Since the beginning of the Russian invasion, the already fragile Ukrainian health system has been attacked, severely stressed and people’s health threatened. The consequences will continue long after the war is over.
“Six months after the Russian invasion of the country, on February 24, Ukraine’s health system is struggling to continue providing services to a population increasingly traumatized by the ongoing war. According to the United Nations as of August 15, 5,514 civilians were killed and 7,698 confirmed injuries, but the United Nations itself confirms that the real figure may be much higher. Writes Historian Ed Holt Lancet In the Global Report column on August 27.
However, the general scenario of the impact of the war far exceeds the number of people killed or injured by the conflict: in fact, we must take into account the seven million internally displaced people (about a third of the population were forced to leave their homes), about 6 million refugees were welcomed in Europe (In Italy about 150,000), but also 13 million people, on the contrary, remained stuck in the affected areas. “Infrastructure damage is estimated at about $110 billion, including health facilities that were deliberately targeted by invading forces: the World Health Organization has recorded 445 attacks on health facilities since August 11, attacks that have killed 86 people and injured 105,” Holt continues. The young English historian, author of numerous reports on the situation in Ukraine since the Russian invasion, describes how the fighting destroyed health supplies: towns and cities were left without hospitals or primary care facilities, doctors were few and overburdened, there due to a shortage of medicines, many pharmacies were closed Permanent and emergency services struggle to reach patients via bombed roads and bridges.
Holt collected the comment of Oleksiy Korze, Head of the Department of General and Family Medicine at the Kharkiv Medical Academy: “The dismissal of medical staff, including specialists, and the attacks on health facilities had a significant impact on the health care system. Moreover, the disruption of supply chains meant That necessary medicines and medical devices may not be available in the right place at the right time. Even in places that are considered relatively safe, services do not always run smoothly, and medical staff have been forced to adapt to new ways of working. Such as, for example, to keep working Even under bombardment.
Health care workers are increasingly exhausted by the enormous efforts they have to put in to keep essential services running.
Old and new diseases: the risk of outbreaks
Having repeatedly reported on the strain on Ukraine’s health system, the World Health Organization recently highlighted the threat linked to infectious disease outbreaks, warning of the need to strengthen surveillance.
Even before the war, Ukraine was struggling against the fact that epidemics, outbreaks and the health profile were among the worst in the world (as we already mentioned in an article published a little over a month after the conflict began: War is Bad for Your Health). In fact, the country bears the second largest burden of HIV/AIDS in Europe and the fifth largest number of confirmed cases of drug-resistant TB. Moreover, according to the World Health Organization, the spread of poliovirus type 2 began as early as September 2021, hepatitis B and C virus infections have been identified as major public health problems and the country has recorded measles outbreaks for the past decade.
And this is not enough, Holt continues in his letter: “Coverage rates for all vaccine-preventable diseases are low and the vaccination rate against COVID-19, about 36% for the first dose, is among the lowest in Europe. Moreover, vaccination coverage is less than 50 % is specifically in areas, such as eastern Ukraine, where the population has grown the most as a result of displacement.” The World Health Organization fears that with the approach of autumn and winter, ongoing fighting could hamper efforts to prevent potential disease outbreaks (for example, The polio vaccination campaign that was launched at the beginning of February, had to be stopped due to the war and that was just that. It can be restarted now.) The mixing associated with the conditions in which the displaced are forced to live is another risk factor: «During the air strikes on you To find shelter in shelters, where healthy and sick people can come into contact. In any case, it is normal for groups of displaced people to live together in one room.”
The doctors’ determination saved many lives
However, in many cases, health workers have been able to keep public health services running. It was feared, for example, that mass displacement would exacerbate the vulnerabilities of the most vulnerable, such as drug addicts, people with HIV, tuberculosis and hepatitis: well, doctors and health workers often continued, despite great difficulties, to provide services necessary. Assistance, including monitoring.
Healthcare professionals who spoke to Holt repeatedly emphasized that “the dedicated efforts of colleagues intent on keeping services running were critical to ensuring the health system continued to function. Among the operators themselves, many suffered from the war but continued to work to save lives.”
International relief agencies and humanitarian organizations also play a critical role in keeping health services running, providing assistance to ensure medicines and equipment are available, rehabilitating facilities, and training medical personnel. But although government officials, authorities and health personnel have been able to keep the system running, the situation in areas no longer under Ukrainian control looks much more dire. Some reports speak of an almost complete interruption of health care in some cities and territories occupied by Russia and raise the alarm about the lack of drinking water and inadequate sanitation conditions, which, together with high summer temperatures, create the potential for outbreaks of dangerous diseases. Diseases such as cholera.
It is difficult to confirm these ultimatums because the Ukrainian authorities can no longer access these territories and because the occupation authorities strictly control communications within them. Thus, the little information available comes through the exchanges conducted by individual operators with colleagues.
Holt was able to take a certificate from a nurse in a primary care center in the self-proclaimed Donetsk People’s Republic. Yulia Petrenko (name fictitious), 60, described how limited health care is in the city and region: “There are serious problems with access to services. Doctors are gone, diagnostic centers have closed so that patients cannot undergo examinations and diagnoses. First aid is provided in hospitals. , but specialist advice is difficult to get, as many medical professionals have left. The supply of medicines is in jeopardy because as hostilities intensify no one wants to risk delivering them.”
The end of war will not be the end of suffering
Ukrainian government officials have repeatedly condemned the Russian authorities in the occupied territories for treating local residents, and in early August, Health Minister Viktor Lyashko confirmed that Russia had denied local residents access to medicine.
An important aspect of the Holt report is related to the demand for mental health services. It is estimated, in fact, that up to 15 million Ukrainians will need psychosocial support as a result of the war and that 3-4 million people will need pharmacological support.
Oksana Vikievska, a psychologist with MSF in Kyiv, told Holt: “Since the war began, people have faced a variety of traumatic experiences: from bombing to abandonment of their homes and lives. Others have lost loved ones, others are constantly worried about their families in danger » Mental health practitioners encounter people with symptoms of chronic stress: anxiety, panic attacks, insomnia, fear of loud noises, loss of appetite, nocturnal enuresis and nightmares in children.To try to remedy this situation, at least in part, the Ukrainian government, along with the World Health Organization, announced, About creating a new national mental health program, open to anyone who needs it.
According to Vykhivska, mental health services are “flexible” as central authorities collaborate with NGOs to meet the growing needs for psychological support. But the psychologist is sure that these services will also be necessary in the future, when people come to terms with the traumatic experiences they have had. “Even if the war ends, we will see its effects for a long time to come,” he said.
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