I’m glad I saw this, was about to post a request for better Voiceover access myself.
A few more details.
As far as I can see, most of the user interface is invisible to voiceover. No status bar, no keyboard bar, etc. what we see when we open the app is the title of the note and the note, nothing else.
The other big problem is it’s impossible to toggle any settings. You can do things like edit file names and paths etc, and you can add community plugins, although the problem there is that you can’t toggle safe mode off to see them initially, and of course you can’t enable core plugins because you can’t toggle them, 
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For any voiceover users, if you can, hook up an external keyboard. This makes most things possible. The way I’ve handled the settings issues are to edit the settings files directly. I’ve found a couple of github repositories with settings files, and just made sure Obsidian wasn’t running and cut and pasted settings into the right file. Again, this is tricky because the Obsidian settings folder is hidden. You’ll need something like Working Copy or Textastic to see it.
Oh, and I haven’t actually had any trouble pulling down to get to the command pallet, which is lucky, .
The right and left side panels, backlinks, tags etc work fine too. Again, I think there are buttons that Voiceover can’t see, but that hasn’t been too much of a problem yet.
Even with all the hassles, I’ve imported my markdown notes folder and I’m having quite a lot of fun playing with it.
