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Ukraine: Public Health Situation Analysis (PHSA) - Long-form (Last Update: July 2022)

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Ukraine
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Health Cluster
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Executive Summary

Note: This update to the Public Health Situation Analysis (PHSA) builds upon the rapidly-developed document published on 3 March 2022 and the update published on 29 April 2022. This update adds depth to the information presented in the previous version, tracks changes in the situation, considers additional threats, and incorporates data from assessments.

Health Cluster Ukraine continues to serve as the coordinating link between over 149 partners engaged in humanitarian health activities in Ukraine. This Public Health Situation Analysis (PHSA) is one of the resources developed by the Health Cluster secretariat to promote a common understanding of the public health situation in Ukraine.

The invasion of Ukraine on 24 February 2022 has caused massive civilian displacement and casualties. An estimated 6.6 million people are internally displaced,2 and approximately 6.2 million have fled from the conflict and registered as refugees across Europe. 3 As of 24 July 2022, 12 272 civilian casualties were recorded, with a reported 5237 killed and 7035 injured. 4 The number of attacks against health facilities and the use of heavy weapons to commit the incidents is extremely high given the short period of time. As of 27 July 2022, there were verified 414 attacks on health care, which took the lives of 85 people and injured 100 people.5

Health status and threats

With large population movements, increased social mixing, and disruption of vaccination services and surveillance, there is an increased risk of outbreaks of vaccine-preventable and other outbreak-prone diseases. Prior to the war, vaccination coverage was particularly low for polio, measles and hepatitis B (HBV), and COVID-19 vaccine uptake was among the lowest in Europe.Tuberculosis (TB), HIV and viral hepatitis programmes have been disrupted, impeding access to medicines and potentially interrupting testing and delaying treatment. In 2020, Ukraine had the second highest rate of newly diagnosed HIV infections in the WHO European Region7 and had been identified as one of the top 20 countries with the highest estimated number of drug-resistant TB cases.8

Ukraine also has a very high prevalence of non-communicable diseases (NCDs) and their behavioural and biological risk factors, especially in men.9 Access to essential health services and medications are crucial for the treatment of NCDs, particularly prevalent in older persons, many of whom have been unable to flee due to reduced mobility.

There have been increasing reports of gastrointestinal infections and bacterial diseases; 10 in the in first six months of 2022, there has been a 40% increase in the number of cases of acute intestinal infections compared to the same period in 2021. 11 Botulism cases, linked to the consumption of contaminated meat and fish, have been reported in several oblasts. In addition, waterborne diseases are likely to become widespread in conflict zones, particularly over the summer months.
A lack of access to water due to disruption to services and damage to distribution systems has resulted in increased reliance by the population on well water, rainwater, and water run-off. 12 As a result, thousands of civilians are at risk of contracting illnesses such as cholera and dysentery, due to damaged water and sanitation systems, especially in areas around the Azov Sea.

Ukraine’s maternal mortality ratio remains among the highest levels compared to neighbouring countries, nearly 10 times that of neighbouring Poland, and the war is likely to worsen the situation. 13 It is estimated that there were around 265 000 women pregnant in Ukraine at the time of the invasion, and that roughly half (132 500) of these pregnant women will deliver by the end of July 2022. 14

Vulnerable groups affected

Vulnerable groups are disproportionately impacted by health threats and barriers to accessing health care. Vulnerable groups in the conflict-affected regions include people over the age of 60, people with disabilities, children and youth, women and girls, victims of human trafficking, Roma, health care workers, and internally displaced persons (IDPs). The majority of the displaced population are women and girls, increasing the need for woman-, adolescent- and child-specific services. However, men both on and off the battlefield are at a high risk of war-related injury and death, as well as psychological trauma, increasing the need for, among others, rehabilitation as well as mental health and psychosocial support.

Infrastructural damage

The war has caused significant infrastructural damage, leaving hundreds of thousands of people without electricity or water. 15 Around six million people either have limited or no access to safe water, with active hostilities preventing repair teams from fixing damaged systems and restoring access.

The ongoing hostilities continue to disrupt local supply chains. Nationally, one third of households were found to be food insecure. 16 Oblasts in the eastern and southern parts of the country recorded the highest level of food insecurity, with one in every two households being food insecure.

Health system needs

According to the Ukrainian Ministry of Health (MOH), as of 24 July, more than 746 health care facilities are in need of restoration, and more than 123 destroyed, since the beginning of the war.17 WHO’s/Health Cluster’s Attacks on Health Care Team has verified 414 attacks on health care, including 350 reports of attacks affecting health facilities, as of 27 July. 18 Many health care workers have had to leave their health facilities due to the conflict.
The supply chains for medicines and medical supplies have been disrupted, creating urgent need in conflict-affected areas. The availability of pharmacies has improved across the country, but regional differences remain, particularly in places where there is active conflict on the ground.

Humanitarian response

The Health Cluster, led by WHO, currently links 149 partners (NGOs, UN agencies, national authorities, donors, and observers) engaged in the humanitarian health response in Ukraine. The majority of implementing partners are national NGOs.

Meeting health needs and ensuring that reconstruction efforts are successful will continue to be shaped by the duration and nature of the war. Maintaining and strengthening strategic- and operational-level awareness of the various support networks at national, regional and global level remains vital, including within the context of identifying and addressing gaps and synergies in a timely and effective manner.