Health consequence in Ukraine war- an editorial

Abstract

War is not desirable to anyone, but sometimes it is essential to gain indepence. In majority cases it is illegal exercise of power for invasion.

About eight months is over of war between Ukraine and Russia. According to the UN human rights office, 136 civilians have died in the war on Ukraine so far. But it acknowledges that the figure is probably much higher. Other reports have recorded 3167 civilian Ukrainian casualties (including 1232 killed and 1935 injured),¹

These deaths may have occurred directly – collateral damage to the fighting – but war affects people’s health beyond bullets and bombs.

As we are seeing in Ukraine and its neighbouring countries, war generates mass population movements, both within the country (so-called internally displaced persons) and externally (refugees). In less than a week, the Russian invasion of Ukraine has created nearly half a million refugees. Heartbreaking scenes of families separated, not knowing when or if they will next see each other again, have become commonplace. An estimated 4 million refugees have been forced to flee Ukraine,² and 6.5 million people have been internally displaced within the country, ² including an estimated 4.3 million children (nearly half of the child population of Ukraine).³

“In 100 days of war, there have been over 260 verified attacks on health care in Ukraine. Some health facilities have been destroyed, while others have been overwhelmed by people seeking care for trauma and injuries resulting directly from the war.

Ukraine’s health system is under severe pressure. No health professional should have to deliver health care on a knife edge, but this is just what nurses, doctors, ambulance drivers, the medical teams in Ukraine are doing,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

Wars are complex health emergencies. They lead to the breakdown of society,

cause considerable damage and destruction to infrastructure, create insecurity and have a significant economic impact.

Russia's invasion has inflicted extreme physical and psychological trauma inside Ukraine.

The health system suffers too due to the damage to health infrastructure such as hospitals and clinics. It triggers the flight of health staff, leaving understaffed health systems to cope with growing patient loads caused by the conflict. This is on top of the interruptions to supply chains.

The risk of infectious diseases spreading is also heightened if the supply of clean water and functioning sanitation systems are compromised. And the disruption of immunisation programmes, leading to lower vaccine coverage, increases the risks of outbreaks of vaccine-preventable diseases such as measles and polio. The Syrian conflict, for example, substantially reduced polio vaccine coverage, which led to an outbreak of polio in 2017.

Disruptions to surveillance and treatment programs risk an eruption of infectious disease outbreaks. Interruptions to chronic care and routine health services threaten to increase mortality and decrease life expectancy.

Low vaccination rates among Ukrainians put them at increased risk of outbreaks of vaccine-preventable disease, particularly for refugees in crowded conditions or with limited access to clean water, where unsanitary conditions may allow pathogens to spread more easily.

This is further compounded by the ongoing surge in COVID, with around 1,700 patients currently in hospitals across the country.

wars do not just cause physical harm, they can also have considerable mental health consequences, ranging from depression and anxiety disorders to post-traumatic stress disorder. The short- and long-term mental health effects of the conflict are also likely to be severe for the general population and healthcare workers in particular.

The war has caused a massive increase in psychological harm and distress. Throughout the country, health care professionals report that the most common request now is help to deal with sleeplessness, anxiety, grief and psychological pain.

Women, children, the elderly and people with disabilities, in particular, are often most in need of help.

The stocks are rapidly consumed, particularly items needed for treating war injuries, such as antibiotics, blood products and dressings.

The World Health Organization has also warned that medical oxygen supplies in Ukraine are dangerously low.

Mobile populations may have difficulty finding a consistent supply of drugs, as is critical to the proper management of chronic infections such as HIV and MDR-TB or for cancer care, particularly as many neighboring countries have insufficient supply of these expensive medicines. 

Ultimately, as Galea⁴ stated, “fundamentally war is about health. The near-term and long-term consequences of war can be catastrophic for health.” War is a medical emergency.

Physicians and other health professionals, who are dedicated to healing and preserving life, are once again on the forefront of emergency aid and humanitarian relief efforts during war.⁵

 They are keeping vital services and hope alive in the face of unbelievable sorrow and suffering, and we salute them,”  

Another major need is training to deal with the effects of war – trauma surgery, mass casualties, burns and chemical exposure.

WHO is committed to being in Ukraine both now and in the longer term – addressing immediate health challenges and supporting reconstruction of the health system. The World Health Organization (WHO) has increased its presence, both in Ukraine and in those countries hosting displaced Ukrainians, to help meet the escalating health needs.

National and local authorities and civil society organizations have led the health response to the refugee crisis across EU member states.

Sanctions have been imposed on Russia, but they don’t have a great track record of success.

Economic sanctions may create social disruption and material deprivation, as well as reduce the availability of drugs, vaccines and spare parts for health equipment.

Prolonged economic sanctions on Russia will hurt ordinary citizens but probably leave the ruling elite relatively unscathed.

The mortality and morbidity and public health consequences resulting from the war in Ukraine are difficult to comprehend and impossible to tolerate—and will have long-lasting effects that will require the aid and attention of physicians and health care professionals throughout the world.

The one medicine that Ukraine needs most is peace that health authority the WHO can’t deliver.