Ukraine

Ukraine crisis strategic response plan for June-December 2022

Attachments

Overview

This WHO Strategic Response Plan (‎SRP)‎ will be implemented in collaboration with partners providing life-saving support to people affected by the conflict in Ukraine, whether they are inside or outside Ukraine. It is an overarching framework built on the Ukraine Flash Appeal 2022 to guide priorities and work, according to access and location, in support of national and local authorities who are leading the readiness, response and early recovery activities. The timeframe of this SRP is six months.

Context

On 24 February 2022, the Russian Federation military offensive commenced in Ukraine. Since then, intense hostilities have been escalating across Ukraine, including around the capital, Kyiv, in the north, and in the eastern, southern and western parts of the country, triggering one of the world’s fastest-growing displacement and humanitarian crises. To date, more than one-third of Ukraine’s entire population has been displaced: 8 million people, of whom 60% are women and 40% men, have been internally displaced, and over 6.3 million people, of whom 90% are women and children, have fled across the border to neighbouring countries, with the United Nations High Commissioner for Refugees (UNHCR) reporting 2.5 million people continuing their journey to other countries. At the same time, authorities have reported more than 1.8 million movements back into the country (1).
Another 13 million people have been directly affected in the hardest-hit areas of north, east and south Ukraine, including many who have been trapped in hotspots of intense fighting, or stranded due to destruction of infrastructure, and who face acute shortages of food, water and medical care. This is on top of eight years of armed conflict already in eastern Ukraine. As of 26 May, there were 8766 civilian casualties in the country, including 4031 killed and 4735 injured, according to the Office of the United Nations High Commissioner for Human Rights (OHCHR) (2).
More than half of all casualties so far verified were recorded in the government- and non-government-controlled areas of the Donetska and Luhanska oblasts. Attacks on health care, including those against health facilities, transport, personnel, patients, supplies and warehouses, continue.
Cumulatively, between 23 February and 30 May, 265 attacks were reported, resulting in 59 reported injuries and 75 reported deaths (3).
In addition to the immediate devastating physical and psychological impacts of ongoing violence and attacks, the unfolding humanitarian crisis is impacting, and will impact, everyone in the country in a variety of ways that will increase morbidity and mortality in the medium- to long-term. Some 300 health facilities are located in conflict areas, and 1000 health facilities are in areas where control has changed, which leaves the health system vulnerable to infrastructural damage and severe disruptions.
Consequently, there is limited or no access to medicines, health facilities, or health care workers in some areas.
Nearly 50% of Ukraine’s pharmacies are presumed to be closed, and many health workers are either displaced or unable to work.
Emergency medical services, surgical departments and intensive care units have been overwhelmed with trauma patients. Accessing health care has been limited, essential health services have been disrupted or are collapsing, and the treatment of chronic/noncommunicable diseases, such as diabetes, cancer and cardiovascular disease, has been jeopardized. Equally, mental health, sexual, reproductive and maternal health care, antenatal care, child health and assistance to people with disabilities are also being severely compromised. The long-term physical and mental health and psychological impacts, including those due to genderbased violence, cannot be underestimated.
Health care service disruption coupled with conflict conditions has also increased the affected population’s vulnerability to communicable diseases, such as COVID-19, tuberculosis, polio and measles. Low vaccination coverage increases the risk of outbreaks of preventable communicable diseases, particularly among children; the COVID-19 pandemic and the recent reported cases of polio in the western part of the country compound this risk.
Population movements across borders continue to be unpredictable. UNHCR estimates that, by the end of 2022, about 4.2 million refugees will remain in these neighbouring countries and another 4.1 million will have continued onwards to other countries in the WHO European Region, such as Germany, Czech Republic and Bulgaria, as well as beyond (4).
Most refugees are women and children due to a ban in place on Ukrainian men aged 18–60 leaving the country. There are reports of vulnerable and marginalized populations among the refugee population, including older people, persons with disabilities, and ethnic minorities. Nearly one-third of the displaced households have a child under the age of five and more than half have an elderly person. The provision of family friendly services that cater especially to mothers and children will be critical.
Governments in countries neighbouring Ukraine and those of final destination for refugees have generously kept their borders open, and local communities have welcomed refugees and other persons of concern. These governments and health authorities are leading the response for this crisis, with UN agencies and non-governmental organizations (NGOs), and local responders, including civil society organizations, faith-based institutions, refugeeand women-led organizations, academia and the private sector, as well as private citizens, playing an important role in supporting and complementing state authorities’ efforts. Local and national authorities have established reception facilities at border crossing points to receive new arrivals as well as urgent medical referrals from within Ukraine, and are providing life-saving assistance, including accommodation, food, emergency medical care and other basic needs. They are then providing onward transport to referral health facilities as well as for those seeking to reach urban centres. At these urban centres, information is provided on the asylum process and temporary protection, as well as on the risks of trafficking. Access to basic rights and services, such as health, has been facilitated.
On 4 March, European Union (EU) Member States activated the Temporary Protection Directive (TPD) for the first time.
Under the TPD, Member States grant temporary protection (TP) to Ukrainians and persons with protection status in Ukraine and their family members residing in Ukraine before 24 February. The TPD enables access to national health services at the same level as host communities, including free access to health services in line with national regulations. Steps have been taken to foster protection and inclusion into national systems, such as for health and education services. While this may be feasible in the short-term for many EU countries, it is critical to monitor access and financial barriers for both refugee and host populations, as even now some countries, such as Republic of Moldova, may not be able to afford equitable access for increased populations.