Healthcare workers in Ukraine are exhausted.
The war is in its sixth month and shows no signs of ending, with Russia now occupying about a fifth of the country’s territory. The conflict has driven more than 6 million refugees to other European countries, and another 6 million have been internally displaced.
An army of staff on the ground are battling fatigue to maintain health services despite ongoing violence and attacks on health care – all during a pandemic.
“The front line is advancing, my team in the east sees almost daily shelling outside their window. They have been working 24/7 for six months, they are exhausted and the situation is not improving” , Heather Papowitz, emergency coordinator for the World Health Organization’s response in Ukraine, told POLITICO.
Since February 24, there have been 414 attacks on health care in Ukraine, killing 85, according to the WHO’s monitoring system. Very few, like a Russian airstrike on a maternity hospital in the southern city of Mariupol in March, make headlines. There have been a total of 595 attacks on healthcare worldwide this year.
“It’s just an incredible amount,” said Papowitz of Copenhagen, who has just returned from Ukraine after his own trip was cut short because all the armored vehicles were accompanied by field crews. “It really reduces their access to health care.”
Still, staff are doing what they can to ward off the looming specter of increased COVID-19 cases in the fall and winter.
But it’s hard to even sketch the scale of the problem now. As in much of the world, testing for COVID-19 has dropped dramatically, and in times of war the urgency of the pandemic has slipped onto many people’s list of concerns.
“If you think about your priorities and your access to care, you’re more likely to get your diabetes meds than get tested,” Papowitz said.
The disruption of testing and treatment by the war, compounded by low COVID vaccination rates – about 36% for one dose – increases the risks of serious illness and death for the most vulnerable.
It’s no surprise that health care workers give their weight to prevention. But promoting the vaccine is “always difficult,” Papowitz said, citing current skepticism about the COVID vaccine, combined with people prioritizing access to food, water and other health care needs.
But Ukraine is no stranger to coronavirus outbreaks.
In February, more than 31,000 patients were hospitalized with suspected and confirmed COVID-19, while in the previous wave last November, that figure was over 53,000. Although hospitalizations for COVID are currently lower – at around 1,000, according to a Department of Health tracker – there are fears that stress on the health service could make it harder to manage a new surge.
Ukraine has recorded over 5 million confirmed cases of COVID since January 2020, with over 108,000 deaths reported to WHO.
Whatever happens, those on the ground want to be ready. They helped repair an oxygen plant and store other materials like oxygen concentrators and personal protective equipment, Papowitz said.
They are also looking to assess the capacity of the country’s health services to treat patients with COVID and other illnesses, she said. Ukraine has low vaccination rates for all vaccine-preventable diseases, so in addition to COVID, fear of a winter measles outbreak also persists. There are also concerns about the possibility of an increase in flu cases depending on what countries in the southern hemisphere see.
The current response – and preparations for the coming months – are all happening after a number of health workers left the disputed eastern Donbass and other hard-hit areas.
Those still on the ground face less support and greater health risks.
“I’ve been a doctor in very dangerous situations,” said Papowitz, who is an internal medicine and public health physician and has worked in places like Kosovo during the war and amid Chicago’s gang wars.
“I can’t even imagine how they feel after all this time working in this setting.”
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