‘There is No Safe Place in Ukraine’ 
Ukrainian child with his dog -displaced by war, in a refugee camp on the Moldova-Ukranian border

There have been 52 attacks on Ukrainian health facilities in the past 25 days, more than two every day, according to the World Health Organization (WHO).

Meanwhile, the health of fleeing refugees, their impact on the health services of neighbouring countries, and the fate of Ukraine’s tuberculosis patients are foremost on healthcare providers’ minds.

“In less than a month, over three million people have left the country and nearly two million have been internally displaced,” said Jarno Habicht, WHO’s Representative in Ukraine.

“This has happened faster than in any previous European crisis. There is no safe place in Ukraine right now, yet we need to ensure that health services are available.”

“The military offensive continues, with a number of cities being entirely isolated – people are running out of food and water, and hospitals might not have electricity,” added Habicht, who has been head of the Ukraine office since 2018.

“Worse still, we have seen many attacks on health workers and health facilities as well as patients. This is happening daily and is unacceptable. So, if you ask me how to describe it, every day things are getting worse, which means every day the health response is becoming more difficult.”

Jarno Habicht, WHO’s Representative in Ukraine (centre)

Banned cluster munitions

According to Bonnie Docherty, a senior advisor for Human Rights Watch, Russian forces have “relied heavily” on cluster munitions, which are banned in most countries in the world, and explosive weapons with wide-area effects.

Cluster munitions, large bombs that contain dozens or hundreds of smaller sub-munitions, were used to attack a hospital in Vuhledar on 24 February in which four civilians were killed, and 10 people including six healthcare workers were injured, wrote Docherty in the online security news outlet, Just Security, on Monday.

Unexploded, the submunitions can lie dormant like landmines, exploding months and years later when picked up by children or farmers, she explains.

However, artillery shells, mortars, rockets, missiles, and enhanced blast (thermobaric) weapons, and aerial bombs, have caused the bulk of the damage in Ukraine, adds Docherty.

Concern for drug-resistant TB patients 

On the eve of World Tuberculosis Day on Thursday, WHO TB experts also expressed concern for Ukrainian TB patients, particularly those with drug-resistant TB.

“Ukraine is one of the 18 high-priority countries in the WHO European region for TB and is on the global list for having a high burden of multidrug-resistant tuberculosis,” Dr Askar Yedilbayev, WHO Europe’s Regional TB advisor, told a media briefing on Monday.

Dr Askar Yedilbayev
Dr Askar Yedilbayev

“Before the war, Ukraine was one of the pioneering countries in response to TB and drug-resistant TB in the WHO European region,” he added.

“However, destroyed health infrastructure, including limited access to TB treatment and public health services, is affecting the provision of essential tuberculosis services, causing significant delays in diagnosis of TB, affecting initiation of TB preventive treatment, and treatment of active TB and MDR TB,” he added.

Shortly before the war, all TB medication had been distributed to regional warehouses and patients had been given one or two months’ supply of medicine, he added. But some of these warehouses had been damaged or were under threat of damage, and there was a need for the “emergency redistribution of procurement of medicines to ensure continuity of treatment”. 

In addition, as Ukraine’s neighbours did not have the same burden of TB disease, they were unlikely to have the medicine to treat large numbers of people with TB.

Yedilbayev appealed for donations to the Global Fund and WHO Foundation to enable the delivery of health services to Ukrainians.

Every second, a Ukrainian child becomes a refugee

Every second, a Ukrainian child becomes a refugee, according to UNICEF and half of the over 3.5 million refugees estimated to have fled to neighbouring countries since 24 February are children under the age of 15.

Almost two million refugees have fled to Poland, according to the WHO. 

“Refugees can be vulnerable to infectious diseases because of lack of health care,  interrupted care in the country of origin, because of exposure to infectious infections and lack of care in transit, and if living conditions are poor in the destination country,” said Yedilbayev.

Image Credits: UNICEF/UN0599222/Moldovan.

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