Introduction by Croakey: On 23 February this year, as the threat of full scale war hung over the people of eastern Ukraine, the Medical Association for Prevention of War (Australia) warned in an article for Croakey of the horrendous health threats.
On 25 February, the day after the Russian Federation launched its brutal invasion, Croakey reported statements by health and medical leaders expressing solidarity with the people of Ukraine, and warning against attacks on civilians and healthcare facilities.
Now the 100-day anniversary of the war has been marked, global health leaders continue to call for peace as they confront the terrible toll upon healthcare facilities, people and the environment.
Alison Barrett writes:
Ukraine’s ability to provide healthcare – even more vital in times of trauma and war – has been significantly hit by 100 days of conflict, due to a significant increase in demand as well as the hundreds of attacks on healthcare facilities.
The World Health Organization (WHO) has reported more than 260 verified attacks on healthcare in Ukraine since the Russian assault began on 24 February this year.
“These attacks are not justifiable, they are never okay, and they must be investigated,” Dr Hans Henri P. Kluge, the WHO’s Regional Director for Europe said in a statement on 3 June.
“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.”
According to the WHO, one of the immediate challenges for healthcare in Ukraine is the distribution of medicines and medical supplies, such as ventilators, ambulances, trauma surgery supplies and electric generators.
Elise West, Executive Officer of the Medical Association for Prevention of War (MAPW), told Croakey that “one of the greatest challenges for healthcare in conflict are attacks on health facilities and health workers”.
West added that attacks on healthcare are not limited to the Ukraine conflict, but commonly occur during conflicts or complex situations.
“This year the WHO has also reported 77 attacks on healthcare in the occupied Palestinian territories, and Physicians for Human Rights has documented 415 incidents in Myanmar, including arbitrary arrests of health workers,” West said.
Threats to public health
Conflicts have both immediate and long-term impacts on health, including physical injuries, psychological trauma and disruptions to routine care, which “can exacerbate threats to public health”, according to West.
West said:
The connection between war and infectious disease is well established. Syria has seen a resurgence of measles, and Yemen has suffered cholera outbreaks, for example, when both these diseases were previously controlled. Breakdowns in health systems, disruptions to water and sanitation, displacement, poor nutrition all contribute.
In Ukraine, tuberculosis – and particularly drug-resistant TB – is causing concern. Ukraine has relatively high rates of TB and the invasion is expected to impact on transmission rates, treatment, and treatment outcomes.”
Médecins Sans Frontières (MSF) said in a statement that mental health needs are growing in Ukraine.
According to the organisation, people escaping conflict do not usually consider their mental health, but the MSF mental health teams in Ukraine are seeing a real need for support to be provided in a collaborative way with communities.
Displaced children
The Ukraine conflict has displaced 5.2 million children who need urgent humanitarian aid – three million inside Ukraine and 2.2 million in “refugee-hosting countries”, according to a statement by UNICEF.
Many families are unable to meet basic needs for their children due to the mass displacement and lost income opportunities.
In addition, children fleeing the conflict are exposed to trafficking, sexual exploitation and separation from family, according to UNICEF.
Child protection services, psychosocial support and safety are urgently required.
However, what children most need is peace.
UNICEF Executive Director Catherine Russell said: “Without an urgent ceasefire and negotiated peace, children will continue to suffer – and fallout from the war will impact vulnerable children around the world.”
Response by aid organisations
International aid and health organisations have responded to the Ukraine crisis in various ways.
WHO has supported delivery of essential medical supplies and equipment to Ukraine and countries hosting displaced Ukrainians, including Poland, Czech Republic and Romania.
They have trained healthcare staff to deal with the effects of war, such as performing trauma surgery and responding to mass casualties and exposure to chemicals, and established hubs in areas close to conflicts for increased access to healthcare.
UNICEF has also helped with the distribution of health and medical supplies, enabled access to safe water and provided mental health and psychosocial support.
In neighbouring countries that are hosting refugees, UNICEF has supported initiatives such as anti-trafficking training for border guards and expanded learning opportunities for children.
MSF mental health teams have been “providing mental health support in shelters for displaced people” in metro train stations or mobile clinics in remote villages.
They have also implemented practical methods to help children cope with their experiences, such as making paper birds or other craft-based activities.
However, “while there has been a significant international response, around 60 percent of partners in the emergency health response are Ukrainian NGOs and health services,” West told Croakey.
Calling for peace
UNICEF and the WHO are calling for an immediate ceasefire, and for protection of children from harm, including ending the use of explosive weapons in populated areas and enabling full humanitarian access to reach children in need.
“This war has gone on for 100 days too many, shattering lives and communities, and imperilling the short- and long-term health of Ukraine’s people,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
“WHO is doing everything we can to support Ukraine’s Ministry of Health and deliver essential medical supplies and equipment. But the one medicine that Ukraine needs most is the one that WHO can’t deliver – peace. We call on the Russian Federation to end the war.”
In April, the MAPW and other Australian health and medical organisations, (see full statement for signatories here) joined together “to condemn attacks on healthcare – wherever they happen – and to call for universal protection of the principle of medical neutrality,” West told Croakey.
West added: “While intentional attacks on healthcare are prohibited under international law, perpetrators are rarely held accountable. We at MAPW think the Australian Government can take a stronger position on the protection of health in conflict.
“The Safeguarding Health in Conflict Coalition has recommended that the UN Security Council refer Saudi Arabia to the International Criminal Court for investigation of alleged war crimes against health care in Yemen – yet the Australian Government has continued to approve arms exports to Saudi Arabia.”
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