Ukraine has more radiotherapy machines than before the invasion — and no cobalt supply

A national survey of Ukraine's radiotherapy departments, published on 26 August, arrives at a conclusion that is easy to state and hard to hold in the head at once: four years into a full-scale war, the country is treating more cancer patients with radiation than it did before the invasion, using more and better machines — and the single largest technical dependency in its old equipment base has been severed with no replacement route [s1].

What the survey counted

The study combined two data sources: a 38-item survey conducted by the Help Ukraine Group across all Ukrainian radiotherapy departments in August 2025, covering patient volumes, waiting times, equipment status, cobalt-60 source replacement, staffing, training needs and operational challenges; and International Atomic Energy Agency DIRAC datasets collected by the Grigoriev Institute from 2021 to 2025 [s1].

The 2021 baseline: in December of that year, before the full-scale invasion, Ukraine operated 41 radiotherapy departments with 82 megavoltage machines — 38 linear accelerators and 44 cobalt-60 units — alongside 53 orthovoltage units and 36 brachytherapy afterloaders [s1].

What happened next is recorded in the survey in unusually specific terms. During the first three months of the war, four centres were occupied, most departments experienced service disruptions averaging 26 days, and patient volume fell by 27.5% [s1]. Volumes returned to baseline in 2023, then rose 8.9% in 2024 and 9.3% in 2025 relative to 2021 [s1].

By December 2025, Ukraine operated 42 radiotherapy departments with 96 megavoltage machines — 68 linear accelerators and 28 cobalt-60 units — with 38 orthovoltage units and 34 afterloaders [s1]. Compared with 2021, that is 30 more linear accelerators and 16 fewer cobalt units.

The cobalt problem

Cobalt-60 teletherapy units do not wear out so much as fade: the radioactive source decays, treatment times lengthen, and the source must eventually be replaced. Ukraine's sources were historically procured from Russia [s1]. In the survey, 56% of departments still relied on cobalt-60, and 94.1% reported that future source replacement would be unfeasible [s1]. Consequently, 78.6% of cobalt users planned a transition to linear accelerators [s1].

That is the mechanism behind the headline shift from cobalt to linacs. It is not, on this evidence, purely a modernisation choice. It is also what a supply chain looks like after it has been cut.

Where the constraint has moved

The survey's other finding is that the binding constraint is no longer machines. Workforce deficits were reported at 41.4% for medical physicists, 33.6% for radiation therapists and 21.1% for radiation oncologists [s1]. Average waiting times rose from 6.4 days in 2021 to 10.3 days in 2025 [s1]. The authors' conclusion is that workforce development and targeted training are now urgently needed to convert equipment investment into sustainable clinical capacity [s1].

A linear accelerator is a more demanding machine to run than a cobalt unit. It needs treatment planning, dosimetry, quality assurance and machine physics support that a cobalt-60 unit, with its simpler beam and fixed output, does not. Replacing 16 cobalt units with 30 additional linacs while carrying a 41.4% medical-physicist deficit [s1] is a workload transfer as much as an upgrade — which is consistent with waiting times rising even as capacity grew.

How this fits what was already known

A review of Ukraine's wartime oncology system published in BMJ Oncology in February described the same arc from the system level: a well-functioning pre-war oncology service supported by universal health coverage; profound disruption across diagnostics, treatment, research and palliative care after February 2022; hospitals in combat zones pivoting to trauma care while facilities in safer regions reorganised; and core cancer care in government-controlled territories largely recovering to near pre-war levels by late summer 2022 [s2]. That review also recorded that drug and radiotherapy capacity rebounded after early shortages, aided by modernisation efforts and by partnerships with WHO, the European Union and oncology societies covering drug supply, telemedicine, workforce training and patient evacuation [s2].

The review is explicit that the recovery "remains fragile and uneven," with some patients still facing barriers related to displacement, insecurity and disrupted pathways [s2]. The August survey supplies the numbers underneath that caveat for one modality.

What the study cannot say

This is a cross-sectional survey of departments, not a study of patients. It reports treatment volumes, machine counts, staffing deficits and waiting times; it does not report cancer stage at presentation, treatment completion, local control or survival. Rising volumes are consistent with recovering access and also with a backlog of later-stage disease being treated; the design cannot distinguish these. The survey covers departments that could be surveyed, which excludes occupied territory. And a self-reported staffing deficit is a department's assessment of the gap against its own establishment, not an externally benchmarked figure.

What to watch

Two things are measurable from here. The first is whether the cobalt-to-linac transition completes: 28 cobalt units remained in December 2025, and 94.1% of departments using them said replacement sources are out of reach [s1]. The second is whether waiting times move back down, which on the survey's own analysis depends on physicists and therapists rather than on machines [s1].

Sources

• Impact of Russian invasion on radiation therapy capacity in Ukraine: a national survey study, BMJ Global Health, 26 August 2026
• Cancer care in wartime Ukraine: disruption, resilience and recovery, BMJ Oncology, 23 February 2026