Dr. Jarno Habicht, WHO Head of Country Office in Ukraine, WHO Representative, in an interview with the Interfax-Ukraine agency told about the impact of the war and the aggressor's actions on the medical infrastructure and access of Ukrainians to medical services

Text: Anna Levchenko

 

What are the main problems currently identified by the WHO in the field of health care and medicine in Ukraine? Which of these problems are related to war?

After eight months of the Russian invasion of Ukraine, the country’s critical infrastructure has been affected but the resilient health system continues to provide life-saving care with the support of WHO and partners as it prepares for a challenging winter ahead.

Access to healthcare has been stymied due to the war amid ongoing attacks against healthcare which renders some healthcare facilities non-functional and significantly impacts how people access healthcare.

The ongoing war has also significantly impacted supply lines to allow for the provision of life saving medical supplies to reach those most in need by humanitarian actors, including WHO. Ensuring access to life saving medical supplies to newly accessible areas in Ukraine remains one of the key priorities for WHO in Ukraine and we continue to bring in much needed supplies to these areas.

WHO has verified more than 660 attacks against healthcare in Ukraine since 24 February 2022. National authorities have also recorded attacks on healthcare in the country. These attacks mark a violation of international law and have injured or killed healthcare workers, patients, and have disrupted supply lines, and damaged hospitals and health facilities.

Other issues related to health include the increase in chronic diseases including hypertension, high blood pressure and other noncommunicable diseases. The mass displacement of populations within Ukraine has also caused additional strains on local health facilities, especially in the small towns and rural areas as health systems learn to adapt.

Recent health needs assessment conducted by WHO in Ukraine has shown that spiraling costs, logistical hurdles and damaged infrastructure are making access to essential services all the more challenging for growing numbers of civilians. Read more.

Does the WHO have answers to solve these problems based on the experience accumulated by other countries, or is the experience of Ukraine unique to some extent?

WHO works in close collaboration with the Ministry of Health, national and local healthcare authorities and its more than 150 partners on the ground to work for the recovery of the healthcare system in Ukraine.

WHO is one of the largest suppliers of medicines to Ukraine and has delivered more than 1,300 metric tonnes of medical supplies to the country since the Russian invasion on 24 February 2022. These supplies include oxygen generators to ensure the continued functioning of ICU units, power generators to ensure that hospitals can continue to function and provide life saving care during emergencies, surgical kits, essential medicines to treat chronic diseases, ambulances and much more. These supplies can often mean the difference between life and death and allow for the healthcare system to continue functioning even among some of the direst of circumstances.

We continue to bring in much needed supplies to newly liberated areas as well, including in the Kharkiv and Donetsk regions. Areas including Izium, Lyman, Kharkiv and Sviatohirsk have been reached in the last few weeks with life-saving humanitarian supplies and more areas will be reached in the coming days and weeks.

WHO also works programmatically across a range of areas to ensure that it is responding to health needs in Ukraine. In collaboration with the Office of the First Lady, WHO supports the provision of mental health and psychosocial support for the civilian population and healthcare workers. Tens of thousands of psychosocial support consultations have been held since the war.

WHO has trained thousands of healthcare workers across a range of needs including gender based violence, trauma surgery, mass casualties, chemical exposure, epidemiology and laboratory diagnostics. WHO also supports the continuation of COVID-19 vaccination with vaccine donations through COVAX facility and other immunization programmes, all the more critical as winter approaches with an expected rise in respiratory infections.

Supporting the coordination of Emergency Medical Teams across Ukraine in providing medical consultations, trauma and emergency surgery, and rehabilitation supplies, and supporting medical evacuations.

We continue supporting the project of mobile health unit teams for 7 regions to ensure continued access to health care. It is focused on treating non-communicable diseases, including cardiovascular disease, hypertension, respiratory disease and diabetes, which remain the leading cause of premature deaths in Ukraine. WHO is also helping to distribute medicines for NCDs in hard-to-reach areas with a focus on the most vulnerable.

What assistance does the WHO provide to Ukraine? How and by whom is the provision of this assistance coordinated?

WHO coordinates with authorities at the national level with the Ministry of Health of Ukraine and at the local level with health authorities and facilities. WHO support is complementary to efforts made by authorities at the national and local levels. We also coordinate with fellow UN agencies and more than 150 humanitarian partners, as WHO is the Health Cluster lead agency.

Does WHO monitor the distribution/use of the aid provided?

We have established an effective supply chain that enables us to bring tonnes of health supplies into Ukraine and distribute these throughout the country in coordination with the Ministry of Health.

The emergency prepositioning of medical supplies in regional warehouses ensure that they are ready for immediate use in the areas as acute needs emerge. For this purpose, besides our main office in Kyiv, we have established five regional hubs with warehouses in Lviv, Vinnytsia, Odesa, Dnipro and Poltava.

WHO in Ukraine is in regular dialogue with healthcare authorities at the national and local level and monitors the distribution of and use of aid that is provided.

How does the WHO assess the prospects for the post-war recovery of the health care system? How much money do you need for this? How much time will it take?

A key question that must guide recovery is how to ensure that key health services reach populations that need them the most. While re-building some facilities may be part of the answer, WHO is also committed to supporting the long term recovery of the healthcare system in Ukraine. 

Building a better, smarter health system is as much about improved processes and policies as it is about increased investment in healthcare. Strengthening the health workforce, ensuring the availability of affordable pharmaceuticals and other critical medical supplies, and driving evidence-based change through the effective use of data and clinical and public health practices remain a priority for WHO in Ukraine.

Investing in health doesn’t only ensure well-being, it also lays the foundation for long-term national recovery and growth. The availability of health services and medicines convey a sense of security and normalcy for all and promotes reconciliation and trust in local and national government. In short, health must be at the center of recovery.

What attention should be paid to supporting the mental health of Ukrainians during the war? What resources will be needed to support the mental health of Ukrainians after the war?

It is estimated that one in every fifth person in conflict settings have a mental health condition. Ukraine is no exception. An estimated 22% of the population currently living in areas affected by conflict will, at any time during the next 10-year period, likely have some form of mental health challenge - with one in 10 suffering from a moderate or severe condition like depression with suicidal behavior or psychosis. People with pre-existing mental health conditions who previously relied on public mental health and social care are facing additional challenges in accessing the services they need.

The population are also affected by anxiety or sadness, difficulty sleeping, fatigue, anger and unexplained somatic symptoms. Ensuring people in Ukraine and healthcare workers have continued access to mental health and psychosocial support is a priority for WHO in coordination with its partners on the ground. 

Everyone should value and be aware of how to protect ones mental health and wellbeing. In this regard, basic self-help strategies and the practice of basic stress management techniques must be prioritized during these challenging times and consulting the services of public health facilities and mental health specialists where necessary.

However, we believe that with such a level of commitment and innovation from the Government and First Lady office – Ukraine is well positioned to advance its mental health system and services quite quickly as many preparatory steps have been taken as a part of ongoing reforms in this area in the past years.

Does Ukraine have the appropriate infrastructure? What help can WHO provide in this direction?

WHO provides technical guidance to the Ministry of Health and to the Office of the First Lady as well as other partners. WHO also chairs a group of up to 300 partners working in the mental health and psychosocial fields in Ukraine through the promotion of best practices, the training of first-line responders in stress management, the training of PHC staff in management of common mental health conditions.

Ukraine has taken steps to revise its mental health infrastructure. This process was initiated before the war. In the context of the war, the structures for supporting mental health should be further carefully planned, supported and successfully implemented in the end as supporting mental health is critical for Ukraine’s recovery.