March 3, 2022 -- The World Health Organization has called on top-level officials involved in the Russian invasion of Ukraine to ensure access for 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 grow more dire in the weeks and months ahead, WHO officials predicted Wednesday. Setting up a secure “corridor” to get these supplies into Ukraine is needed, particularly as pre-positioned supplies placed in 23 hospitals around the country remain largely out of reach at the moment.
The COVID-19 pandemic is making the situation more challenging. Many cities in Ukraine are isolated, and so are their hospitals. At the same time, an estimated 65% of the population in Kyiv is fully vaccinated, but the rate varies considerably, down to only 20% of people in cities of Donetsk and Luhansk.
Add to that an estimated 1 million people who already fled Ukraine into neighboring countries, potentially spreading the coronavirus as they move or find themselves in crowded situations. The situation inside and around Ukraine means coronavirus transmission is likely to rise, WHO officials said during a media briefing.
"WHO is deeply concerned by the unfolding humanitarian emergency in Ukraine," said WHO Director-General Tedros Adhanom Ghebreyesus, PhD.
The first shipment of trauma kits and other supplies is scheduled to leave Dubai in the United Arab Emirates and land in Poland on March 3. On the plane will be 6 metric tons of supplies for trauma care and emergency surgery to meet the needs of 100,000 patients, as well as enough general health supplies to help 150,000 more.
In addition to 5.2 million in U.S. dollars released from contingency funding so far, the WHO plans on spending another $45 million in Ukraine and $12.5 million in neighboring countries supporting the refugees over the next 3 months.
Attacks on Health Care 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 infrastructure, and one confirmed incident last week in which a hospital came under heavy weapons attack, killing four people and injuring 10, including six health workers."
"In the past few days, my main discussions with the [Ukrainian] minister of health is how to ensure that health care workers are protected … the health care workers who have gone through last 2 years treating COVID," said Jarno Habicht, MD, from the WHO Head of Country Office in Ukraine.
"Many of them with whom I talked yesterday are working from the shelters or have repurposed their hospitals," he said.
International law protects access to health care during times of conflict, Adhanom Ghebreyesus said. "The sanctity and neutrality of health care, including of health workers, patients, supplies, transport, and facilities, and the right to safe access to care must be respected and protected."
Supporting Ukraine's Health System
The WHO's primary purpose now is to sustain and preserve the health system so it can serve the people of Ukraine, said Michael Ryan, MD, executive director for the WHO Health Emergencies Program. "We will do everything in our power to make that happen."
The WHO engaged in mass casualty management and major surgical training in hospitals all over Ukraine in the months before the military conflict.
"WHO is not going into Ukraine. We have always been in Ukraine," Ryan said. "We've been in Ukraine for years, working with the government on the health 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 happening there, it's very hard to see how that can be achieved in the coming days," Ryan said. "The tragedy unfolding for the people of Ukraine is so avoidable and so unnecessary."
Don’t Forget the People Behind the Numbers
Many WHO officials are used to addressing humanitarian crises during conflicts, Ryan said. "Some of us have been in this a long time and developed very thick skins. But when you see nurses mechanically ventilating infants in the basements of hospitals, you know even the toughest of us have struggled to watch this."
And it’s hard to carry adults receiving intensive care down to a basement. "So many patients in the ICU are being cared for by doctors and nurses while the bombs fall around them," he said.
Throughout the conflict, it will be important to not just speak in terms of supplies, Ryan said. "This is people's bodies and people's bones that have been broken. People's lives are being lost, and there isn't a health service available to deliver lifesaving care. So something's got to change."
There is 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.
"Second thing you do as it unfolds is you protect your health care system. You've got to protect services. The third thing that is you try and prioritize your vaccinations for your vulnerable people, including for your health care workers," he said.
COVID-19 Concerns Grow
Just before the conflict, Ukraine had a surge of cases of COVID-19, Adhanom Ghebreyesus said.
"There is likely to be significant undetected transmission, coupled with low vaccination coverage, that increases the risk of large numbers of people developing severe disease,” he said.
And it's not just a concern inside Ukraine.
"Anytime you disrupt a society like this and put literally millions of people on the move, infectious diseases will exploit that," Ryan said.
Refugees are highly vulnerable to infection, he said, because they're not eating or sleeping properly, and they are packed together.
This increases their risk for infection and the risk that infection will spread.
"A mild variant could be a very different experience for someone who is in that situation,” Ryan said, adding that refugees should be offered proper vaccination.
The WHO is working on providing antivirals to people in the region.
"This may be one situation where the available therapeutics may be more lifesaving than in other situations," Ryan said. "We've been prioritizing Ukraine over the last 48 to 72 hours for extra supplies of therapeutics for COVID-19, including the newer antivirals."
Not Enough Oxygen
A shortage of oxygen will make it harder to treat patients with COVID-19 and many other conditions. Part of the shortage stems from closure of three major oxygen plants in Ukraine.
In addition, "it's difficult to find drivers who are willing to drive and to bring oxygen from some of the factories, which still have reserves," Habicht said.
An estimated 2,000 people in Ukraine rely on oxygen therapy.
"That's 2,000 people that need oxygen to survive," Ryan said. That number is likely to increase "because we have people with injuries, people undergoing surgery, in addition to the children with pneumonia and women having difficulties during labor."
"And you need it when you need it," he continued. "You can't wait till tomorrow for oxygen. You can't wait till next week. You can't be put on a waiting list for oxygen."
Without enough oxygen or other lifesaving supplies, people will die needlessly, Ryan said.
"In those territories, where the military offensive takes place, and where hospitals are getting isolated and where we don't have access, it's also about electricity, it is also about the medicines," Habicht said.
Addressing Other Health Concerns
The WHO plans to help neighboring countries address key health issues among refugees and forcibly displaced people, including mental health and psychological assistance, as well as treatment for chronic diseases like diabetes, HIV, and cancer.
Insulin, blood pressure medications, and goods and medicines related to sexual and reproductive health and children and maternal health also are needed, Habicht said.
Refugees will also need access to primary health care, said Heather Papowitz, MD, an emergency management specialist for the WHO. Surveillance and vaccination for COVID-19, measles, and polio are paramount, she said.
"But also looking at water sanitation and hygiene to prevent diarrheal diseases.” Everything happening in Ukraine is affecting other countries, Papowitz said.
"It's just a real regional crisis."
What the Future Looks Like
Going forward, it will be important to shift from providing general supplies to supplies specific to wartime injuries, Ryan said. This will include equipment for doing major surgery "and, unfortunately, equipment for doing amputations, bone grafting, and bone wiring."
"I think this gives you the graphic nature of what's happening," he said.
"If the military offensive continues, then the situation that we will see when we meet in a week to weeks, months, or 2 months' time will be much worse that we discussed today," Habicht said.
"Every single life matters, every single life," said Maria Van Kerkhove, PhD, technical lead on COVID-19 for the WHO. "We need to work as hard as we can to not only end the conflict, but to end COVID-19."