After almost eight years of conflict, there are an estimated 2.9 million people in need of humanitarian assistance and protection, of which 1.52 million are considered in need of humanitarian health care.The public health situation in the government-controlled areas (GCA) of Donetska and Luhanska oblasts is tenuous, and has only been exacerbated by the COVID-19 pandemic.
This analysis has identified the priority health threats to the conflict-affected population based on the current situation and their expected evolution over the next 12 months. Across Ukraine, COVID-19 is currently the highest priority health threat. With cases and deaths continuing to mount amid low vaccination rates, the health care system is struggling to cope, prompting more strict public health and social measures (PHSM). The situation is not expected to improve until most of the population is vaccinated. The recently reported case of polio in the western part of the country highlights the threat of vaccine preventable diseases. Despite childhood vaccination coverage reportedly being close to WHO targets in 2020, disruptions to immunization programmes due to insecurity and the pandemic place the population in Donetska and Luhanska oblasts, especially children, at risk. COVID-19-related restrictions have also impacted TB and HIV programmes, evidenced by lower case-reporting, potentially delaying treatment of unreported infections and risking further disease transmission in regions known to have higher TB and HIV/AIDS death rates than the national average. Non-communicable diseases (NCDs), such as cardiovascular disease, are the leading cause of death in the conflict-affected oblasts. 8 Reduced access to health care and medicines due to hostilities and the pandemic is likely to increase the burden of NCDs. Mental health and psychosocial support needs of the conflictaffected population are intensifying as a result of the significant distress and indirect socioeconomic effects caused by the COVID-19 pandemic.
Vulnerable groups in the conflict-affected regions are disproportionately impacted by health threats and barriers to accessing health care. Of particular concern in Donetska and Luhanska oblasts are the elderly. It is estimated that 31% of the people in need of humanitarian health care assistance are 60 years and older – the highest proportion of elderly people in need among humanitarian settings in the world. Other vulnerable groups identified in this analysis are people with disabilities (PwD), children and youth, women and girls, victims of human trafficking, people in isolated settlements, health care workers, and internally displaced people (IDPs). Each of these groups has distinctive humanitarian health care needs which demand attention.
Many of the social determinants of health, such as water, sanitation and hygiene (WASH), food security, shelter, security, restriction of movement, continue to be impacted by the conflict and exacerbated by the COVID-19 pandemic. Having an understanding of the status of these determinants gives context to the health issues faced by the conflict population and can help inform intervention planning.
The needs of the health system are highlighted by describing the disruptions experienced by key health system components and the predicted impact of these disruptions over the next 12 months. The assessed areas include access to health care, health care management, health care financing, service delivery of non-state providers, supply chains, alert and response systems, health workforce, health facilities, and attacks against health.
To address the needs of the conflict-affected population and the health system, Health Cluster Ukraine serves as a link between the 69 partners engaged in humanitarian health activities in Ukraine to better coordinate the response. The Health Cluster gathers and shares information to guide partners’ response planning. This PHSA is one of the resources developed by the Health Cluster secretariat to promote a common understanding of the public health situation in the GCA of Donetska and Luhanska oblasts.