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Public health catastrophe looms in Ukraine, experts warn


An aid tent in Kyiv in the aftermath of an explosion at a residential complex on Sunday. Officials fear that wartime conditions will lead to new waves of infectious disease, as well as deaths resulting from lost care.

By Apoorva Mandavilli


A convoy of five vans snaked slowly 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 HIV.


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 HIV 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 HIV.


Sherembei, 45, learned he had HIV 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% drop in new HIV infections and a 36% 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.


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


More than 3 million Ukrainians have fled to neighboring countries, most of them to Poland, and nearly 7 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 HIV 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% 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.


These are the ingredients of a public health calamity, many experts fear. The WHO 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.

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