The Russia-Ukraine War, insidious and all-encompassing, stealthily transformed from a mission to conquest to a war of attrition while flitting in and out of the public conscience – and Ukraine’s health and medical infrastructure has felt the heaviest of blows.
Although the war officially began in February 2014, the war intensified on February 24, 2022, when Russian President Vladimir Putin announced plans to target Ukrainian military assets and cities through a full-scale air, sea, and land invasion [1].
Ukraine had already been struggling prior to the war, and this is evidenced across various measures. The landlocked country is ranked antepenultimate of the 42 European Union countries, and 74th in the world on the Human Development Index, a composite measure of a country’s achievement in knowledge, health and standard living. Like many countries formerly in the Soviet Union, the healthcare infrastructure was outdated. This is especially deleterious, as Ukraine has high incidences of mental illness. The thirty percent of the population who suffer from psychological problems like alcohol use disorder, suicidal ideation, and depression, are the second highest contributers to the disability burden of the nation [2].
Despite international human rights law clearly stating that wartime attacks must not affect civilian spaces, such as hospitals, Russian forces have focused heavily on the Ukrainian healthcare system. According to the Surveillance System for Attacks on Health Care, there have been 634 confirmed attacks on healthcare facilities in Ukraine since 2014, and 631 of those have taken place after Putin’s decree this past February. These attacks affected all tenets of medical care such as general hospitals, primary care clinics, emergency departments, and mental health facilities [3]. Of the hundreds of assaults that have been waged against related facilities within this year, 522 were perpetrated using heavy weaponry.
The advancement of the war has prompted the creation of more unified, consolidated hospitals, which have replaced the very separated public and private health care systems. Additionally, it delineated two types of hospitals: those in war zones, which commonly provides intensive care for grave injuries, and those outside of active conflict, which provide the full gamut of medical care mainly for internal refugees [4].
Within these hospitals, rates of communicable diseases, including diarrheal and respiratory, have increased because they are “more easily transmitted,” due to the “crowded living conditions, decreased access to safe water and food, compromised sanitation and hygiene, inadequate medical care, and lapses in immunization campaigns” [5]. Additionally, the chaos has disrupted access to long-term care. People in need of life-saving therapies, like cancer treatments or diabetic interventions, are forced to forgo treatment. Lastly, diminished access to maternal and infant care has led to higher incidences of low birth-weight and premature infants, pregnancy complications, and maternal deaths. Consequently, much of the civilian mortality and morbidity are due to issues stemming from “forced displacement and damage to food and water supply systems, health care and public health facilities, and other civilian infrastructure” [5].
Alongside physical health challenges, the war undoubtedly aggravates the psychological struggles of the population. Various studies have already proven increased levels of depression, as well as post-traumatic stress and anxiety disorders. Health care professionals constantly receive requests from civilians to aid them with psychological pain, grief, sleeplessness and anxiety. However, many are still entrenched in the wartime mindset, which makes them unaware of their psychological needs.
Much of the world, just like Ukraine, has been tasked with deciphering how to handle the atrocities and difficulties of this war. Neighboring countries like Poland, Romania and Moldova have been inundated with refugees, leading to the EU passing the Temporary Protection Directive, granting people a renewable year-long permit to live in EU nations and access health assistance, as well as other essential services [6]. Furthermore, WHO launched an appeal for $147.8 million USD to aid Ukraine’s exacerbating humanitarian need: deciding that 80 million of it would go to in-house support, and the remainder would be allocated to refugee hosting and receiving countries [7].
Even with such aid, the Ukrainian government and populace has much to grapple with. With supply chains being decimated as part of Russia’s war offensive, the situation becomes more precarious by the day. Hospitals are running low on consumables, devices, and medicine, and continuous operation becomes increasingly difficult. Roughly 6.7 million people have been internally displaced, and this internal movement leads to economic instability. As local currency depreciates, the cost of goods like drugs surges. Seeing that “as much as 70 percent of money people were forced to spend on healthcare [is] for drugs, not services” because the government mostly pays for the most expensive drugs, an issue in the near future may be an inability to purchase medications. Furthermore, mental health practitioners must be trained now to deal with the psychological traumas every citizen has endured, and the country needs help in training them to be deployed “as soon as 2023-2024” [8].
The influx of civilians and veterans alike in need of care ranging from psychological therapy to process the travesties they have witnessed, to intensive hospital treatments to address complex and emerging illnesses brought on by the devastation. In order to help those impacted by the war, efforts to fortify Ukraine’s medical infrastructure must begin now in order to quicken their post-war reconstruction.
References
Council on Foreign Relations. (2022, October 20). Conflict in Ukraine. Global Conflict Tracker. https://www.cfr.org/global-conflict-tracker/conflict/conflict-ukraine l
Kuntz, L. (2022, March 2). Before the Toils of War: Mental Health in Ukraine. Psychiatric Times. https://www.psychiatrictimes.com/view/before-the-toils-of-war-mental-health-in-ukraine
Ukrainian Health Center. (2022). Massive. Brutal. Deliberate.: Attacks on Hospitals in the Russia-Ukraine War during the First Phase of the Invasion (February 24-April 7, 2022). In Ukrainian Health Center.
Reichardt, A., & Chernenko, O. (2022, July 6). Ukraine’s health care system was not prepared for this war. New Eastern Europe. https://neweasterneurope.eu/2022/07/06/ukraines-health-care-system-was-not-prepared-for-this-war/
Levy, B. S., & Leaning, J. (2022). Russia’s War in Ukraine — The Devastation of Health and Human Rights. New England Journal of Medicine, 387(2), 102–105. https://doi.org/10.1056/nejmp2207415
Marchese, V., Formenti, B., Cocco, N., Russo, G., Testa, J., Castelli, F., & Mazzetti, M. (2022). Examining the pre-war health burden of Ukraine for prioritisation by European countries receiving Ukrainian refugees. The Lancet Regional Health - Europe, 15, 100369. https://doi.org/10.1016/j.lanepe.2022.100369
World Health Organization. (2022, June 3). One hundred days of war has put Ukraine’s health system under severe pressure. World Health Organization. https://www.who.int/news/item/03-06-2022-one-hundred-days-of-war-has-put-ukraine-s-health-system-under-severe-pressure
Posner, L. (2022, September 15). War-Proofing Ukraine’s Health System I Council on Foreign Relations. Think Global Health. https://www.thinkglobalhealth.org/article/war-proofing-ukraines-health-system
Mpoke Bigg, M. (2022, March 26). A history of the tensions between Ukraine and Russia.: Here is a look at some key events in the run-up to Russia’s invasion of Ukraine. New York Times.lhttps://www.nytimes.com/2022/03/26/world/europe/ukraine-russia-tensions-timeline.html
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