Meet Natasha, 21. On 27 February 2022, she walked for 12 hours in freezing temperatures to seek safety, with her three-year-old in tow. She was seven months pregnant.

It was just three days into the full-scale Russian invasion, and her home city of Kharkiv was a major target.

Natasha fled, first by over-crowded train, then by taxi, before heading to the Moldovan border on foot. “Nobody cared that I was pregnant and tugging my daughter along. I can’t be angry at those who didn’t stop for us though. Most of the cars were full.”

She made it to a refugee camp in Moldova, then to a hospital in need of emergency prenatal care, where UNFPA supported her.

© UNFPA Moldova/Eduard Bîzgu

A year of relentless bombardment across Ukraine has caused appalling human suffering.

Nearly a third of the population – roughly 14 million people – have been forced to flee their homes since Russia launched its full-scale invasion of Ukraine on 24 February 2022.

© A still from the documentary Lust for Life, about women who have given birth during the war.

As men who are eligible for military service are required to remain in Ukraine, the refugee crisis is overwhelmingly a migration of women and children.

Here, on 12 March 2022, women who have said goodbye to husbands, partners, sons and other loved ones cross the border with young children – wrapped in aluminum blankets for the journey – to seek safety across the border in Moldova.

UNFPA provides safe spaces for the protection of women and children, and access to essential services.

© UNFPA/Siegfried Modola

Refugee camps were set up overnight, including this one at the Manej Athletics Sports Centre in Chisinau, Moldova, which housed 650 people while longer-term solutions were sought.

UNFPA was on site to provide information, supplies and services.

© UNFPA Moldova/Eduard Bîzgu

Pregnancies and births do not stop during war. Family-planning needs do not stop during war. In fact, these services become even more vitally important so that women can give birth safely and make decisions about their reproductive health amid the crisis.

Dariya (right), from Odesa, received antenatal care in Moldova.

© UNFPA Moldova/Adriana Bîzgu

Dr. Tetyana Postolovska works in Vinnytsia from one of UNFPA’s mobile reproductive clinics.

There are currently 20 mobile clinics across Ukraine – stocked with medicines, equipment, contraceptives and tests for HIV, hepatitis and sexually transmitted diseases. They were set up in April 2022 to meet the needs of internally displaced people.

“The number of miscarriages have increased by 10 to 15 percent compared to the pre-war period,” says Dr. Postolovska, an obstetrician-gynecologist. "We need to be as accessible to people as possible…and every family [should have the] chance to give birth to a healthy child at the expected time.”

© UNFPA Ukraine/K. Hryshko

Over the past year, UNFPA has delivered reproductive health supplies and equipment to hospitals and mobile teams sufficient to cover the immediate reproductive health needs of 7.2 million people.

Here, in April 2022, a humanitarian cargo delivery of UNFPA emergency reproductive health kits arrives at a maternity hospital in Dnipro.

© UNFPA Ukraine/Mark Kachuro

Valentina, 29, during labour at Chisinau’s Municipal Clinical Hospital No. 1 in Moldova on 1 March 2022.

A few days earlier, a heavily pregnant Valentina, who is a veterinary surgeon, urgently drove herself and her mother from the Ukrainian city of Odesa in search of safety. They found shelter with a local family across the border.

“I regret that my husband is not close with me,” she says, noting that this is her first child. “We planned this moment for a long time and dreamed it would be different.”

© UNFPA Moldova/Eduard Bîzgu

In 2021, there were just over 270,000 births in Ukraine. In 2022, this fell to 195,000, due to the war and with many women leaving the country. All women, no matter where they are, must have access to safe births.

Nataliia’s son Artem was born three months prematurely. Mother and child required care at Kyiv’s Perinatal Centre, which has received emergency medical supplies from UNFPA.

“He was so very tiny, [just] 1.6 kilograms — I am afraid to hold him and hold his hand because he is fragile and very small,” says Nataliia.

© UNFPA/Serhii Tymofieiev

Dr. Olena Samoilenko is head of the neonatal department at Mother and Child Medical Centre in Kyiv.

Despite attacks on more than 760 health facilities — including maternity hospitals — during the past year in Ukraine, she has stayed on to provide the specialist care that pregnant women and new mothers and babies need.

Almost a third of the 195,000 women who gave birth in Ukraine in 2022 delivered at maternity facilities supported by UNFPA.

© UNFPA/Serhii Tymofieiev

From safe births to safe spaces, UNFPA works around the clock to sustain life-saving services for women and girls.

At a Safe Space for women who have experienced violence in Lviv, Ukraine, a basement has been converted into a bedroom, supporting women who need a refuge from violent partners and those who have experienced physical and sexual violence carried out by soldiers.

For these women and their children, they need qualified, sensitive support to deal with a crisis within a crisis.

© UNFPA Ukraine/Oleksandr Sorokin

For Kateryna, the war brought her back into contact with her ex-husband.

“When the war started, people started to get closer. My ex-husband began to visit our child,” she says. “Violence returned to our lives.”

The city of Kherson was under Russian military control at the time. “I was afraid to leave the city,” she says. “We had strengthened the basement, plastered it. We were preparing to spend the winter in the city. The crisis that forced me to evacuate was domestic violence.”

Kateryna and her three children are receiving protection and support in a UNFPA-supported Safe Space.

© UNFPA Ukraine/Volodymyr Ovsychenko and Anastasia Saprykina

“Puss in Boots” and a story about “Fluffy and Stripey” are among the books on hand for children at the Safe Space in Lviv.

UNFPA has established more than 48 centres for survivors of violence and women at risk across Ukraine, including shelters, crisis rooms, a national hotline and more than 100 mobile support teams.

© UNFPA Ukraine/Oleksandr Sorokin

While UNFPA provided safe spaces and refuge for thousands, we were aware that many other people remained trapped in occupied areas – including in Mariupol, where civilians and soldiers took shelter in underground bunkers at the Azovstal steel plant for 80 days.

In May 2022, survivors evacuated the steel plant. Here, families leave the plant and head to Zaporizhzhia.

UNFPA was there to greet and support the evacuees, providing four psychosocial support mobile teams and 750 essential packs to help women and girls with basic needs.

© UNFPA Ukraine/Olha Opilat

Initiatives supported by UNFPA are helping people deal with the invisible scars of war.

“Art helps us all to cope with our pain, the injustice of losing friends and normal life,” says 18-year-old Sabina (seated, second from right), who is from Melitpol, a city which remains under Russian occupation.

Sabina is a youth volunteer at a youth centre in Gratiesti, Moldova, supported by UNFPA.

“I am not the only one who lost friends or family in the war,” she says. “Many of the young refugees here are struggling with stress and depression.”

© UNFPA/Siegfried Modola

Psychologist Victoria Semko has returned to Irpin, and is helping to re-establish community connections.

"When I first came back to Irpin, it was scary. There were shot cars and burnt tanks on the streets. The city was emptied. Absolutely everything was different. The city seemed like a ghost,” she recalls.

“I took matters into my own hands and started a psychological support group. Later, I was invited to work in the UNFPA socio-psychological assistance mobile teams." says Victoria. 

She describes supporting people through immense psychological pain, including a woman who was unaware the city had been returned to Ukrainian control, as she had remained in hiding, traumatized by the atrocities she had seen.

“It is extremely pleasing when I see positive changes in the people I work with," says Victoria.

© UNFPA Ukraine/Roman Buchko

A big wedding, a house by the sea and a family business. These were Anastasiia’s plans before the war.

In March 2022, Anastasiia left Berdyansk, as she could not access the prenatal medical care she required in the occupied city.

She gave birth to twin boys in June 2022. “We had to endure so much,” she says. “My sons have withstood everything. We must stay strong for their sake. Because children are our future, they replace those who, unfortunately, passed away.”

With the conflict ongoing, UNFPA continues to invest in vital services to protect women and girls from violence, and to ensure they can make their own reproductive decisions, access safe births and fulfill their potential.

© UNFPA Ukraine/Eugen Hoptynskyi

KYIV, Ukraine/CHIȘINĂU, Republic of Moldova – On 5 November, the capitals of Ukraine and the Republic of Moldova were connected by direct rail for the first time in 24 years. The new train line aims to offer refugees fleeing the war a safe route out of Ukraine and into the neighbouring Republic of Moldova – especially with a harsh winter looming and heating cuts already widespread.

Since the onset of war in Ukraine, more than 700,000 people have left the country for the Republic of Moldova, which is now also facing its own energy crisis. Some 100,000 refugees remain in the country, two thirds of them women, who face particular challenges when fleeing conflict.

“For them, displacement will bring increased vulnerability to violence, sexual abuse and exploitation,” said UNFPA Executive Director Dr. Natalia Kanem on International Women’s Day 2022.

But for many, the risk of staying behind in Ukraine and facing the threat of Russian attacks and a bitterly cold winter without heat or power outweighs any risks associated with making for Moldova – especially with the new train route providing passengers a secure pathway across borders.

The Kyiv-Chișinău train offers them hope that better, safer days are ahead. Follow along for one of its cross-border journeys between Ukraine and the Republic of Moldova, which transports passengers from the threat of peril towards the opportunity of peace.

[Pictured above]  A conductor checks tickets before letting passengers board the train. © UNFPA/Mihail Kalarashan

The train from Kyiv to Chișinău leaves at 5 p.m. On the platform, in the dim lamp light, passengers say goodbye and embrace those staying behind. Many leaving Kyiv will not be back soon, having made the difficult decision to leave the country before the onset of a bitter winter.
 

Larisa is a conductor and one of the veterans of Ukrainian Railway. © UNFPA/Mihail Kalarashan

The conductors check tickets, and soon after, the train starts moving. Those remaining on the platform, visible through duct-taped windows, wave the train goodbye. The windows are sealed in case Russian missiles explode nearby. 

One of the conductors, Larisa, recalls working non-stop to help evacuate people as soon as full-scale war broke out. 

“We spent weeks taking hundreds of people out of Kramatorsk and Kharkiv. Most of them simply slept in aisles between compartments, and left their luggage at the stations,” she said. “Women and children were a priority for us; they were the first to board a car that had at least some free space. We tried to support and care for them.” 

Larisa’s last train trip to Kramatorsk was on 8 April. On that day, the Russian army fired a rocket at the railway station; the attack killed many civilians who were waiting to be evacuated.
 

Tatiana is the mother of a soldier who lost an eye in the war. They are now on their way to the Republic of Moldova to fly to Türkiye, where her son will have an operation. 
© UNFPA/Mihail Kalarashan

The train stops to allow new passengers to board. Tatiana enters Larisa’s train car with her 23-year-old son. The young man was wounded while serving on the front lines; he sits alone in one of the train’s compartments, his head wrapped in bandages.

“He already lost one eye, but there is a chance to save the second one,” Tatiana said. “We decided that we needed to get treatment in another country.”

Mother and son are travelling together through the Republic of Moldova to Türkiye, where he will seek another operation. 

“The doctor said that God has big plans for my son – almost no one survives with his injuries. For me, the greatest happiness was to learn that he survived,” Tatiana said. In the intensive care unit where her son recovered, many others did not.
 

Violeta tries to calm the children on the train. In a couple of hours they will arrive in Chișinău, where a new stage of their lives will begin. © UNFPA/Mihail Kalarashan

The train has seven carriages, each a separate world. In one, children laugh, play and watch cartoons while their mothers chat and prepare for the train’s arrival in Chișinău. 

Marina and Violeta are friends. Each of them has two children: Older daughters and younger sons. This is their second time leaving Ukraine for Europe, as they have decided to spend the winter in Chișinău. 

Marina’s family lost electricity after a rocket attack on Kyiv, and her son caught a cold when the house grew chilly. She hopes Chișinău will not only be safer, but warmer.

“We knew that the winter would be hard. But after the latest attacks on infrastructure, everything changed,” Marina said. “We have small children, and we cannot risk their health and lives.” 

Violeta agrees the decision to leave was difficult. “We still do not know what to expect, how to deal with the children’s education, how to settle down. But the main thing now is that we are safe.”
 

 Yulia, a young mother from Kyiv, is also moving to Chișinău with her young son, Vlad. Vlad was born a week after the war began: He is a child of war. © UNFPA/Mihail Kalarashan

In an adjacent compartment, a young mother named Yulia holds her baby boy, Vlad, who was born just a week after the start of the war. 

“The military was assigned to our maternity hospital to protect us if the Russian army entered Kyiv,” she said. “It was scary in those days; we heard explosions.” 

Yulia worries that her son’s short time on earth has been dominated by conflict. He is a little afraid of men, as since his birth, he’s spent most of his time with women. “He is a child of war, and we don’t know when it will all end,” she said. 
 

Pavlina, a UNFPA safe space manager at the Chișinău station. © UNFPA/Mihail Kalarashan

After 18 hours of travel, the train arrives at the Chișinău railway station – its final destination. And it is warm. 

Pavlina, the manager of UNFPA Moldova’s safe space at the station, greets arriving passengers. Safe spaces are facilities set up by UNFPA to address the humanitarian and psychosocial needs of refugees and others. Inside, newly arrived Ukrainians are offered compassionate care: First aid, dignity kits, essential information, cups of tea. 

Safe spaces also provide reproductive health and crisis prevention services. For the hundreds of thousands of women fleeing Ukraine, the risk of gender-based violence remains high, as does the risk that their reproductive health needs will go unmet – with potentially life-threatening consequences.
 

A safe space centre in the Chișinău railway station building. © UNFPA/Mihail Kalarashan

Pavlina recalls a particular woman who passed through the Chișinău safe space on her way from Kyiv to her parents in Tbilisi, Georgia. “We began to talk, and she burst into tears. She said that her husband stayed in Kyiv, and she was pregnant,” Pavlina said. 

The UNFPA team provided the young woman with some essentials and offered psychosocial support. She later wrote to Pavlina from Tbilisi, asking where UNFPA was located in the city. 

“The next day, she said she was bleeding,” she said. “The girl lost her child.” 
 

Chișinău railway station. © UNFPA/Mihail Kalarashan

The train makes a reverse trip from Chișinău for Kyiv every day at 5:45 p.m. It used to run every two days, but the schedule changed for the holidays.

Although returning to Ukraine carries certain risks, many choose to make the trip back across the border to celebrate Christmas and the arrival of the new year in their home country among family and friends. The pull is strong. “East or West, home is best,” one passenger, 29-year-old Yulia, said.

With heavy bags in hand, people at the Chișinău railway station on their way to Kyiv head towards a blue train with yellow stripes – the colours of the Ukrainian flag. In 18 hours, the train will arrive at the Kyiv railway station, decorated with a Christmas tree whose lights are powered by pedalling a bicycle. Hugs and smiles await those reuniting with loved ones. 

For the train of hope’s passengers, the rail link is a lifeline, providing both a route to safety and a way back home.
 

Kyiv landscape near the railway station. © UNFPA/Mihail Kalarashan

UNFPA’s humanitarian response to the war stretches across Ukraine, the Republic of Moldova and several other countries hosting refugees. The agency is working with its partners to deliver essential services for women and young people, including by expanding safe spaces and online services to support survivors of gender-based violence and by providing reproductive health services and psychosocial support in hard-to-reach areas. As of December 2022, a total of 118 tons of life-saving reproductive health, medical and hygiene supplies had been distributed to health facilities in areas affected by the war.

In Moldova specifically, UNFPA is responding to the protection and health needs of refugees, including women and girls, through interventions such as Orange Safe Spaces, where refugees and host communities can get support related to gender-based violence and sexual and reproductive health. UNFPA also helps upgrade perinatal centers to ensure safe births, and works with the Government to ensure refugee women and girls have free access to sexual and reproductive health services and psychosocial support.