsk hospital in Luhansk, the only functioning hospital left in the city. With no water, gas or electricity in Severodonetsk, Vodyanyk has turned the hospital, which has more than 50 patients, into a humanitarian hub, providing hot food, wifi and medical support. About 220 patients have left in the past month, but many elderly people have no desire to evacuate, with nowhere to go and no one to care for them. “How do you evacuate a hospital in this situation? How do you leave them all behind?” asks Vodyanyk. So despite the shelling and along with local authorities, NGOs and volunteers, he is not leaving either. Elderly people are often the forgotten category in any humanitarian crisis – an analysis of Google news search keywords between 24 February and 22 April found that 97% of all Ukraine-headlined articles that mentioned either children or the elderly were focused on children. Only 3% mentioned elderly people, of which only three touched on elderly women. Despite there being more than 50% more retirees in Ukraine than children under 15, the 390 UK NGOs operating in Ukraine are nearly twice as likely to be helping children than elderly people, According to Justin Derbyshire, CEO of HelpAge International, the problem is global: elderly patients’ specific needs are neglected by governments and international bodies during and after wars. “This is systemic ageism and an example of how bad the global system is at responding to older people’s needs.” Elderly people, such as Vasylivna and Bodnar, are at the centre of the crisis in Ukraine, as victims and rescuers. After a lifetime of looking after others, they are now vulnerable, not only to loneliness and hunger, but also to rape and murder. “I’ve seen everything – the Holodomor [great famine of 1932-33], the second world war, so many horrors. What else could scare me?” says Vasylivna. She never imagined Russia would invade. It is her inability to take care of herself that scares her now. She feels trapped. “I would evacuate if I could take care of myself. I was working my whole life. It’s such a shame I can’t do anything any more.”