Healthcare in Wartime: How Women’s Labor Is Changing

Beyond weapons and the defense industry, war also depends on the constant reproduction of human resources. For years, the Defense Ministry has struggled with a shortage of soldiers on the front lines. Meanwhile, labor shortages in the defense industry, transportation, energy, and other sectors essential to sustaining the war economy are forcing the Kremlin to exploit migrant labor in new regions.

In this context, healthcare becomes part of the wartime infrastructure essential to sustaining both the military and the economy. At first glance, this should give the state a clear incentive to strengthen the healthcare system by improving working conditions for healthcare workers and increasing resources across the sector. Yet the logic of militarization demands the constant reallocation of material and human resources in favor of the armed forces and the defense industry, thereby exacerbating the longstanding problems of Russian healthcare. Rather than strengthening the healthcare system, the state seeks to extract the maximum possible output from it at minimal cost. Underfunding, staff shortages, mounting workloads, and deteriorating working conditions are no longer merely collateral effects of the war. By the fifth year of the full-scale invasion, they have become a means of governing and managing the healthcare system itself.

These processes are particularly pronounced for women, as healthcare remains one of the most feminized sectors in Russia. According to official data, women account for 70% of all medical doctors and 95% of the nursing staff nationwide. The state continues to rely heavily on their labor while expecting them to absorb the consequences of budget cuts, staff shortages, and growing demand for medical care. Women in healthcare are among those bearing the direct social and economic costs of the militarization of society.

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How the War Has Exacerbated the Longstanding Socioeconomic Problems of Russian Healthcare

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Since 2010, Russian healthcare has been shaped by a policy of ‘optimization.’ The term is a euphemism used by the authorities to describe the closure and consolidation of medical facilities, particularly in small towns and rural areas, as well as reductions in the healthcare workforce. This policy has had a direct impact on access to medical care across the country. Since 2010, Russia’s hospital bed capacity has declined by an average of 20,000 beds a year, with a further 5.4% reduction between 2020 and 2024. Such measures are routinely justified by claims of low hospital occupancy, despite widespread discontent among both doctors and patients.

The war has also led to a decline in hospital supplies. Polina, a maxillofacial surgeon interviewed by Posle Media (her name has been changed for security reasons), said that shortages of medications at her hospital became particularly acute between 2022 and 2024. As she recalls, staff were told bluntly: “You know where the medications are going.” Another Posle Media source, Mariya, a surgeon whose name has also been changed for security reasons, said that the deterioration in supplies became apparent soon after the Russian invasion of Ukraine. The lack of high-quality medical consumables, many of which had previously been imported from Western countries, quickly became apparent at her workplace. “The substitutes at our disposal are noticeably worse in quality; this applies even to such simple items as venous catheters,” she said.

Over the years of war and against the backdrop of the authorities’ campaign to boost the birth rate, the policy of optimization has taken a particularly heavy toll on maternity hospitals and obstetric departments across the country, especially in small towns and rural areas. Closures are typically justified by a low number of annual deliveries or by local authorities’ lack of funds for repairs, equipment, and staff salaries. As a result, pregnant women in regions such as Kemerovo, Sverdlovsk, Tula, Novosibirsk, and Kurgan, as well as the Moscow region, are being redirected to the nearest maternity hospitals. In some cases, this means traveling hundreds of kilometers, sometimes even thousands, to access basic maternity care.

Following the elimination of ‘excess’ hospital beds, staff positions are also being cut. Labor unions, in particular, point to especially painful cuts at ambulance stations. Even positions that remain are being reduced, even though their pay levels in the regions might already seem shockingly low to residents of Moscow and other major cities. For example, a group of ambulance workers in Sverdlovsk Region reported monthly salaries ranging from 12,000 to 28,000 rubles.

Following the elimination of ‘surplus’ hospital beds, staff positions are being eliminated as well. Trade unions, in particular, point to especially painful cuts at ambulance stations. Even positions that remain are being reduced, although salaries in the regions can already seem shockingly low to residents of Moscow and other major cities. For example, a group of ambulance workers in Sverdlovsk Region reported monthly salaries ranging from 12,000 to 28,000 rubles. Meanwhile, the medical staff at Glazov Interdistrict Hospital in the Udmurt Republic collectively receive just 12,000 rubles for attending a birth. This amount is divided among the doctors, midwives, nurses, and orderlies. Notably, the hospital administration receives the largest portion. According to the medical professionals, “Under the childbirth certificate system, a doctor receives 270 rubles for a natural delivery; for a surgical delivery, the surgeon gets 320 rubles, and the assistant receives 150 rubles.” Low wages also help perpetuate a troubling practice in which women giving birth sometimes make unofficial payments to midwives and doctors in advance, ostensibly as a matter of personal choice. However, these payments rather function to reduce the risk of mistreatment during childbirth and secure access to adequate medical care while women are in an extremely vulnerable situation.

An expert with the labor mutual-aid project Antijob, who spoke to Posle and wished to remain anonymous, said the situation is also critical for pediatricians. According to the expert, they “receive poverty-level wages: for example, 35,000 rubles for two full-time positions — while seeing four to six times as many patients as they are supposed to.” Our source said that since 2024, pediatricians have increasingly reported deteriorating working conditions: “Their workload has increased dramatically, without any corresponding pay raise. They are forced to extend consultation hours to squeeze in more patients, around 40 per shift. Bathroom and even lunch breaks have become virtually impossible, while the time allotted for each medical appointment has been reduced to just 10 minutes. Medical administrators justify these ‘schedule adjustments’ as necessary to ‘improve access to medical care.’”

The already difficult working conditions marked by meager wages became even more challenging with the outbreak of the war, particularly in terms of interactions with patients. All Posle’s sources described a broader pattern of their work being routinely devalued. Polina, the maxillofacial surgeon, explained that with the outbreak of the war, the patient population at her hospital changed, as a ward was opened there for patients with injuries sustained on the front lines. “Let me mention specific circumstances surrounding these patients. Given their supposedly heroic past and difficult lives, they are allowed to drink alcohol regularly while undergoing treatment in the hospital; moreover, this is encouraged by the administration.”

The risks women face when working under these conditions are rarely considered. One Posle interviewee said she feels increasingly unsafe treating patients who are under the influence of alcohol or struggling with other forms of addiction. “I’m not a military doctor; I’m a civilian doctor and a woman. I never agreed to these kinds of working conditions, and I honestly never thought I would have to deal with anything like this in my professional life. Maybe it’s naive to expect this, but I should be able to feel safe at work — and I see the hospital administration doing less and less to ensure that.”

These concerns are echoed in the Health Ministry’s guidelines on communication between doctors, nursing staff, and veterans of the war in Ukraine. The guidelines, for example, advise medical workers to bear in mind that waiting for an appointment or having a request denied may trigger an aggressive reaction from a patient. This leaves medical workers in a situation where post-traumatic stress disorder (PTSD) among those returning from the war is not treated as a common consequence of military service. In other words, the problem is not being addressed at the systemic level. Instead, doctors and nurses are effectively tasked with dealing with it on the ground. 

Speaking to Posle, an expert from Na Ravnykh, an initiative that provides support in labor disputes, summed up the situation: “On the one hand, the sector’s longstanding problems persist: staff shortages, low base salaries, unpaid overtime, dependence on opaque performance-based bonuses, and a steady expansion of job descriptions without a corresponding increase in staffing. On the other hand, the war and mobilization have introduced additional pressures: increased workloads at individual institutions, expanded military-registration duties, an outflow of specialists, and even greater opacity in management decisions.”

Because healthcare remains a predominantly female workforce, the expert noted, medical workers also face a distinct gender dimension to their professional burden. She noted that unpaid work at home, including caring for children and other family members, still falls disproportionately on women. “As a result, irregular schedules, night shifts, last-minute substitutions, and being called in to work affect them particularly severely.” The expert pointed out that the Russian Federation's Labor Code formally provides protections for pregnant women, parents of young children, and workers with family responsibilities. “In practice, however, exercising these rights can invite pressure from management, reduced performance-based bonuses, or a deterioration in workplace relations with superiors.”

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Recruiting the Next Generation

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Low wages, combined with difficult working conditions, have long made healthcare an unattractive career choice for young professionals. According to Health Ministry estimates, in 2026, one-third of graduates from medical universities and colleges will not pursue careers in healthcare, a figure amounting to tens of thousands of specialists. Moreover, more than half of medical students say they do not plan to work in state-run clinics. According to the Izvestiya newspaper, Russia's healthcare system is expected to have a shortage of approximately 23,000 doctors and over 63,000 paramedical professionals by 2026. 

The authorities are acutely aware of the healthcare staffing crisis. In November 2025, the State Duma passed a law introducing mandatory service requirements for medical school graduates. This new measure, which critics have compared to serfdom, sparked a wave of criticism within the medical community. As Andrey Konovalov, co-chair of the Deystviye trade union, put it, the state has “effectively admitted that it was unable to solve the staffing crisis through other means, namely, by genuinely improving working conditions and making medical professions more attractive.”

In a comment to Posle, human rights lawyer Yevgeniy Stupin described the measure as the most significant change affecting medical workers since the beginning of the war. An Antijob expert, meanwhile, emphasized that graduates will no longer have a say in where they will complete their mandatory service: “Young medical professionals will be sent to the most troubled healthcare facilities, where staffing shortages are at their worst. And those shortages exist precisely because of low wages and poor working conditions.” Critics also warn that new problems will arise from the introduction of this practice, including inadequate compensation for supervising physicians, further staffing shortages, and increased responsibility for those overseeing newly qualified doctors.

Beyond the mandatory-service law, the state is pursuing other ways of so-called “supporting” young medical professionals. Starting in 2026, medical universities have begun recruiting medical doctors and residents to serve in the war in Ukraine. Those who sign contracts are promised monthly salaries of 200,000–300,000 rubles, one-time payments worth millions of rubles, federal benefits, preferential mortgages, and even the cancellation of loan debts. Medvestnik media found more than a dozen advertisements published within a single week on a Russian job-listing platform recruiting people with and without medical training for contract military service in the combat zone. According to the publication, recruiters were based in the cities of Moscow, St. Petersburg, Kovrov, Yekaterinburg, Ufa, Samara, Rostov-on-Don, and Ivanovo.

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We Will Definitely Win. Because We Are Victors”: Women in Healthcare and Propaganda

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The participation of medical workers in the war has become part of the official narrative of supposed national unity in the face of an external threat. Propaganda portrays “thousands of Russian women” serving in the “special military operation zone” as having chosen “a path where steely determination and feminine fragility are two sides of the same coin.” The dichotomy of fulfilling a role on the front lines that is vital to the state, combined with the supposedly traditionally feminine character traits of female medical workers, is a constant source of fascination for Russian propaganda. For example, Russian media quote Warrant Officer Angelina Manova, who has received four awards during the war: “My boys out there on the front line are heroes. And I must bring them back. Sometimes I need to support, comfort, or reassure them — that’s where a woman’s strength at the front lies.” Women medical workers are thus instrumentalized to construct the myth that support for the war in Ukraine is across-the-board — even among those portrayed as society’s most caring, gentle, and compassionate members.

The first woman to receive the Hero of Russia title since the beginning of the war was Corporal Lyudmila Bolilaya. Russian media described her as a “‘delicately built female nurse’ serving with a motorized rifle unit who saved the life of a wounded soldier by shielding him with her own body and taking the full force of the blast.” Russian media reports also emphasize that, after recovering from her injuries, Bolilaya returned home to raise her son, Vanya, in peacetime. Although she is unlikely to forget what she experienced at the front lines:

“Today, when she walks past memorials to the Great Patriotic War, tears well up in her eyes. She says she feels as though she has joined the ranks of those who defended the Motherland before her. ‘I did what I had to do. We are bound to win. We won’t let them get any further… Because we are victors.”

Aydysmaa Mongush, a female military medic, is another figure whose story has become firmly embedded in the pantheon of Russian military propaganda. A film about her is already in production. She is from Tuva, the region with the lowest standard of living in Russia, where nearly 20% of the population lives below the poverty line. According to Russian media reports, in 2023 Mongush went to the combat zone to join her husband, who was serving with another unit. In September 2024, he was killed in a shelling attack, and Mongush evacuated his body on her own. When presenting her with a state award, President Vladimir Putin urged Mongush not to return to the front, saying that she needed to “raise the children,” a reference to her three children, who had lost their father.

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The Most Protest-Prone Sector in Russia?

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The idea that healthcare workers represent one of the pillars of social support for the Kremlin’s policies in general and for the invasion of Ukraine in particular is wishful thinking.

Healthcare remains one of the most protest-prone sectors of Russian society. Speaking to Posle, an expert from Na Ravnykh clarified the picture, citing monitoring data from the Center for Monitoring and Analysis of Social and Labor Conflicts at St. Petersburg University of the Humanities and Social Sciences. According to the Center’s data, 2024 marked a peak: 105 social and labor conflicts were recorded in the healthcare sector, accounting for 62% of all conflicts documented that year. As of 2026, healthcare remains one of Russia’s three most conflict-prone sectors, despite its share of all recorded labor disputes falling to 22%. It now ranks alongside manufacturing (23%) and construction (19%). The expert attributes the decline to a shift in the “overall pattern of labor tensions: conflicts have become more pronounced in manufacturing, construction, transportation, and extractive industries. This shift can be linked to the growing imbalances of the war economy, including the reallocation of budgetary resources, labor shortages, accelerated production, dependence on government contracts, and uneven increases in wages and workloads across sectors.” The expert has also stated that, against this backdrop, the problems in healthcare have not disappeared but have simply ceased to stand out so sharply in the overall statistics.

However, strikes are rarely used as a form of resistance in this sector. Given the legal and organizational difficulties involved in organizing one, as well as healthcare workers’ professional responsibility toward their patients, collective action more often takes the form of petitions, complaints, open letters, refusals to take on additional workloads, and mass resignations. For example, in January 2026, staff members of the intensive care and resuscitation unit at Kursk City Hospital No. 6 recorded a video appeal to the region’s health minister, Svetlana Yermolova, calling for an investigation into their meager wages, the hospital’s deteriorating conditions, and what they described as unlawful demands from management. The video showed black body bags containing deceased patients. According to the workers, the bodies could remain in the corridors for hours, emitting a foul odor and distressing patients, as the hospital had no morgue. The appeal received a lot of public attention. Five days after the regional governor publicly criticized the situation, the hospital designated a facility to store bodies.

The Antijob expert identified several factors behind the high level of protest activity in Russian healthcare. The first is strong professional solidarity, rooted in the very nature of the work itself: “the strong interdependence between colleagues and the specific profession-related problems that only fellow medical workers can truly understand.” The Posle source emphasized that healthcare frequently involves high-stress and critical situations that workers experience together, fostering a strong sense of community.

Russian healthcare, in this sense, is no exception. Research from around the world over the past several decades has shown that hospitals are fundamentally cooperative institutions. Through informal coordination and the interdependence in their work, healthcare workers develop strong social ties that can later provide the social infrastructure for protest and collective action, including strikes.

Another distinctive feature of healthcare, according to the Antijob representative, is the limited ability of medical workers to improve their working conditions by simply changing employers. “In other professions, the differences between employers can be enormous. In healthcare, however, the public sector dominates, and similar problems exist across institutions. This is especially true for smaller settlements, where private healthcare may not exist at all. Although medical workers, like other employees, may feel that ‘there’s no point in fighting,’ they are nevertheless more likely to engage in collective action because they have so few viable alternatives.”

The potential for protest also depends on the presence of an organizing force, particularly trade unions. Recent media reports of successful protests by medical workers have often involved the Deystviye trade union, which was founded in 2013 in response to the “optimization” of the healthcare system and the problems it created. For example, nurses in the surgical department of Borzya Central District Hospital in Zabaykalskiy Kray successfully pressured hospital management to improve their working conditions. With legal support from the Deystviye trade union, the nurses negotiated with management and secured monthly bonuses for the intensity of their work. They also secured a revision of staffing levels that resulted in the creation of additional staff positions. 

Extensive media coverage of egregious decisions made by healthcare facility administrators demonstrates that public pressure can sometimes influence the outcome of labor disputes, as the Antijob representative told Posle Media. At the same time, they described the gains made by the protests of healthcare workers as modest. They said, “Essentially, these are all rear-guard actions.” Then again, workers in other sectors don’t have many major victories to boast about either. As the news shows, the Deystviye trade union wins court cases often and, in a sense, restores some measure of justice, but it’s a drop in the ocean.” The expert stressed that systemic problems require systemic solutions, not at the level of individual healthcare institutions but rather at the level of state policy. As long as the government continues to pursue its policy of optimization, he argued, meaningful change will remain out of reach. “Russia is still a very long way from that.”

As in other areas of Russian society, emigration has become another form of dissent available to at least some members of the medical community. The scale of politically motivated emigration among healthcare workers since the start of the war is difficult to assess. Migration comes with significant and conventional challenges, such as validating professional credentials, learning a new language, and rebuilding social networks. Yet for some medical workers, simply avoiding military conscription has been sufficient motivation to leave the country.

However, emigrant medical professionals also report improvements in more conventional aspects of working life. Mariya, a surgeon who left Russia in late 2022, first for Armenia and later for Germany, told Posle Media that “medical doctors leave not only for higher salaries, as is commonly assumed, but also for better working conditions, as hospitals are better equipped, patients receive better care because there are more nurses, and medical professionals are treated with greater respect. You’re no longer being hassled over trivial matters, and professional liability insurance is available. You can make a living from a single full-time job without having to take on additional workload.”

Mariya added that “many simply want to live in a freer, more democratic society, and the demand for doctors that exists in almost every country makes emigration easier.”

However, emigrant medical professionals also report improvements in more conventional aspects of working life. Mariya, a surgeon who left Russia in late 2022, first for Armenia and later for Germany, told Posle that “doctors leave not only for higher salaries, as is commonly assumed, but also for better working conditions: hospitals are better equipped, patients receive better care because there are more nurses, and medical professionals are treated with greater respect. You’re not constantly being hassled over trivial matters, and professional liability insurance is available. You can make a living from a single full-time job without having to take on additional work.” Mariya added that “many simply want to live in a free, more democratic society, and the demand for doctors that exists in almost every country makes emigration easier.”

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A Resource for Sustaining the War Machine

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The war has not fundamentally changed the model of exploitation faced by healthcare workers in Russia. The sector continues to grapple with longstanding problems: chronic staff and funding shortages, low wages, excessive workloads, and the elimination of staff positions. The change lies in how the labor, professionalism, and resilience of healthcare workers are currently being weaponized to sustain the state’s war effort. The authorities demand ever more from medical workers while simultaneously narrowing the space for their professional autonomy.

Women in healthcare are among those who bear the burden of compensating for the consequences of the Kremlin’s policies through their labor, time, and physical and emotional resources. Meanwhile, state propaganda recasts this exploitation as heroism, portraying women’s caregiving as a natural and voluntary contribution to the war effort.

However, the image of medical workers as submissive and loyal to the regime is rather unrealistic. The same conditions that make healthcare vulnerable to exploitation also lay the groundwork for collective resistance. Workers’ interdependence, shared professional experience, and limited ability to leave the sector transform workplace solidarity into a source of collective power. Although petitions, collective actions, and trade union efforts may have only a limited impact in Russia's authoritarian system, they highlight an important distinction: fulfilling one's professional duties does not imply consenting to exploitation, degrading conditions, or danger. Furthermore, the militarization of healthcare does not automatically imply support for the war.

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