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Peer Reviewed Article: War Zone Fall Out & Health Risks Associated to Radiological Problems

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Peer Reviewed Article: War Zone Fall Out & Health Risks Associated to Radiological Problems

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This article describes the serious health risks imposed on those in the surrounding area of Ukrainian war zone near Chernobyl. With radioactive debris and material being disturbed there are risks of exposure and development of cancer.

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New York Times News Article: Public Health Catastrophe Looms in Ukraine

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New York Times News Article: Public Health Catastrophe Looms in Ukraine

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This news article covers the concerning overcrowding and poor sanitation among refugees in combination with the lack of incoming time sensitive medicines and scarce medical supplies to hold over those that could not leave.

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Even before the war, the country struggled with epidemics of H.I.V., tuberculosis and hepatitis. The conflict threatens to undo decades of progress.

Credit... Lynsey Addario for The New York Times

March 26, 2022

A convoy of five vans snaked slowly on Friday from the battered Ukrainian capital, Kyiv, toward Chernihiv, in the northeast of the country. On board were generators, clothes, fuel — and medications needed to treat H.I.V.

With a main bridge decimated by shelling, the drivers crept along back roads, hoping to reach Chernihiv on Saturday and begin distributing the drugs to some of the 3,000 residents in desperate need of treatment.

Organizers of efforts like this one are rushing to prevent the war in Ukraine from morphing into a public health disaster. The conflict, they say, threatens to upend decades of progress against infectious diseases throughout the region, sparking new epidemics that will be nearly impossible to control.

Ukraine has alarmingly high numbers of people living with H.I.V. and hepatitis C, and dangerously low levels of vaccination against measles, polio and Covid-19. Overcrowded and unsanitary living conditions for refugees are breeding grounds for cholera and other diarrheal diseases, not to mention respiratory plagues like Covid-19, pneumonia and tuberculosis.

“If they don’t get the medicines, there is a high risk that they will actually die because of the lack of therapy, if they don’t die under the shelling,” said Dmytro Sherembei, who heads 100% Life, the organization delivering medications to Chernihiv residents with H.I.V.

Mr. Sherembei, 45, learned he had H.I.V. 24 years ago. He is one of more than 250,000 people in Ukraine living with the virus, a huge epidemic driven largely by the sharing of contaminated needles among intravenous drug users.

Ukraine and the surrounding region also make up a world epicenter of multi-drug-resistant tuberculosis, a form of the disease impervious to the most powerful medications.

The Ukrainian health ministry in recent years had made progress in bringing these epidemics under control, including a 21 percent drop in new H.I.V. infections and a 36 percent decline in TB diagnoses since 2010.

But health officials now fear that delays in diagnosis and treatment interruptions during the war may allow these pathogens to flourish again, with consequences that ripple for years.

“Last year, we were working to differentiate between different TB mutations,” Iana Terleeva, who heads tuberculosis programs for Ukraine’s Ministry of Health, said in a statement. “Now instead, we are trying to differentiate between aerial shelling, raids and other military hardware.”

The fighting also has damaged health facilities throughout the country and spawned a refugee crisis, imperiling thousands of people with chronic conditions like diabetes and cancer who depend on continuing care.

“Everything is at very high risk, as it is always in the battlefield,” said Dr. Michel Kazatchkine, a former U.N. secretary general envoy for Eastern Europe.

“We should anticipate major health crises with regard to infectious diseases and chronic diseases across the region that I expect to be severe and durable,” he added.

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Credit...Lynsey Addario for The New York Times

The war “will have a huge impact on health systems that are already very fragile,” Dr. Kazatchkine said.

More than three million Ukrainians have fled to neighboring countries, most of them to Poland, and nearly seven million are internally displaced. The refugees are arriving in countries unprepared for an onslaught of patients with medical needs, experts said.

Moldova, for example, is one of the poorest nations in Europe, ill equipped to care for refugees or to stem infectious disease outbreaks. Countries like Kyrgyzstan and Kazakhstan buy drugs and vaccines produced by Russia and are heavily dependent on its economy.

Russia itself has more people with H.I.V. than any country in Eastern Europe, and Western sanctions are likely to interrupt the already low levels of funding for services in the country.

Within Ukraine, nearly 1,000 health care facilities are close to conflict zones or areas no longer under government control. The World Health Organization has recorded at least 64 attacks on such facilities, including 24 in which the buildings were damaged or destroyed.

The hospitals that are still operational struggle to care for the sick and wounded, and are crippled by dwindling medical supplies, including oxygen and insulin, and a shortage of lifesaving equipment like defibrillators and ventilators.

Hundreds of children with cancer have fled their homes, according to the World Health Organization. The armed conflict has even derailed routine childhood vaccinations.

Only about 80 percent of Ukrainian children were immunized against polio in 2021, and the country had detected a few polio cases even before the war began. The vaccination coverage for measles in Ukraine is likewise too low to prevent outbreaks.

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Credit...Filip Singer/EPA, via Shutterstock

These are the ingredients of a public health calamity, many experts fear. The W.H.O. and other organizations are deploying medical teams and shipping supplies, vaccines and drugs to Ukraine and to neighboring countries. But the aid may never reach areas of active conflict.

‘It’s very scary’

During the pandemic lockdowns, the Ukrainian government began disbursing three-month supplies of medications for H.I.V. and tuberculosis. But many Ukrainians forced to abandon their demolished cities were able to take only limited supplies of the medications needed to keep them alive.

Elizaveta Grib, 16, fled her home in Kyiv with her mother and younger brother on Feb. 28, four days after the bombing began. They packed what they could in suitcases and made their way by train to Mykolaiv, a city near the southern port of Odessa that came under heavy bombardment by Russian forces.

Ms. Grib’s tuberculosis was diagnosed in September 2020 and she took some of her medicines with her, but now is unsure how she might obtain the drugs long-term. Without treatment, her disease could become resistant to all available therapies, perhaps even claiming her life.

“It’s very scary,” she said.

At least 1,200 people with tuberculosis are thought to have fled Ukraine. The Alliance for Public Health, a nonprofit organization, is helping more than 400 such patients in countries like Poland and Moldova. The W.H.O., too, has readied a stockpile of tuberculosis drugs in Poland for refugees from Ukraine.

But most of the refugees are women and children, while the majority of Ukrainians with drug-resistant TB are men who must stay in the country and fight, said Andriy Klepikov, executive director of the alliance.

Within the country, staff members are delivering medicines to the sickest people in cities where it still is possible to travel, and mailing drugs to communities where post offices are still operational.

Dr. Klepikov himself had 20 minutes to fill a backpack and evacuate from a suburb of Kyiv to Lviv. When he returned to Kyiv on a short trip earlier this past week, he was devastated by the destruction of apartment complexes, kindergartens and shopping malls within a few minutes’ walk from his building.

“There are smell of heavy smoke, sound of bombing, artillery, sirens,” he wrote in a text message.

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Credit...Brendan Hoffman for The New York Times

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Credit...Andriy Klepikov

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Credit...Andriy Klepikov

In Lviv, a city that has become a refuge for displaced Ukrainians, the alliance’s staff members are delivering condoms, syringes and tests. But in many other cities, there is little the organization can do to help.

Staff members have lost contact with colleagues in Mariupol, the southern city under siege by Russian forces; only the coordinator of the alliance’s mobile team called to confirm that she was alive. Staff members have also lost touch with 60 percent of their clients in the suburbs of Kyiv, which has been under attack for weeks.

“What has been gained over these 20 years can be destroyed in days,” Dr. Klepikov said. “We will not allow this — we will fight for sustaining these gains.”

More than one in four new H.I.V. infections in Ukraine occur among the country’s roughly 350,000 injecting drug users. Before the war, Ukraine’s policies on harm reduction enabled more than 17,000 of its citizens to receive so-called opioid substitution therapy.

The demand for treatment has increased as access to street drugs has decreased during the conflict. But now stocks of the opioid substitution drugs methadone and buprenorphine are unlikely to last beyond one to two weeks, experts said.

So the W.H.O. and other nonprofit organizations are requesting drug donations from the Czech Republic, Austria and other countries. The Global Fund, an enormous global health organization, has made more than $3 million available to purchase these treatments over the next year.

Some experts worried that if Russian forces prevailed, Ukraine’s drug users would be in grave jeopardy. Opioid substitution therapy is illegal in Russia. Within 10 days of its annexation of Crimea in 2014, Russia shuttered all of the methadone delivery centers, resulting in deaths from overdoses and suicides.

“You can’t just stop these treatments from one day to the next,” Dr. Kazatchkine said.

Women who use drugs face particular stigma and discrimination from state organizations and medical institutions, said Tetiana Koshova, regional coordinator in Kyiv for the Ukrainian Network of Women Who Use Drugs.

Before the war, the organization helped 50 to 70 women each month, but now that number has doubled, Ms. Koshova said.

Ms. Koshova got her diagnosis of H.I.V. in 2006, at age 27, and said she worried about the availability of H.I.V. drugs as the war grinds on. Although warehouses still hold stocks of antiretroviral medicines, “the situation can change in any moment, because rockets fly anywhere and destroy everything indiscriminately,” she said.

She spent much of Tuesday “sitting in the basement” because of a threat of rocket attacks.

“Explosions are constantly heard, and periodically there are problems with electricity,” she added. “All night and several times a day, I have to go in bomb shelter.”

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Public Health Catastrophe Looms in Ukraine, Experts Warn

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Even before the war, the country struggled with epidemics of H.I.V., tuberculosis and hepatitis. The conflict threatens to undo decades of progress.

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Peer Reviewed Article: Ukraine War Impacts on Child Health 

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Peer Reviewed Article: Ukraine War Impacts on Child Health 

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This article focuses specifically on the psychological and physical damage that children will face due to separated families, lack of health resources, and increased prevalence of disease. All of these combined do not give these children the opportunity to grow, learn, and thrive safely in their environment.

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From this article the WHO gives their plan of support to Ukraine by delivering medical supplies, deploying more medical teams, and working with health authorities to limit supply disruptions.

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WHO is working through our offices in Ukraine and neighboring countries, and with partners, to respond to the health emergency triggered by the Russian Federation's invasion of Ukraine. We are delivering specialized medical supplies, coordinating the deployment of medical teams, and working with health authorities to minimize disruptions to the delivery of critical healthcare services within Ukraine and in countries hosting refugees.

WHO continues to deliver much-needed support on urgent health needs, with urgent priorities being mental health, rehabilitation - of the health systems and the affected populations - and community access to health services.

During the crisis, health must remain a priority pillar, with health workers being protected so they can continue to save lives and with health systems and facilities being protected so that they remain functional, safe and accessible to all who need essential medical services. It is imperative to ensure that life-saving medical supplies - including oxygen - reach those who need them. WHO is coordinating nearly 200 health partners to deliver various health services across the country, reaching 8.5 million people in 2022.

Annual report

The war in Ukraine, which erupted on February 24, 2022, continues to cause intense suffering to its people and serious damage to the country's infrastructure....

From WHO's Europe office See all →

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WHO is working through our offices in Ukraine and neighboring countries, and with partners, to respond to the health emergency triggered by the Russian Federation's invasion of Ukraine. We are delivering specialized medical supplies, coordinating the deployment of medical teams, and working with health authorities to minimize disruptions to the delivery of critical healthcare services within Ukraine and in countries hosting refugees.

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Current News Article: Worsening Health of Ukraine Refugees From Lack of Access to Care

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Current News Article: Worsening Health of Ukraine Refugees From Lack of Access to Care

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This article describes the worsening health among Ukrainians after most recent shell bombings on hospitals leaving limited access and what that could mean for the ongoing battle with Polio, TB, and HIV.

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[Muaz Kory/Al Jazeera]

As the war in Ukraine continues, ongoing damage to infrastructure, limited access to medical supplies and the shelling of hospitals has caused concern about the provision of medicines and healthcare - not only for people fleeing the conflict but also for those left behind.

Sadly, the conditions of war and conflict - the mass movement of people, overcrowding, lack of access to clean water and food compounded by the difficulty in accessing even the most basic medical care - are conditions in which infectious diseases thrive.

Recent reports from Humans Right Watch (HRW) say Mariupol, a Ukrainian city under siege, has not had access to running water, electricity or heat since March 2, when Russian forces surrounded it as part of a larger offensive. Prior to the war, Mariupol had a population of almost half a million. The city sits at the mouth of the Kalmius River, which has dangerously high levels of pollution, according to the World Wildlife Fund, and relies on water treatment plants that run on electricity to provide clean water to residents.

Staff working with Doctors without Borders (Médecins sans Frontières, MSF) in Mariupol reported that they were collecting snow and rainwater as a means of getting clean water to drink, as the queues for free clean drinking water were "huge". MSF also said many grocery shops were destroyed by Russian missiles, food was scarce, and it was not clear when and where basic provisions of bread would be delivered.

To make matters worse, safe exit routes for civilians out of the city are also being targeted.

According to international law, those responsible for armed conflict must protect objects indispensable to the survival of the civilian population. They need to ensure civilians' access to adequate water and sanitation. Starvation as a method of warfare is prohibited.

A humanitarian health crisis

In areas under attack, people are having to shelter underground in cramped conditions, while the COVID-19 pandemic continues.

The shortage of food may also lead to individuals suffering from malnutrition, while limited access to clean water can help diseases spread.

Water that is safe and readily available is important for public health, whether it is used for drinking, domestic use, food production or recreational purposes. Contaminated water and poor sanitation are linked to the transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A, typhoid, and polio.

Diarrhoea is the most widely known disease linked to contaminated food and water. Those who are already dehydrated and poorly nourished who then drink unclean water run the risk of contracting a variety of bacteria and viruses. These can cause diarrhoea, which will then further dehydrate them and make them lose vital electrolytes and sugars. Children and the elderly are particularly at risk of severe illness from dehydration and diarrhoea. Without access to timely hospital care, they could die.

Additionally, those living with chronic health conditions like diabetes and asthma could be deprived of life-saving medication such as insulin and inhalers as pharmacies are emptied or unable to remain open.

At the same time, the war poses risks for the tens of thousands of existing patients in the country needing vaccinations, medicines or continuity of care for other diseases.

Polio

Before the war, Ukraine had just embarked on a nationwide immunisation programme to vaccinate more than 100,000 children who were unprotected against polio. This came after a case of paralytic polio was found in an unvaccinated 17-month-old girl in the Rivne region in October 2021. Then, a couple of months later, a second case appeared in the Zakarpattya region. After this, 20 more cases of polio were detected in children, though not all suffered paralysis.

Health authorities planned to ramp up vaccination efforts against polio for children in the country and the campaign got under way at the start of February. But it was brought to a halt a few weeks later when the war began.

Polio, or poliomyelitis, is a disabling and life-threatening infectious disease caused by the poliovirus. The poliovirus spreads from person to person through faeces and saliva, most often through dirty hands, infected food, and water. Most people with polio will not have any symptoms and will fight off the infection without even realising they were infected. A small number of people will experience a flu-like illness 3 to 21 days after they are infected. In a small number of cases, the poliovirus attacks the nerves in the spine and base of the brain. This can cause paralysis, usually in the legs, that develops over hours or days. If the breathing muscles are affected, it can be life-threatening.

Polio remains a serious public health hazard in countries including Pakistan and Afghanistan but was thought to have been eradicated in Europe, so the outbreak in Ukraine last year caused grave concern. Every unvaccinated person can get polio, but children under the age of five are most susceptible to the poliovirus. That is why it is recommended that all children are fully vaccinated.

With the invasion and as people flee the fighting, it will be impossible for healthcare workers to safely locate and vaccinate those who need it.

The concern now, with a population on the move, is that polio could move with them, particularly as many people have no symptoms at all. Efforts must now be made to vaccinate children as they enter surrounding countries, to protect them and those who are giving them refuge.

Tuberculosis

Ukraine has one of the highest rates of tuberculosis (TB), particularly multidrug-resistant TB, in the world. There are an estimated 30,000 new TB cases annually in Ukraine, and the World Health Organization estimates the country has the fourth-highest TB incidence rate in Europe.

TB is an airborne bacterial infection caused by Mycobacterium tuberculosis. It can be acquired by breathing contaminated air droplets coughed or sneezed by a person nearby who has active tuberculosis. The most common form of infection is pulmonary TB, which affects the lungs. In some cases, the bacteria can also attack the lymphatic system, central nervous system, urogenital area, joints and bones.

Health experts have said that the war could lead to a "devastating" TB problem in Ukraine. MSF, which has been treating drug resistant-TB patients there for years, previously said the disease "poses a significant public health challenge".

During the 2014 conflict in eastern Ukraine, doctors said the TB situation worsened as a result of the fighting and associated disruptions to treatment and access to vital medicines.

This month, the NGO StopTB Partnership, which has been working in Ukraine to ensure people with TB get access to the medicines they need, tweeted about the Russian invasion, saying: "It's clear we expect many more cases of TB."

Interruptions in treatment or diagnosis can drive up wider transmission as well as risk patients' lives... It's clear we expect many more cases of TB - @StopTB https://t.co/eAMwVKlHAY @Reuters_Health @Reuters #endTB #Ukraine

- Stop TB Partnership (@StopTB) March 1, 2022

As bombardments continue in parts of Ukraine, access to essential medicines is becoming more difficult so people with existing TB may find their symptoms worsening, but also as they seek shelter in crowded underground bunkers, they run the risk of passing TB on to those around them.

HIV

HIV also remains a public health issue in Ukraine. According to UNAIDS, an estimated 250,000 people (the second-highest number of any country in Eastern Europe and Central Asia) are currently living with HIV in Ukraine - 156,000 of whom are on antiretroviral therapy.

Many of those diagnosed with HIV/AIDS in Ukraine are intravenous drug users, but there has been an increase in the number of people testing positive who are not drug users. According to Winnie Byanyima, UNAIDS executive director, people living with HIV in Ukraine only have a few weeks' worth of antiretroviral therapy remaining with them and, without continuous access, they are at risk of developing AIDS, a life-threatening condition. It is therefore vital that supplies of medicine for these people continue.

UNAIDS has called for the protection of health workers and the uninterrupted continuation of HIV and health services for all people, including people living with and affected by HIV.

As the war rages on, the people of Ukraine will be increasingly relying on international efforts to help with the emerging health crisis. Neighbouring countries will need to be prepared for the new health needs that arrive with the refugees. Efforts must be made to ensure those left behind have access to clean water, food, medicines and vaccinations and the international community must help those wanting to exit the country to do so through safe corridors.

The prevention of disease and the safeguarding of healthcare provisions must be a priority in any war; if we do not take action, we may see a rise in deadly illnesses such as TB, polio and AIDS.

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Polio, TB, HIV: How the war could worsen Ukraine's health crises

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As the war in Ukraine continues, ongoing damage to infrastructure, limited access to medical supplies and the shelling of hospitals has caused concern about the provision of medicines and healthcare - not only for people fleeing the conflict but also for those left behind.

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Peer Reviewed Article: Health Implications for  Refugees Due to the War 

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Peer Reviewed Article: Health Implications for  Refugees Due to the War 

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This article gives perspective from Poland as 60% of refugees are are coming and seeking support. This urgent surge of refugees requires Poland to set in place public health measures to ensure safety and security.

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The International Rescue Committee addresses the major public health concerns such as the rapid spread of TB, the danger of development from HIV to AIDS with lack of medicine, poor maternal and newborn safety, and the continued outbreak of Covid-19.

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More than 90 attacks on health facilities, ambulances and staff have shaken Ukraine since the start of the Russian invasion.* Although targeting health care providers violates international humanitarian law, such attacks have become increasingly common not only in Ukraine but also in Syria, Yemen and other conflicts.

War also fractures entire health systems and the longer a conflict continues the harder it will become to access care, with people dying otherwise preventable deaths as a result. People who are injured in an attack may not be able to receive emergency treatment. Those who fall ill may not get a diagnosis and the care they need. People with chronic conditions such as asthma or diabetes may be unable to access medications. Women may lose vital sexual and reproductive health services. And survivors of violence and abuse may not receive urgently needed medical and mental health support.

Safe water may also become harder to access, contributing to the spread of infectious disease and making the ongoing public health crisis much worse.

The IRC is shocked and appalled at this senseless killing of civilians in Bucha.

The conflict in Ukraine has gone on far too long and the international community must step up its efforts to find a diplomatic solution. Civilian life must be protected. https://t.co/ryYzeHEmhS
- IRC - International Rescue Committee (@RESCUEorg) April 4, 2022

"Our experience in places like Syria demonstrates that protracted conflict and systemic attacks on health infrastructure can cause health care professionals to leave the country," says Dr. Mesfin Teklu Tessema, senior director of health at the International Rescue Committee (IRC). "This results in further strains on the system and lack of access to care for those that need it most."

Here is a closer look at five growing health crises Ukraine is facing amid the ongoing war:

Maternal and newborn health

A recent photo of a woman being evacuated from a maternity ward in the hard-hit Ukrainian city of Mariupol showed the world the dire impacts of the Russian invasion on maternal and newborn health. More than 4,300 babies were born in Ukraine between Feb. 24 and Mar. 13 alone, many of them in basement bomb shelters. Some 80,000 Ukrainian women are expected to give birth in the next three months-not knowing if they will have prenatal care, a safe delivery or follow-up visits with their health team. The World Health Organization estimates that 15% of pregnancies will experience complications that require skilled medical care-but oxygen and medicines are scarce. As Ukraine's health system buckles under the weight of the conflict the risks to the lives and health of mothers and babies will only continue to grow.

COVID-19

As the global COVID-19 pandemic continues, Ukraine reported its highest daily case count on February 10-just two weeks before the war began. Less than 40% of Ukraine's population is vaccinated against COVID-19. While the vaccination rate in the capital Kyiv is 65%, it is as low as 20% in some regions of the country. The Russian attacks have disrupted peoples' access to health care, including COVID-19 vaccinations, tests and treatment. At the same time, people are having to crowd together in bomb shelters during attacks, or at border crossings as they flee the country, creating conditions ripe for the spread of the coronavirus.

Polio

Ukraine was already experiencing a polio outbreak when Russia's invasion disrupted a campaign to vaccinate children in the impacted region. The highly contagious polio virus largely affects children under 5 years of age and can infect the spinal cord, causing paralysis and death. While vaccinations can prevent the virus from spreading from person to person, polio vaccination rates are below 50% in some areas of Ukraine, including its second-largest city, Kharkiv. This is a source of grave concern for global public health experts who have been working to eradicate polio worldwide.

HIV/AIDS

HIV is a virus that attacks the body's immune system. Left untreated, it can lead to AIDS (acquired immunodeficiency syndrome). Ukraine has the second highest rate of HIV/AIDs in Eastern Europe, with approximately 1% of its population infected with HIV or AIDS. Infection rates are especially pronounced among more marginalized communities such as those who use intravenous drugs and men who have sex with men. The war will make it harder for Ukrainians to learn their HIV status, access treatment, and manage their condition.

Tuberculosis

Tuberculosis is a major public health concern in Ukraine. It is caused by a bacterium that usually attacks the lungs but can infect any part of the body. Not everyone infected with TB bacteria becomes sick, but each year some 32,000 people in Ukraine develop active TB-with a third of the cases resistant to drugs. More than one in five are also HIV positive, and TB is the leading cause of death among HIV/AIDS patients in Ukraine. With the country's health system already strained by the COVID-19 pandemic, diagnosis and treatment of TB had declined significantly. Now disruption of health services because of the war could lead to increased transmission and deaths.

How the IRC helps in Ukraine

We are working with our local partners in Ukraine to support evacuation efforts for women and children and provide psychological care to people displaced by violence. We're also providing uprooted families with groceries, blankets, warm clothes, cook stoves, cash and other essentials.

With our local partners in Poland we are providing refugees from Ukraine with psychological and legal support, translation services, cash assistance, and essentials including sleeping bags. And we're also providing medical equipment for health teams operating at border crossing points and refugee reception centers.

Inside the IRC's health work

The IRC envisions a world where all people, including those affected by crisis, have access to the essential health services they need to survive and thrive. In 2020 alone we provided health programs and services to 31 million people across 32 countries. We also provide water and sanitation services and work to strengthen the capacity and resilience of local health systems.
*Source: World Health Organization Surveillance System for Attacks on Health Care

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5 health crises that endanger Ukrainian lives as the war continues

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More than 90 attacks on health facilities, ambulances and staff have shaken Ukraine since the start of the Russian invasion.* Although targeting health care providers violates international humanitarian law, such attacks have become increasingly common not only in Ukraine but also in Syria, Yemen and other conflicts.

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This video addresses the large influx of refugees due to the war conflict and World Health Organization working carefully to surveillance any cases of Covid-19 or other infectious disease to treat immediately .

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The health impacts arising from the Ukrainian refugee crisis