In his interview with Interfax-Ukraine, Dr. Jarno Habicht, WHO Representative and Head of WHO Country Office in Ukraine, shared his views on the Ukrainian healthcare system and outlined the main challenges that healthcare faces in wartime.

 

- How can you characterize changes in healthcare in Ukraine during the month of war? What has changed?

- What has changed, first of all, is that very many people have been forced to relocate. According to the UN, more than 10 million people have become forced migrants: about 6.5 million have become internally displaced persons, and about 4 million refugees have left the territory of Ukraine and gone abroad. This means that people who have migrated to other regions of Ukraine will look for opportunities to receive health services in those regions, which will affect the performance of the healthcare system.

Secondly, we are seeing attacks and strikes on healthcare institutions. WHO monitors this information, checks, verifies, and validates it. As of today, we see that there have been 85 strikes against health care facilities. This is unacceptable. This situation threatens doctors, nurses, and other healthcare personnel. In addition, in such a situation, many people are afraid to visit healthcare facilities.

Third, we observe active combat and we see the focus of healthcare shifting to the treatment of trauma, wounds, burns, fractures, etc. At the same time, we understand that this re-focusing means that care for patients with non-communicable diseases, the continuity of care for patients with TB, HIV, and diabetes has a lower priority. We see a disruption in the continuum of care for tuberculosis, HIV/AIDS, diabetes, and other diseases. This means that everything must be done to ensure that such care is provided and the continuity of care is respected.

At the same time, in the face of these displacements, attacks, and strikes on healthcare institutions, the disruption of the provision and continuity of care, we see that the healthcare system in Ukraine is adapting to these changes. For the past five weeks, I have been witnessing the Ukrainian healthcare system adapting, trying to provide services to Ukrainians to the maximum extent possible. I really want to praise my colleagues working in the Ministry of Health, local authorities, and healthcare workers, who are doing their best to provide services 24/7, even in bomb shelters. I want to thank healthcare workers for being able to adapt to such wartime working conditions. 

- According to your estimates, what volume of health services relocated to the western regions after the war broke out?

- The health system has been hit hardest in the East and the South, with most of the forcibly displaced seeking refuge in the West, although the impact is felt in the entire country. It’s important to remember that the consequences are both immediate and long-term. The current challenges to accessing health care, with active hostilities and a lack of public transport restricting movement, are many. Close to 1000 health facilities are in proximity to conflict areas or in changed areas of control. As a consequence, there is limited or no access to medicines, facilities, and health-care workers in areas where there is heavy fighting. Only around half of the countries’ pharmacies are currently open, and WHO has so far, verified 85 attacks on health care; attacks that shake communities to their very core and deprive people of basic health care. Immunization has come to a halt, and cancer treatment and diagnoses are disrupted across the country. That has grave implications, not only today, but further down the line.

- In recent years, Ukraine has been undergoing a health reform, which, among other things, provided for the accounting of health services provided. Under war conditions, such accounting has become more complicated, and healthcare facilities receive funds based on the pre-war indicators. What do you think will be the future of the reform based on the quantitative principles of health services accounting?

- I believe the reform should continue. We understand that even in the face of hostilities, the use of information under these conditions is important and becomes even more important. Sharing information during warfare becomes even more important, especially when people are displaced. Using information from primary care, using statistics from the National Health Service of Ukraine is very important to understand where people are and what services they need. Tracking the provision of services, statistics, and record-keeping from the primary to the other levels really helps to understand the situation correctly, understand the needs of healthcare, and, thus, ensure better provision of these services to Ukrainians. in pain, everyone is in need. It will also be necessary to meet the needs of the healthcare system, from mental health to HIV, TB, and non-communicable diseases.

Therefore, all the work in terms of the reform, even during the war, must continue by adapting approaches and ensuring the delivery of services to the people. Besides, after the war health will be the top priority. We will need to make sure that, first, the powerful institutions that have joined the reform since 2016 are in place.

- What are the consequences of the war that could have the greatest impact on Ukraine’s healthcare system – bombing of hospitals, migration of health professionals, spread of infectious diseases, limited access to treatment and medicines, and the like?

- In fact, each of these aspects is crucial and they are all very important. This includes displacement of people, strikes on healthcare, displacement of healthcare providers, which leads to a lack of appropriate specialists in the right places – all of these have a huge impact. Moreover, the disruption of supply chains and systems is also a challenge. This means that the right drugs and medical devices may not be available in the right place at the right time.

All this has a huge negative implication. 

Besides, an important point is a certain restructuring in terms of adapting the healthcare system to today’s current needs. We can say that the healthcare system in Ukraine today is undergoing a stress test, but we can see that it is working, it is operational, and continues to work. In recent weeks, we have seen how it is adapting and how the health system, together with the international humanitarian aid component, is adapting to the new conditions.

Despite the challenging stress test for the system, it remains functional. Over the past few weeks and within the next weeks, it is very important to monitor how the health system and the humanitarian response, where necessary, will work together.

- Does the WHO provide assistance to Ukraine in war settings? If so, what kind of assistance?

- We have a $45 million dedicated budget for the health sector for the next three months. And now another delivery of humanitarian aid is in progress. Humanitarian convoys bring commodities such as trauma supplies and other supplies to support primary care.

In total, we have already delivered 160 tons of medical supplies in the last five weeks. In recent weeks, deliveries have been made to Zaporizhia, Kyiv Oblast, Kyiv City, Sumy, Kharkiv, Chernihiv, Poltava, and Odesa. 

We continue doing this work every day, just as other people and supporting organizations do. In addition, as the WHO, we are not only continuing our humanitarian response but also thinking about how to strengthen the health system in the future.

- What exactly is included in this aid – medications, medical devices, medical equipment?

- WHO shipments include medical supplies to support trauma, surgery and primary health care in Ukraine such as oxygen, insulin, surgical supplies, anaesthetics, and transfusion kits to collect, test and safely transfuse blood. Oxygen generators, defibrillators, monitors, rehydration salts, gauze and bandages, have also been delivered – the list is long. We work in close coordination with the Ministry of Health of Ukraine. Together with our partners, we have so far reached half a million people - with medical, emergency and trauma supplies. The UN as a whole has reached close to a million people with life-saving aid, to date.  

- How does WHO assess the work of military medicine in Ukraine, since it differs from peacetime medicine? Are there consultations with international experts in this domain?

- I would like to note that Ukrainian health professionals have had experience in dealing with such challenges since 2014. In general, healthcare workers in many countries, including Ukraine, are well-trained to work with trauma and injuries. We see that many hospitals are being completely repurposed for trauma and injury care. They require sufficient supplies to save the health and lives of citizens. In my opinion, Ukrainian doctors and nurses are doing their best. Furthermore, we also see the involvement of international emergency medical teams. We are in constant dialogue with our partners and the Ministry of Health of Ukraine, and we see that Ukrainian doctors and nurses are now keeping the situation under control.

- Regarding medical needs in wartime: Are there enough drugs and medical technologies required specifically for treating wartime injuries?

 - Ukraine’s health system and health workers have shown remarkable resilience in past weeks. Many have been impacted by the conflict themselves but continue working in order to save lives. Several hospitals have been repurposed; down-prioritizing their regular services – to treat the wounded. Stocks of medicines and equipment in the country are not endless and will at some point be depleted. The longer the conflict drags on, the greater the challenge in sustaining medicine and equipment supplies. That is why WHO works around the clock on shipping trauma and emergency surgery kits, medical equipment and essential medicine, to the most affected regions.

- What role can WHO play in resolving military conflicts? Will the negative stories concerning the International Committee of the Red Cross (ICRC) affect the activities and image of international humanitarian organizations?

- It is not WHO’s mandate to solve conflicts. The WHO is primarily tasked with supporting health systems, health workers and patients and that is what we’re doing in Ukraine, 24/7. Negative stories about ICRC have been fueled by misinformation on social media. This is not a new phenomenon but becomes heightened and more intense during the war times. The rumors about ICRC put their staff at risk and prevent them from carrying out their humanitarian duty.