Ukrainians in Poland after the change of rules found themselves between the law, illness and lack of insurance
After the end of the special law on assistance to Ukrainian refugees in Poland, some war migrants found themselves in a situation where legal stay was preserved, but access to healthcare became much more difficult. For most working-age Ukrainians, the new model may look understandable a person works, pays contributions to the social insurance system and has access to medical services. But for elderly people, seriously ill people, people with disabilities and parents who care for children with disabilities, this logic has created a trap.
It concerns those who physically cannot work, do not have the ability to pay for treatment on their own and at the same time do not always fall into the categories that have retained the right to free assistance. In such cases, the law formally works, but the person is left without real access to a doctor, medicine or surgery. The stories told by public organizations show exactly what this gap looks like. Seventy-four-year-old Nadiia has cancer after the removal of her thyroid gland, but an oncologist refuses to see her because she does not have medical insurance. She cannot pay for a private visit on her own, and she also cannot obtain the status of a person with a disability. Larysa needs medicine every day, but she has been left without insurance and without a clear way to obtain it. Iryna cares for three children, two of whom have disabilities, while the third child is undergoing the procedure to obtain this status. Because of the changes, she is losing financial assistance and cannot remain in a collective accommodation center, because formally she does not belong to the defined vulnerable categories. This is where the main weakness of the new system appears. It is built around employment as the main condition for access to insurance. For people who can work, this is understandable. For those who cannot, such a model becomes a barrier.
“The law is built on one logic: if you work, you have access to public healthcare and social payments for children. If not, then no. The problem is that there are people who physically cannot work.”
On March 5, the special law on assistance to Ukrainian refugees stopped operating in Poland. The main mechanisms of temporary protection were transferred to other laws, in particular to legislation on granting protection to foreigners. Formally, Ukrainians with temporary protection status have access to medical services on conditions similar to those that apply to Polish citizens. But the key condition is having medical insurance and paying contributions to ZUS. Without insurance, a person can count on free assistance only in certain cases: when there is an urgent threat to life and health, during pregnancy and the postpartum period, for children under 18, and in the prevention and treatment of infectious diseases. Separate exceptions are provided for those wounded as a result of hostilities, victims of torture or violence, as well as those living in collective accommodation centers. On paper, this system has exceptions. In practice, another problem arises: medical institutions do not always interpret the rules in the same way. Because of the lack of clear instructions, people may receive refusals even when their condition requires urgent intervention.
“We receive reports from people who formally have the right to assistance but are refused. There are no unified instructions for medical institutions each hospital decides in its own way.”
One of the most acute examples is a woman who went to an emergency department after several days in Poland. Because she had no medical insurance, she was refused for several hours. In one of the hospitals, she was asked for 1,000 zlotys just to register the call. Eventually, doctors found that she had a ruptured ovary, the woman was operated on, and she survived. But the time lost on refusals created a direct threat to her health. This shows that the problem is not limited to administrative formalities. When a hospital does not understand or interprets a person’s right to assistance differently, the risk moves from the legal field into the medical one. For a cancer patient, a person on dialysis or a patient with a scheduled surgery, even several weeks of uncertainty can have severe consequences. Public organizations emphasize that Ukrainians in Poland were not only recipients of assistance. According to data cited by the Polish Migration Forum, in 2024, 69% of Ukrainian refugees worked in Poland. They provided 2.7% of the country’s GDP. Last year, Ukrainians paid more than 4.1 billion zlotys in taxes to the Polish budget, while the cost of treating all Ukrainians amounted to 2.57 billion zlotys.
“That is, the healthcare system earned more from Ukrainians than it spent. Now the law that made such integration possible has been rolled back. And those who cannot work elderly people, the sick, those caring for children with disabilities have been left without support. Not because they abused the system. But because the system no longer provides a place for them.”
This argument is important because it changes the focus of the conversation. It is not about people who did not want to integrate or did not take part in the Polish economy. Most Ukrainians work, pay taxes and support the Polish budget. But after the change in rules, those who cannot prove their “usefulness” through work were left outside the system, because they are ill, elderly or caring for children. Oksana Pestrykova from the Support Center of the Ukrainian House in Warsaw explains that appeals about losing access to healthcare began appearing even before the full launch of the new rules. Medical institutions informed patients that treatment could be stopped or would not begin if the person lost the right to insurance. This especially affected patients who need dialysis, cancer surgeries or long-term treatment.
“For example, in some situations a person can register at the labor office. And then they have access to insurance while they are in unemployed status. But most pensioners, most people with disabilities cannot register there, because it is obvious that they will not find work.”
That is, even a seemingly available mechanism often does not suit exactly those who need it most. A pensioner or a person with a disability cannot always register as unemployed, because such registration assumes readiness to work. And if a person cannot work, they again fall out of the system. The issue of emergency assistance remains separately difficult. Formally, it is guaranteed. But the line between a critical and non-critical situation is not always obvious. The final decision often remains with the doctor or the specific medical institution. That is why one person may receive assistance, while another may be refused. The fundraiser organized by the Polish Migration Forum together with partners quickly showed that society is ready to support vulnerable Ukrainians. The initial goal was 100,000 zlotys, but as of June 3, more than 1.8 million had been collected. This is a strong signal of solidarity, but it does not solve the systemic problem.
Charity can pay for a separate surgery, several doctor visits or urgent medicine. But it cannot replace a state system of medical protection for people who need constant treatment. Public organizations say directly this money is needed for the most acute cases, but it must not become a substitute for a political decision. The Polish Migration Forum, together with other organizations, has already appealed to ministries, ombudsmen, Prime Minister Donald Tusk and relevant agencies. The letters concerned specific people who are threatened with losing treatment or housing. However, there is currently no confirmation that legislative changes that could fully close this gap have already been prepared. One possible mechanism is insurance for Ukrainians with temporary protection through transferring a Ukrainian pension to Poland. But it also has serious problems. A person must apply to the Polish social insurance institution with a request to receive a Ukrainian pension into a Polish account in euros. Then the application must be reviewed by the Pension Fund of Ukraine. This entire process can take a long time. During the processing period, pension payments are suspended, and the person still has no access to medical services. For an elderly or sick person, this may be too difficult a period. Ukraine’s ambassador to Poland, Vasyl Bodnar, acknowledges that the scope of medical services has indeed narrowed, although he emphasizes that it is not about millions of people, but about hundreds of difficult cases.
“Since 2022, medical services were provided in a wide range from basic medical assistance needed, for example, when calling an ambulance, to treatment of oncological diseases, sanatorium care and many other services that are paid even in Ukraine. Of course, now there has been a certain narrowing of services. But we are talking about hundreds of situations when people stopped having hospital stays or treatment for certain diseases paid for. These are not thousands, not millions.”
This assessment is important because it places the problem within precise boundaries. Poland has not closed the door to all Ukrainians. Almost one million citizens of Ukraine still have temporary protection status. But even several hundred cases can be critical when it comes to oncology, dialysis, serious illnesses or people who do not have family support.
Bodnar also notes that the embassy is communicating with Polish agencies, and the main priority is uninterrupted access to necessary services and social guarantees for the most vulnerable citizens of Ukraine. But while internal discussions on the implementation of the legislation continue, it is vulnerable people who find themselves in the transition zone: the old rules no longer apply, and the new ones do not give them sufficient protection. An additional risk is updating data in the PESEL register. By August 31, 2026, Ukrainians with temporary protection status must update their data if the PESEL UKR number was obtained using a document that is no longer valid, without a foreign passport, on the basis of a birth certificate, or if after obtaining PESEL the person changed a document or personal data. This also applies to children. Formally, this is an ordinary administrative procedure. But for elderly, sick people or those who do not navigate Polish bureaucracy well, it can become another barrier. A mismatch between the data in the register and valid documents may lead to the loss of confirmation of UKR status, and therefore affect the rights connected with temporary protection.
Poland has moved from an emergency model of support for Ukrainians to a more standard system for foreigners, but has not created a sufficiently strong safeguard for those who cannot work. For the state, this may look like a technical change of rules. For a cancer patient, a pensioner without insurance or a mother of children with disabilities, it can mean the loss of treatment, housing or basic security. The problem is not that most Ukrainians have not integrated. On the contrary, a significant share works, pays taxes and supports the Polish economy. The problem is that after the change in rules, the system hit not the majority, but the weakest the hardest. They are the ones who do not have the resources to get around bureaucracy, pay for private treatment or quickly find a new source of insurance. That is why the solution cannot be reduced only to fundraisers. A clear state mechanism is needed for those Ukrainians with temporary protection who cannot work because of age, illness, disability or caring for children with disabilities. Without such a mechanism, even a small number of cases will remain very painful. Because behind each of them is not statistics, but a person who needs a doctor not someday, but now.
About the Author
Related posts:
What Rules Will Remain for Ukrainians in the EU and What This Means for Vulnerable Groups 
Temporary Protection for Ukrainians in Poland: What Changes and What to Expect 
Poland Changes the Rules: What Awaits Ukrainian Refugees in Autumn 2025 
Veto Instead of Support: How the President of Poland Is Changing the Rules for Ukrainian Refugees
