Ukraine's humanitarian disaster: priorities for health

Abstract

As the Russian invasion of Ukraine enters its third week, the results of President Vladimir Putin's cruel and destructive onslaught are becoming clearer. At least 352 civilians have been killed and 1684 wounded so far, although Ukraine's State Emergency Service puts the number of civilian deaths at more than 2000. Official sources report that 17 children have been killed and 30 injured. Roughly 2 million people have fled to neighbouring countries. Russian officials have reported that nearly 500 of their troops have been killed; Ukrainian armed forces puts the number at more than 11 000. The global community has spoken of solidarity with Ukraine, but the humanitarian emergency and widespread harms to health and wellbeing demand a concerted international plan. The first priority is to halt the conflict. But diplomatic talks between Russia and Ukraine have so far proven fruitless. Putin's reported hopes of a rapid victory look increasingly unlikely. If Kyiv and other key cities fall, the result could be a protracted insurrection against an occupying force with bloody house-by-house urban battles. The situation has historical precedent: the conquest of Grozny, which began in December, 1994, lasted for 3 months, and was not complete until tens of thousands of civilians had died and the Chechen capital had been laid to waste. More than 200 health facilities have found themselves along conflict lines or in areas of changed control. Indis-criminate shelling of hospitals and health-care facilities by Russian troops has been reported. The Pavlusenko Maternity Hospital, in Zhytomyr, 90 miles west of Kyiv, was the first health-care facility in Ukraine to be hit, followed by a hospital in Vuhledar, in Donestsk. More than 670 patients have been trapped and are running out of water and medicines at a psychiatric hospital in Borodyanka. Such actions fly in the face of conventions and norms supposed to guarantee the safety and protection of health workers; however, they should not cause surprise—Putin's forces previously bombed hospitals in Syria. Reliable ceasefires and safe passages are needed to urgently relocate civilians caught up in the war, the Geneva conventions need to be respected, health care safe-guarded, and medical neutrality observed. When attacks violating human rights do occur, they need to be documented and the responsible parties brought to account. Although aid agencies are sending essential medicines and emergency supplies, Ukraine's health facilities, trying to provide care for trauma patients, have seen regular care seriously disrupted and are now running short of basic provisions. As a World Report in this issue shows, child health care is being severely harmed. WHO has warned about crisis-related trauma and injuries, non-communicable diseases and patients who need urgent medical care, and infectious diseases. Mental health and psychosocial support services are urgently needed for conflict-affected citizens. The effects of Russia's invasion are beginning to be felt far beyond Ukraine's borders. Energy and food prices, already rising, are set to reach unprecedented heights. Along with Ukraine, Russia is the world's largest supplier of wheat, with both countries providing nearly a quarter of total global exports. The World Food Programme was warned that the war will worsen the global hunger crisis. The International Monetary Fund says that the conflict will have “a severe impact on the global economy”. The effects will be felt most keenly by those with low income and will require a huge response. Poland, Moldova, and Hungary are providing most of the immediate help and support to the growing number of refugees; the EU commissioner for crisis management said neighbouring countries should expect over 7 million refugees. Aid agencies, non-governmental organisations, local authorities, and even individual citizens have been providing basics such as food and water. However, the burden of support for the refugees should not fall on a few countries alone. Mistakes made in the lack of provision of care for refugees fleeing Syria cannot be repeated with Ukraine. Specialist help needs to be made available for the most vulnerable: the acutely ill, older, and pregnant people, as well as women, neonates, and children. Passport controls should be waived and money for necessities should be provided. Ongoing travel to other countries should be free and unrestricted. Full refugee status should be granted to all Ukrainians, giving them the right to work and the right to access local services. All European countries—including the UK, Norway, and Switzerland—need to act. Children's health caught up in Ukraine conflictAs well as killing and injuring children directly, Russia's invasion is preventing children from getting the care they need. Saleyha Ahsan reports. Full-Text PDF