WHO representative in Ukraine: In 2024, Russian attacks on Ukraine's medical infrastructure will intensify
The representative of the World Health Organization in Ukraine, Dr. Jarno Habicht, in an interview with Interfax-Ukraine, spoke about the WHO's view of the situation in Ukraine's medical system during the third year of the war, the assistance provided by the WHO to Ukraine and forecasts regarding the impact of the war on the state of healthcare in Ukraine and Europe.
Author: Anna Levchenko
How does WHO assess the condition of Ukraine's medical infrastructure after 2 years of war? To what extent is the medical system of Ukraine capable of providing medical services?
The war that has gone on for ten years already continues to put health system under test and devastate the health system's capacity to deliver essential services and address the population's health needs.
As of today, from February 2022, WHO has verified 1,773 attacks on healthcare in Ukraine that took the lives of at least 136 health workers and patients. In 2024 the attacks have been intensified.
There is significant damage to health infrastructure, especially in areas closer to the frontline with up to 14% of facilities being fully damaged and up to 48% sustaining partial damage.
From all the attacks during the period, primary health care was affected by 40% of these attacks, impeding Ukrainians' access to basic health services. 15% of attacks impacted emergency medical care centers.
At the same time while looking to whole country and area under control of Ukraine, majority of the facilities are functional.
We’re especially concerned with the increase in double-tap attacks which put first responders and civilians in ever greater danger. Our data shows that first responders and health transportation workers are x3 more likely to suffer harm from attacks compared to the rest of the healthcare staff.
Together with Ministry of Health and partners we continue to support the affected regions with early recovery to continue providing health services. This includes support to health services as primary healthcare, vaccination, providing medications to address increasing needs from non-communicable diseases and supporting health care workers. Over last months we have opened number of modular primary healthcare units in affected areas as Kharkiv, Kherson and Sumy Oblasts.
Investing now in the health system is crucial for addressing the immediate needs posed by the war, as well as for laying the groundwork for a healthier, more resilient Ukraine in the future.
How did the war affect the supply of medicines, including imported ones? by how much did the volume of deliveries decrease?
What we can see from regular research WHO conducting in Ukraine is that the cost of medicines and treatments emerged as the most significant concern for future health needs, for example, in frontline areas. The percentage of those who experienced difficulty with the rising cost of medicines was about 75% by April 2023. In tandem with this, problems associated with medication shortages, closed pharmacies and security concerns continue to decline during last year, that shows health system to adapt.
We as WHO do provide medicines, purchased in Ukraine and other countries, to healthcare facilities during the bilateral donations and UN inter-agencies convoys. Beginning from 2022, more than 3,5 thousand tons of medical goods, including medicines had been disseminated in various oblasts of Ukraine.
How does the destruction of the energy infrastructure affect the medical infrastructure? is there enough power supply for the clinics? What are the forecasts/expectations for autumn-winter?
The energy infrastructure damage effects directly healthcare facilities. This relates to electricity, water supplies and other, so this is really a concern so we plan to continue supporting energy systems throughout the summer.
During my recent mission to Kharkiv oblast and visit to the Chuguyivska Central Hospital WHO team donated a modular heating unit that will support the hospital’s functioning amidst emergency conditions, which unfortunately are a daily reality for this region. This heating unit allows the hospital to act autonomously using natural materials like firewood.
Overall, about 250 generators and 3 heating units have been donated by WHO to health facilities in different regions and this process is ongoing. But there are many international partners and local stakeholders who are investing to energy infrastructure to ensure essential services to be available.
After last month’s attacks to energy infrastructure, we can anticipate very difficult 2024-2025 winter season ahead of us. However, it is now time to do utmost to be prepared and support population access to health services.
We should also pay attention to access to safe water, adequate sanitation, and proper hygiene practices which are fundamental prerequisites for public health and quality care. We continue to support Ukraine in strengthening WASH for better population health & quality basic medical services via education for healthcare workers.
To what extent are the frontline territories provided with medical services? what problems are there? are there enough medical personnel?
In frontline areas, 22% of households delay seeking medical care, with financial constraints being a significant issue. Specifically, 24% cannot afford medicines, and 51% are unable to pay for medical services. So this is really an issue. Since 2022, we have donated more than 800 kits, consisting mainly of different medicines in high-risk zone. While universal in nature, the kits are to address the needs of elderly people.
As I have mentioned before WHO supports primary healthcare and installs modular primary care facilities in Ukraine, where healthcare facilities were destroyed or damaged. These units offer rapid solutions for ensuring continuity of healthcare provision. Currently, 17 modular units are installed. We focus now Kherson, Kharkiv, Sumy, Donetsk and Mykolayv regions, which are most affected by the war. All clinics are equipped with essential amenities, including electricity, sanitary facilities, sewage systems, and patient examination rooms. Generators and ventilation systems are provided. To allow for additional security, several facilities have been equipped with a shelter located nearby. Usually in these facilities work the same healthcare workers, doctors and nurses as it was before in the facilities, previously damaged by the attacks.
In addition we support doctors and nurses providing primary health care to have outreach services in areas where health care infrastructure is damaged or/and health workforce in not available. This way around 1 700 visits with 50 000 consultations have been made and thousands of people have received health services especially to address imminent health needs and burden from non-communicable diseases in Kherson, Kharkiv, Chernihiv, Dnipro, Kyiv, Sumy, Zaporizhzhia, Mykolayv and Cherkasy oblasts.
Is there a problem with shortage of healthcare personal in Ukraine? Do we have enough specialists to provide the services?
Talking about very concrete data with numbers this is what authorities are monitoring. However, what I have heard during the resent visits of 4 frontline oblasts and talking with local health authorities the shortage of medical personnel is there and notable burnout amongst healthcare workers who have bravely carried on their work since the full-scale invasion.
We are in constant contact with MoH and NHSU to consider the incentives and working conditions of doctors and nurses. Through the number of capacity-building initiatives, we make sure that the medical personnel are available to provide the highest quality care.
Health workers are a part of the affected communities, and they provide support to them. Hence, they experience a double burden. One of the ways to support healthcare workers' mental health is by teaching them stress management skills. To facilitate this, WHO launches a series of stress management sessions through the Self-Help Plus course for primary health care workers. We will start in one of the oblasts soon and then expand this initiative to other oblasts.
What medical services have become more in demand in Ukraine in connection with the war? do Ukrainian doctors have enough experience in working with military trauma? What international experience do Ukrainian doctors have?
Because of the war the fast-growing need for mental health and psychosocial support, as well as rehabilitation services has called for a strong response and innovative solutions from health authorities. Among those solutions, are Community Mental Health Teams, WHO has been supporting since 2015. They provide recovery-oriented care, enabling people with severe mental health conditions to lead fulfilling lives within their communities.
Delivery of rehabilitation equipment and rehabilitation training continues as part of WHO CO Ukraine support to MoH and numerous health care facilities in Chernihiv, Dnipro, Kyiv, Sumy, Zaporizhzhia, Poltava, Rivne oblasts. Multidisciplinary teams providing trainings for healthcare workers in rehabilitation centers. As far as the war continues doctors and other healthcare personnel gain more and more experience in various areas and situations aiming to save as many lives as possible.
After the Russian Federation's large-scale invasion of Ukraine the problem of assisting victims of violence, including gender-based violence (GBV), has intensified. Healthcare professionals, often the first point of contact for victims, play a crucial role in providing not only medical care but often refer victims to social, legal and other services. Our team has been conducting training events for healthcare workers and giving them recommendations on post-contact prevention for victims of gender-based violence.
Talking about knowledge, WHO provided targeted trainings in mass casualty management for participants from hospitals in Zaporizhzhia, Donetsk, Volyn, and Kharkiv regions. There were conducted also various trainings on emergency care such as on safe transfer of critically injured patients, on ensuring effective coordination for the swift deployment of national emergency medical teams (EMTs) in the country, on basic emergency care for all health care professionals, regardless of their specialty. It aims to ensure that all healthcare workers, whether in emergency care, primary care, nursing, or any other field, have the knowledge to assess and treat life-threatening conditions.
We have offered and we will continue this year to conduct with the partners the state-of-the-art Hostile Environment Surgical Training (HEST) course tailored specifically for frontline healthcare workers to upskill Ukraine's surgeons and anesthetists from 4 frontline regions as Mykolaiv, Odesa, Zaporizhzhia and Dnipro
At the same time we should not forget all ‘invisible’ wartime patients. This includes people who already required medical attention before the war, people who live with noncommunicable diseases (NCDs) or chronic conditions like heart disease, cancer, asthma, or diabetes. Non-communicable diseases cause 84% of illnesses and deaths in Ukraine.
How does WHO assess Ukraine's ability to form an effective rehabilitation system? what is missing
The topic of rehabilitation in Ukraine now is more relevant than ever. The President's office and Government, MOH, other ministries and international organizations, also partners are engaged in it at the highest level. To make the current breakthrough in the development of rehabilitation system, Ukraine systematically prepared - the Law of Ukraine "On Rehabilitation in the Health Care Sector" and several necessary regulatory documents of a technical level were adopted, rehabilitation began to be paid for by the medical guarantee program, the Decree of the President of Ukraine defined direction of the beginning of the development of the rehabilitation care system - "as early as possible after the onset of an acute illness or injury."
WHO in Ukraine also provides systemic support, helping to develop a modern evidence-based rehabilitation care system. This includes the creation of a system of rehabilitation care for spinal cord injuries, development of a network of rehabilitation departments in multidisciplinary hospitals. The other support aspect is dedicated to human capital, in particular to training rehabilitation specialists for scaling the best practices of providing modern multidisciplinary rehabilitation care.
WHO also provided assistive technologies for 40 healthcare facilities around the country and will continue to provide the necessary materials.
The key problem now is the lack of qualified rehabilitation personnel, we are training them, but it takes time, rapid legislative changes, in particular regarding rehabilitation education.
Are there currently risks of epidemics of infectious diseases due to war?
Currently, surveillance for vaccine-preventable diseases like Measles, Diphtheria, and other infectious diseases remains functional in all government control areas. All regional public health laboratories have the necessary capacity to monitor and contain any potential disease outbreak.
At the same time, an increased number of Ukrainian children missed their routine vaccinations during the pandemic and due to the war are susceptible to measles and other potentially fatal vaccine-preventable diseases. An outbreak of polio, which was closed in Ukraine just a few months ago is a reminder. The longer the war drags on, the more pool of susceptible children and the higher the risk of Measles and other vaccine-preventable disease outbreaks.
At the same time, increased attacks on infrastructure aggravate the risk of disease caused by poor sanitation and contaminated water supplies.
As well what we need to remember is that the cases of rabies in wild and domestic animals continue to be registered in Ukraine. Unfortunately, cases of rabies also occur in humans and if don’t seek help in time, the infected person may die. That`s why the Ministry of Health of Ukraine together with WHO in Ukraine and other stakeholders / partners started the information campaign about rabies and now is disseminating information materials through all regional centers of disease prevention and control and other institutions.
Regular catch-up campaigns in high-risk areas and intensifying surveillance to detect outbreaks early are crucial and this is where we are investing our efforts.