Ongoing humanitarian crisis in Ukraine

Abstract

More than a month after Russia's invasion of Ukraine on Feb 24, 2022, the situation in many areas of the country is now desperate, and at the time of writing, peace talks have not led to substantial progress. For the people of Ukraine, the invasion has caused enormous trauma and upheaval, with an estimated 4·0 million fleeing to neighbouring countries and a further 6·5 million displaced within Ukraine. Russia's military action tragically unites Ukrainians with many others around the world who live in war-torn areas, such as Syria and Afghanistan. For Europeans, the invasion marked an unwelcome return of conflict within the continent and talk of nuclear war that has not happened since the years of the Cold War in the 20th century. A situation that has shocked many has been Russia's attacks on health-care infrastructure in cities at the epicentre of the conflict, including Kyiv and the now devastated Mariupol, a tactic also used in other conflicts around the world, including Syria, where 600 attacks on health-care facilities have happened and 930 health-care personnel have been killed up to June, 2021, during 10 years of war. In a joint statement on March 13, 2022, UNICEF, UNFPA, and WHO said “to attack the most vulnerable—babies, children, pregnant women, and those already suffering from illness and disease, and health workers risking their own lives to save lives—is an act of unconscionable cruelty.” The disruption of care for patients with cancer caused by attacks on the health-care system and the wider country will affect many with haematological malignancies, with these patients particularly reliant on the administration of time-sensitive and often complex treatments. Reports suggest that the Western Ukrainian Specialized Children's Medical Center in Lviv is working beyond capacity to treat patients who have fled from east to west Ukraine; hundreds of children with cancer who have reached the hospital are at risk of not receiving treatments due to medicine shortages and because donor bone marrow is no longer able to reach this centre. Many health-care workers in Ukraine remain dedicated to helping patients, at great risk to themselves, by continuing with treatments when patients cannot be moved, even when sirens warn of air strikes. The global reaction to President Putin's actions has generally been one of condemnation, but this has not translated into action beyond economic and individual sanctions against Russia because of the fear of igniting a new world war. However, these sanctions will have an impact on Russia's health system and ultimately patients too, which will manifest as severe shortages, particularly of modern therapies supplied by high-income countries. There has been an outpouring of offers of help for Ukraine from around the world in the form of military, financial, medical, and humanitarian aid from governments and citizens. Support of Ukraine's neighbouring countries is essential, with Poland, Moldova, and Hungary expected to be the main recipients of displaced Ukrainians and provide most of the immediate help. WHO has set up a support hub in Poland to ensure that paediatric patients with cancer can resume their treatments, and to help patients with bleeding disorders, The World Federation of Hemophilia is collaborating with haemophilia treatment centres in Poland to provide medical supplies to support displaced patients. Countries in western Europe have relocated dozens of patients and their families to help provide treatment; however, more must be done by countries with advanced health-care systems. A relatively simple action that can be taken is to issue visas to Ukrainians allowing them to live, work, and access schooling and health care in the country that they have fled to; the EU has taken this action, allowing visas of up to 1 year for fleeing Ukrainians with the possibility for extension. In the haematology community, action has come from societies and organisations; the European Society for Blood and Marrow Transplantation changed their annual meeting to a virtual event so that the Prague Congress Centre could be used to host Ukrainian refugees in the Czech Republic, and in a joint statement with sister transplantation organisations, has called for help to allow patients to flee safely and for medical supplies to help those who have stayed in Ukraine. While the world hopes for a peaceful resolution of this aggression against Ukraine, it has been heartening to see the response of the medical community to the humanitarian crisis and the desire to help those in need. However, as we know from other conflicts, further actions are needed now from governments and international organisations to minimise the suffering of everyone affected by this unacceptable invasion.