March 3, 2022 – The World Health Organization has called on senior officials involved in the Russian invasion of Ukraine to ensure access for the delivery of essential medical, surgical and trauma supplies to help the Ukrainian people and refugees in neighboring countries.
A shortage of oxygen, insulin, cancer therapies and other essential supplies will continue to worsen in the weeks and months to come, WHO officials predicted on Wednesday. Establishing a secure “corridor” to get these supplies to Ukraine is necessary, especially as pre-positioned supplies placed in 23 hospitals across the country remain largely out of reach at this time.
The COVID-19 pandemic is making the situation more difficult. Many cities in Ukraine are isolated, as are their hospitals. At the same time, it is estimated that 65% of the population of Kiev is fully vaccinated, but the rate varies considerably, up to only 20% of the inhabitants of the cities of Donetsk and Lugansk.
Add to that an estimated 1 million people who have already fled Ukraine to neighboring countries, potentially spreading the coronavirus as they move or find themselves in crowded situations. The situation in and around Ukraine means transmission of the coronavirus is likely to increase, WHO officials told a news conference.
“WHO is deeply concerned about the unfolding humanitarian emergency in Ukraine,” said WHO Director General Tedros Adhanom Ghebreyesus, PhD.
The first shipment of trauma kits and other supplies is expected to leave Dubai in the United Arab Emirates and land in Poland on March 3. On the plane, there will be 6 tonnes of supplies for trauma care and emergency surgery to meet the needs of 100,000 patients. , as well as enough general medical supplies to help 150,000 more people.
In addition to the US$5.2 million released so far, WHO plans to spend an additional US$45 million in Ukraine and US$12.5 million in neighboring countries to support refugees over the next 3 months .
Attacks on healthcare workers
“We are also deeply concerned about reports of attacks on health facilities and health workers,” Adhanom Ghebreyesus said. “We have received several unconfirmed reports of attacks on hospitals and health facilities, and a confirmed incident last week in which a hospital was attacked with heavy weapons, killing four people and injuring 10, including six health workers”.
“In recent days, my main discussions with the [Ukrainian] Minister of Health is how to ensure that health workers are protected … health workers who have spent the last 2 years treating COVID,” said Jarno Habicht, MD, of the country office chief of the WHO in Ukraine.
“Many of them I spoke with yesterday are working from the shelters or have remodeled their hospitals,” he said.
International law protects access to healthcare in times of conflict, said Adhanom Ghebreyesus. “The sanctity and neutrality of health care, including health workers, patients, supplies, transport and facilities, and the right to safe access to care must be respected and protected.”
Support the Ukrainian health system
WHO’s main focus now is to support and preserve the health system so it can serve the people of Ukraine, said Michael Ryan, MD, executive director of WHO’s health emergencies program. “We will do everything in our power to make this happen.”
The WHO engaged in mass casualty management and major surgical training in hospitals across Ukraine in the months leading up to the military conflict.
“WHO is not going to Ukraine. We’ve always been to Ukraine,” Ryan said. “We have been in Ukraine for years, working with the government on the healthcare system.”
But the WHO cannot support the health system unless it can bring in supplies and distribute the supplies already in the country, he said.
“Right now, in the chaos of what’s going on out there, it’s very hard to see how this can be achieved in the next few days,” Ryan said. “The tragedy unfolding for the Ukrainian people is so avoidable and so unnecessary.”
Don’t forget the people behind the numbers
Many WHO officials are used to dealing with humanitarian crises during conflict, Ryan said. “Some of us have been in this business for a long time and have developed very thick skin. But when you see nurses mechanically ventilating infants in hospital basements, you know that even the toughest of us have hard to watch.”
And it’s difficult to transport adults receiving intensive care in a basement. “So many intensive care patients being cared for by doctors and nurses while the bombs are falling around them,” he said.
Throughout the conflict, it will be important not to talk only about supplies, Ryan said. “These are people’s bodies and bones that have been shattered. Lives are being lost and there is no health service available to provide life-saving care. So something has to change.”
There’s only one simple answer, said Bruce Aylward, MD, senior adviser to the WHO director general.
“What can we do about it? Number one: stop the war,” he said.
“The second thing you do as you go is protect your health system. You have to protect services. The third thing is you try to prioritize your vaccinations for your people. vulnerable, including for your healthcare workers,” he said. .
COVID-19 concerns are growing
Just before the conflict, Ukraine saw an upsurge in COVID-19 cases, Adhanom Ghebreyesus said.
“It is likely that there is significant undetected transmission, coupled with low vaccination coverage, which increases the risk of large numbers of people developing severe disease,” he said.
And it’s not just a concern inside Ukraine.
“Any time you disrupt a society like this and literally set millions of people in motion, infectious diseases are going to exploit that,” Ryan said.
Refugees are very vulnerable to infection, he said, because they don’t eat or sleep properly and are crowded.
This increases their risk of infection and the risk of spreading the infection.
“A mild variant could be a very different experience for someone in that situation,” Ryan said, adding that refugees should be offered an appropriate vaccination.
WHO is working to provide antivirals to people in the region.
“This may be a situation where the available treatments may be more life-saving than in other situations,” Ryan said. “We have prioritized Ukraine over the past 48-72 hours for additional supplies of COVID-19 therapeutics, including new antivirals.”
Not enough oxygen
A shortage of oxygen will make it more difficult to treat patients with COVID-19 and many other conditions. Part of the shortage stems from the closure of three large oxygen plants in Ukraine.
In addition, “it is difficult to find drivers who agree to drive and bring oxygen from certain factories, which still have reserves,” Habicht said.
An estimated 2,000 people in Ukraine depend on oxygen therapy.
“That’s 2,000 people who need oxygen to survive,” Ryan said. This number is likely to increase “because we have injured people, people undergoing surgery, in addition to children with pneumonia and women having difficulties during labour”.
“And you need it when you need it,” he continued. “You can’t wait until tomorrow for oxygen. You can’t wait until next week. You can’t be put on a waiting list for oxygen.”
Without enough oxygen or other life-saving supplies, people will die unnecessarily, Ryan said.
“In these territories, where the military offensive is taking place, where the hospitals are isolated and where we don’t have access, it’s also a question of electricity, it’s also a question of medicine,” Habicht said. .
Respond to other health issues
WHO plans to help neighboring countries address key health issues for refugees and forcibly displaced people, including mental health and psychological assistance, as well as treatment for chronic diseases such as diabetes, HIV and cancer.
Insulin, blood pressure medications, and products and drugs related to sexual and reproductive health and child and maternal health are also needed, Habicht said.
Refugees will also need access to primary health care, said Heather Papowitz, MD, emergency management specialist for the WHO. Surveillance and vaccination against COVID-19, measles and poliomyelitis are paramount, she said.
“But also looking at water sanitation and hygiene to prevent diarrheal disease.” Everything that happens in Ukraine affects other countries, Papowitz said.
“It’s just a real regional crisis.”
What does the future look like
Going forward, it will be important to shift from providing general supplies to specific supplies for war-wounded, Ryan said. This will include equipment to do major surgeries “and, unfortunately, equipment to do amputations, bone grafts and bone wiring”.
“I think it gives you the graphic nature of what’s going on,” he said.
“If the military offensive continues, then the situation we will see when we meet in a week, weeks, months or 2 months will be much worse than what we discussed today,” Habicht said.
“Every life matters, every life,” said Maria Van Kerkhove, PhD, technical lead on COVID-19 for WHO. “We must work as hard as possible not just to end the conflict, but to end COVID-19.”