WHO warns of worsening health situation in Ukraine

One year on from the Russian invasion of Ukraine, data from the World Health Organization reveal a growing health crisis. About 44% of people in liberated areas are seeking health care for chronic conditions, such as kidney and heart disease. One in 3 people can no longer afford to buy medicines. An estimated 10 million people may have a mental health condition. All this is happening against a backdrop of continued attacks on health care in the country. Since the war started, WHO has recorded more than 800 attacks on health care, a huge majority of which damaged or destroyed facilities, including hospitals and pharmacies. “This is not the time to let fatigue win, because we expect a worsening of the situation.” --— Dr. Hans Kluge, regional director for Europe, World Health Organization The data however only show part of the tragedy. There’s little information on the health situation in Russian-occupied areas. “One of the messages I took away from the meeting with the heads of U.N. agencies is that the impact of the war on health is not going to diminish in the next month. Most likely, regretfully, it’s going to increase,” Dr. Hans Kluge, regional director for WHO in Europe, said last week during his visit to the country. Devex spoke with Kluge on how the health situation in the country has evolved, the challenges facing aid groups, the threat of donor fatigue, and what health recovery will look like for Ukraine. The conversation below has been edited for length and clarity. It’s one year of the war in Ukraine. How much has the health situation changed, and what do you see as the biggest impact of the attacks on health care? This is my fifth time … coming here. And somehow, I'm always amazed [at] the heroic health workforce — the doctors, the nurses. They're staying [and] saving lives despite the bombing, despite the huge attacks on the civilian and energy infrastructure, which of course has a huge impact on health and health care. But of course, there are huge, huge issues. For example, if we speak [about] the liberated areas, where there's a lot of destruction … what we see there is that … 44% of the people there are seeking health care for chronic conditions. Initially we focused quite a bit on communicable disease, on vaccination. It's now a lot about cardiovascular disease, hypertension, diabetes, kidney disease. And that's a huge issue, because our latest health survey shows that 1 in 3 people say they can no longer afford the medicines they need, because of the costs. We [together with the government also] launched a mental health project. We estimate that about 10 million people are in need of care for mental health, with about 4 million really severe to moderate. And then the other thing that the prime minister was asking particularly to double our support is in the field of rehabilitation and prosthesis. You mentioned challenges in access to medicines. What's the biggest challenge for agencies like WHO and your partners in addressing this problem? Yes, a number of points here. First is I'm always reminded when driving in this country how vast, how huge this country is. Basically, if you add up all the humanitarian support and development support of all agencies, still there's a huge need. So this is number one. Number two is that we see also from our annual health survey that the areas where there are hostilities … are reporting [many] more barriers accessing medicines. And then not to forget also the internally displaced persons reporting quite some barriers to health care. And here I would like to make a pitch for reproductive health services … That's something that we really, really have to keep in mind. And maybe finally … the black hole, which is Mariupol and Donbas … to get sustained humanitarian access. We have informal reports that there are about 15,000 HIV/AIDS patients there running out of [antiretroviral therapies]. Does WHO have access to the occupied areas? How would you describe access to health care there? No. That's really our concern. In the occupied areas we need humanitarian corridors from the Ukrainian side to reach people in need. But we also need cross-line access. In fact, I have, let's say, gotten some reassurances that it may be possible to enter, but … we need cross-line support [and] we don't have it. That’s a big concern. There's this perception that the war in Ukraine has taken away resources for other crises. But is donor fatigue also becoming visible in Ukraine? What are the health consequences of that? This is not the time to let fatigue win, because we expect a worsening of the situation. But do you see donor fatigue already happening? Do you see that in the financing and engagement by donors in Ukraine? We have just launched as part of the overall U.N. appeal, the WHO appeal of $240 million — $160 million for Ukraine, $80 million for the refugee-receiving countries. Now, we will see in the next weeks or months [the response] to that. I do feel a lot of support from the West, but of course this is a concern … also by the government, that fatigue may come in. There's been some talk of Ukraine recovery and reconstruction. What does that look like for health, where do you see the most important priorities and how feasible is it to accomplish today? Actually, I just came in from London … where we discussed with the ministries of foreign affairs and health [of the U.K. about] the recovery conference in June in London, and the question came up there about the place and the priority for health and health systems. So definitely we made the case that this is the time … but there is a belief here that the [health system of Ukraine] should not go back to how it looked before. I was, for example, in Chernihiv, on one of my missions at the border with Belarus and the Russian Federation. We were close to a building completely destroyed when the minister who was with me [said], “Hans, our idea is not to go for building … expensive TB hospital and expensive HIV/AIDS hospital, but a modern infectious disease clinic linked to the primary health care, linked to mobile teams.” So I think the plans are shaping up very nicely. But of course, the most important message remains peace.