How the on-going conflict in Ukraine is impacting cardiovascular health.

Abstract

Following the outbreak of war in Ukraine on 24 February 2022, we are witnessing a conflict that has led to many civilian, military, and volunteer civil defence force casualties. Those civilians living in a theatre of war are directly exposed to combat-attributable trauma and risks from explosive ordnance. The United Nations Office for the High Commissioner for Human Rights (UNHCR) reported that by 4th September, there had been 13 917 confirmed casualties in the non-combatant civilian population with 5718 deaths1; these figures are likely to be significant underestimates. It is believed that ∼18 million people have been directly impacted by the hostilities with more than 8 million internally displaced. Given the widespread destruction of housing and civil infrastructure, including the disconnection of basic utilities, initial activity to aid those affected has focused on ensuring safe shelter with humanitarian support in the form of clean water, nutrition, sanitation, and clothing. Medical services have been badly disrupted. Monitored by the World Health Organization Surveillance System for Attacks on Health Care, as of 6th September, there had been 512 attacks against healthcare facilities, personnel, patients, transportation, and supply depots, with 100 people killed and 129 injured.2 Some of the remaining clinical resources, particularly those in central Ukraine, have been repurposed as trauma centres to receive casualties from the battlefront if staff are available. These professionals inevitably face ethical treatment dilemmas concerning the allocation of increasingly scarce medicines and equipment, a possible source of moral distress. This war is being pursued against the backdrop of the continuing COVID-19 pandemic, with interruption of public health initiatives to immunize a population already vulnerable due to poor vaccine uptake. Barriers arising from the conflict have hampered the treatment of those infected with coronavirus or other communicable diseases such as HIV and tuberculosis—co-infection with the latter two pathogens is relatively common in Ukraine. The conditions endured by people sheltering from the fighting or seeking refuge through humanitarian corridors, if accessible, seem likely to increase the risk of contagion.