Ukraine
[Excerpts]
1.2 Access to health care in Ukraine
There are many challenges to accessing health care, with active hostilities and a lack of public transport restricting movement. Close to 1000 health facilities are in proximity to conflict areas or are in changed areas of control, multiple hospitals have been repurposed to care for wounds and half of the pharmacies in Ukraine have closed, which leaves the health system vulnerable to infrastructural damage and severe disruptions in critical services. As a consequence, there is limited or no access to medicines, health facilities, and health-care workers in some areas. Between 24 February and 6 April a total of 91 attacks1 on health care have been reported, resulting in 46 injuries and 73 deaths.2 Further attacks are being verified. Since 24 February 274 hospitals have been shelled, 13 have been completely destroyed, and 70 ambulances have been disabled by shelling…
Risk of emergence and spread of infectious diseases
Ongoing epidemics
The incidence of COVID-19 continues to decrease, with 14 120 new cases and 147 new deaths reported between 31 March and 5 April. However, these numbers should be interpreted carefully due to underreporting of COVID-19 cases and deaths. From 23 February to 6 April the seven-day average number of polymerase chain reaction tests and antigen-rapid diagnostic tests has declined significantly, with a 93% (from 42 460 to 1531) and 89% (from 51 484 to 6194) decrease, respectively. Vaccination uptake remains low, particularly in vulnerable populations, and the disruption in testing and treatment puts those most vulnerable at increased risk of severe illness and death.
Epidemic risk
:: Poor ventilation and overcrowding increase the risk of spread of respiratory infections, including COVID-19. Lack of access to water, sanitation and hygiene (WASH) heightens the risk of emergence of foodborne and waterborne diseases. According to United Nations Office for the Coordination of Humanitarian Affairs (OCHA), around six million people have either limited or no access to safe water, with active hostilities preventing repair teams from fixing damaged systems and restoring access to water while also hindering the delivery of water in the hardest-hit areas, like the Donetsk and Luhansk oblasts. Of note, an outbreak of cholera was reported in 2011 in the Mariupol region, while a single case was reported in 2016 in the Zaporizhzhya oblast, highlighting the risk of cholera outbreaks.
:: Suboptimal vaccination coverage for routine and childhood immunizations, including measles and poliomyelitis (polio), increases the risk of re-emergence and transmission of vaccine-preventable diseases. Notably, two cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported in Ukraine in 2021. On 1 February 2022 a national supplemental polio immunization campaign targeting nearly 140 000 children was launched, but due to the current situation it has been deprioritized and significantly slowed down.3
:: With the arrival of spring and rising temperatures, disrupted access to WASH and damage to homes may increase the risk of vector-borne diseases such as West Nile fever and tick-borne encephalitis.
vaccines and global health :: ethics and policy 