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Eastern Ukraine, Donetska & Luhanska Oblasts GCA: Public Health Situation Analysis (PHSA) – Long-form (Last Update: 28 January 2021)

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By Dr Emanuele Bruni, Iryna Koval, Oleksandra Abrosimova, and Michelle Chalker

Executive Summary

Now in its seventh year, the conflict in Donetska and Luhanska oblasts in eastern Ukraine continues to significantly impact the lives of more than five million people living in the region, 3.4 million of whom require humanitarian assistance and protection services. Since the start of the conflict in 2014, more than 13,000 civilian men, women and children have been killed and approximately 30,000 have been injured. As the crisis persists, civilians continue to bear the brunt of the conflict. Fear of shelling, violent clashes, and the threat of landmines and explosive remnants of war are the daily reality for millions of people living on both sides of the more than 420 kilometre-long ‘contact line’, equivalent to the length of the French-German border. Today, eastern Ukraine is considered one of the most mine-contaminated areas in the world (1).

The conflict has severely impacted the quality of life in eastern Ukraine, with daily hostilities damaging critical infrastructure and often disrupting essential water and sanitation services. Many people are increasingly affected by mental health issues, both due to the fear of violence as well as the long-term socio-economic impacts of the conflict. Once considered the industrial heartland of Ukraine, the region of Donbas has experienced a sharp decline in economic activities since 2014. The quality of life for those who have stayed has declined, with job security a persistent challenge. The COVID-19 pandemic has exacerbated many of these challenges, as well as access constraints for Government- and non-Government controlled areas (1).

According to the OCHA 2020 Humanitarian Needs Overview, of the 1.1 million people living 0-5km away from the ‘contact line’ (0-5km zone) in (GCA). 20% of the conflict-affected people with humanitarian needs are elderly, people with disabilities and children (2).

Within the 5-20km away from the ‘contact line’ in GCA, there are approximately 447,000 people in need of humanitarian assistance (15). This zone remains heavily contaminated with landmines and explosive remnants of war (ERW) and require special attention as it hosts the majority of basic services and facilities that service the conflict-affected regions (33 per cent of operational education facilities and some 40 per cent of the “reorganized administrative hubs”)(2).

Beyond 20km of the ‘contact line’ in GCA, there are approximately 518,000 people in need of humanitarian assistance (15). Even though this area does not currently experience hostilities, the toll of the conflict remains relatively high, particularly with regards to socio-economic pressure (2). Finally, 220,000 internally displaced people who live in Donetska and Luhanska oblasts and in other locations across Ukraine, especially among the estimated 6,800 IDPs living in dire conditions in collective centres (2).

Power shortages, damaged infrastructure, and disruptions in water systems have affected the functioning of health facilities, especially in NGCA. Many health professionals, especially among younger population, fled in 2015 and continue to leave the region. Healthcare is characterised by high prices, medicine shortages, and outdated equipment. This is particularly concerning given that 30% of the population in conflict-affected areas are elderly and suffer from chronic diseases (3).

The elderly, children, the disabled and women are particularly vulnerable. Fifty-six per cent of the people in need are women, 12 per cent are people with disabilities and over 30 per cent are elderly - the highest proportion in the world. Some 700,000 pensioners from NGCA have lost access to their pensions since 2014, which is more than half of all pensioners registered in NGCA in 2014; over 40 per cent of them rely on their pension as the main source of income. Nearly 60 per cent of the people who regularly cross the ‘contact line’ are elderly, and most of them cross from NGCA to GCA to access their social entitlements, including pensions, state administrative services, hospitals, markets or withdraw cash. Some 240,000 children living near the ‘contact line’ regularly experience direct shelling and exposure to landmines and explosive hazards (2).

Prior to the closure of the ‘contact line’ due to the COVID-19-related restrictions, which separates Government and non-Government controlled areas, an estimated 1.1 million people regularly crossed each month to access vital services or visit family. Many waited long hours in the bitter winter cold or in the scorching summer heat to reach the other side. The journey was particularly arduous for the elderly, who account for more than 30 per cent of people in need in eastern Ukraine, the highest proportion of elderly living in a conflict-affected area in the world (1).

Hostilities have also damaged essential community infrastructure and civilian assets. Shelling incidents have routinely affected water, sanitation, health and education facilities cutting the affected population off from basic services. Shelling and other conflict-related incidents affected water and sanitation facilities 88 times in 2019 with more than 300 incidents recorded in the last three years – disrupting access to water for millions of people. Over 35 per cent of some 600 health-care facilities in conflict-affected Donetska and Luhanska oblasts have sustained damage. Since 2017, schools have come under fire at least 95 times, disrupting access to education for thousands of children on both sides of the ‘contact line’. Infrastructure that has not been directly impacted by hostilities has deteriorated due to ageing and the impossibility of upkeep and repair due to the ongoing violence (2).