Due to the invasion of Russia, Ukraine may suffer a health disaster. Before the start of war, Ukraine already had a very high number of people living with HIV and hepatitis C, as well as dangerously low levels of vaccination against measles, polio and COVID-19. Added to this picture are the overcrowded and unsanitary conditions of refugees, which are a breeding ground for outbreaks of cholera and other diseases transmitted by contaminated water or food, a situation that can cause increase the risk of more cases of people affected by the Ómicron variant of coronavirus, pneumonia and tuberculosis.
On the ground, there are organizers of solidarity initiatives that try to bring medicines to the sick and consider that the invasion threatens to ruin decades of the progress that had been made in the fight against infectious diseases throughout the region. Outbreaks that are difficult to control are possible.
From the organization 100% Life, the organization that delivers medicines to Chernihiv residents with HIV, Dmytro Sherembei warned that there is a risk that people will die from bombings or lack of access to medicines. In Ukraine there are more than 250,000 people living with this disease.
Another problem already faced by Ukraine was multidrug-resistant tuberculosis. This pathology is that patients are affected by bacteria that resist treatments. In recent years, the Ministry of Health had made progress in controlling these epidemics, including a 21% decline in new HIV infections and 36% in tuberculosis diagnoses, since 2010.
However, health authorities now fear that delays in diagnosis and treatment interruptions during the war could allow these pathogens to reaffect, with consequences that extend for years.
“Last year, we were working to differentiate between different tuberculosis mutations,” said Iana Terleeva, who heads the Ukrainian Ministry of Health's tuberculosis programs, in a statement. “Now, instead, we try to differentiate between aerial bombardments, incursions and other military material.”
Olya Klymenko, who overcame tuberculosis in 2016 and who is the founder of TB People Ukraine, said that “Before the war, Ukraine had done a lot. We had a more or less stable situation. But it all stopped in a day. When the war is over, we will start everything again, not to mention from scratch, because of the years caused to our health system, to our medical infrastructures,” he said during a press conference.
The fighting has also damaged health facilities across the country and endangered thousands of people with chronic diseases such as diabetes and cancer who depend on continued care. “Everything is at very high risk, as is always the case on the battlefield,” said Dr Michel Kazatchkine, former UN Secretary-General's envoy for Eastern Europe. “We must anticipate major health crises in relation to infectious diseases and chronic diseases throughout the region, which I hope will be serious and lasting,” he said.
More than three million Ukrainians have fled to neighbouring countries, most of them to Poland, and nearly seven million are internally displaced. Refugees are arriving in countries that are not prepared for a flood of patients with medical needs. Moldova, for example, is one of the poorest nations in Europe, ill-equipped to care for refugees or to stop outbreaks of infectious diseases. Countries such as Kyrgyzstan and Kazakhstan buy medicines and vaccines produced by Russia and depend heavily on its economy.
Russia itself has more people living with HIV than any other country in Eastern Europe, and Western sanctions are likely to disrupt the already low levels of funding for services in the country. In Ukraine, nearly 1,000 health centers are close to conflict zones or areas that are no longer under government control.
The World Health Organization has recorded at least 64 attacks on these facilities, of which 24 were damaged or destroyed. Hospitals that continue to function have difficulty caring for the sick and injured, and are paralyzed by the decline in medical supplies, such as oxygen and insulin, and the shortage of life-saving equipment, such as defibrillators and respirators. Hundreds of children with cancer have left their homes. The armed conflict has even disrupted routine childhood vaccination.
Added to all this is the risk of cases of poliomyelitis. Only 80% of Ukrainian children were immunized against polio in 2021, and the country had detected some cases of polio even before the war began. Measles vaccination coverage in Ukraine is also too low to prevent outbreaks.
During the pandemic lockdowns, the Ukrainian government began to disburse three-month supplies of HIV and tuberculosis drugs. However, many Ukrainians who were forced to leave their demolished cities were able to take only limited supplies of the medicines needed to stay alive. At least 1,200 people with tuberculosis are believed to have fled Ukraine.
The Alliance for Public Health, a non-profit organization, is helping more than 400 of these patients in countries such as Poland and Moldova. WHO has also prepared a stockpile of anti-tuberculosis drugs in Poland for refugees from Ukraine. But the majority of refugees are women and children, while the majority of Ukrainians with drug-resistant tuberculosis are men who must stay in the country and fight, according to Andriy Klepikov, executive director of the alliance.
Within the country, Alliance members are delivering medicines to the sickest in cities where travel is still possible, and mailing medicines to communities where post offices are still operational.
More than one in four new HIV infections in Ukraine occur among the country's approximately 350,000 injecting drug users. Before the war, Ukrainian harm reduction policies allowed more than 17,000 of its citizens to receive so-called opioid substitution therapy.
Demand for treatment increased as access to street drugs has declined during the conflict. But now stocks of opiate substitution drugs, methadone and buprenorphine, probably won't last more than a week or two, experts say. That is why WHO and other non-profit organizations are requesting donations of medicines to the Czech Republic, Austria and other countries. The Global Fund, a huge global health organization, made more than $3 million available to purchase these treatments over the next year.
Some experts fear that, if Russian forces prevail, drug users in Ukraine will be in grave danger. Opioid substitution therapy is illegal in Russia. Within 10 days of its annexation of Crimea in 2014, Russia closed all methadone supply centers, resulting in overdose deaths and suicides.
From the organization Doctors Without Borders (MSF), it was reported that they have teams in Ukraine and are evaluating ways to adapt activities to respond as the conflict evolves. “We are deeply concerned about the consequences of this conflict for the Ukrainian people and communities. We see on the roads that tens of thousands of people are scared and moving,” said MSF in a statement.
“Due to the drastic change in context, we have had to make the painful decision to stop our activities, which included treating HIV cases in Severodonetsk, caring for tuberculosis (TB) patients in Zhytomyr and improving access to health care in Donetsk, eastern Ukraine, where we have provided services much-needed medical care to communities affected by the conflict. While most of these programs have stopped, we did our best to ensure some continuity of care for our patients,” they said last Friday.
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