Healthcare impact of Ukraine war: War is a manmade public health problem. The impact of war on public health has been extensively documented, and the role of public health professionals in eluding and mitigating the impact of war is unequivocally clear. In 2011, the World Federation of Public Health Associations passed a resolution recommending that public health professionals become active advocates for legislation related to the arms trade, ratifying treaties and protocols related to war, and developing initiatives that address the structural causes of war.
The impact of war on populations arises from the direct effects of combat—namely, battle deaths—and from the indirect consequences of war, which may occur for several years after a conflict ends.
The policy statement The Role of Public Health Practitioners, Academics, and Advocates in Relation to Armed Conflict and War was accepted by the American Public Health Association in 2009. Despite the acknowledged health effects of war, little attention has been paid to developing skills to avert war. The ethical practice principles of public health place a premium on treating the root causes of disease and adverse health consequences.
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A working group offered skills for understanding and preventing the political, economic, social, and cultural drivers of war, notably militarism. According to the working group, schools of public health and public health organisations should incorporate these competencies into professional preparation programmes, research, and advocacy (Wiist et al. 2014).
As Russian troops continue to occupy Ukraine, we need to remind ourselves of the impact of war on health. The public health perspective on war is evident. More than bodies and minds are lost in war; war breaks the fabric of human society apart, severing ties between people and the places where they live and amplifying the social and structural determinants of health. Often public health institutions are the first casualties of war.
Human habitation, healthcare institutions and the environment are physically contaminated by war. A traumatic memory can make finding serenity hard. There can be no real prospects for human health or thriving without peace. For today’s Ukrainians, the invasion is more than a tragedy. It will also have a significant impact on future generations’ well-being.
The impacts of war on one’s health are both personal and broad. Health consequences are immediate; people are injured or killed and then the consequences spread outwards in space and time. The consequences reverberate across individual lives and, all too often, through generations (J. Sheather, 2022).
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Health impact of Ukraine war
As the war rages on in Ukraine, the civilian toll continues to climb. As of March 12, the Office of the High Commissioner for Human Rights (OHCHR) reported at least 1,663 civilian causalities, including 596 killed, although the actual numbers are likely much higher. More than 2 million children under five and pregnant and breastfeeding women need lifesaving nutrition assistance in Ukraine.
An estimated 18 million people in Ukraine are affected by the humanitarian crisis, of which 6.7 million are internally displaced. Nearly 3 million people have fled the country. As a result, supply chains have been severely disrupted. Many medicine distributors are not operational, some medical stockpiles are inaccessible due to military operations, medical supplies are running low, and hospitals are struggling to provide care to the sick and wounded.
According to WHO, as of March 13, there are 31 verified incidents of attacks on healthcare facilities in Ukraine, resulting in 12 deaths and 34 injuries. Every single attack deprives people of lifesaving services. Moreover, attacks on health care are violations of international humanitarian law and human rights. Critical health services are under stress including people with long-term medication needs and patients with cancer and other chronic diseases due to interruption of medical supply lines. Oxygen reserves need to be replenished across hospitals in Ukraine.
Trauma and surgical supplies, essential medicines, backup generators, and fuel for healthcare facilities are under stress. The conflict-affected population also urgently needs mental health and psychosocial support services (MHPSS). Continuation of immunisation campaigns, including polio, measles and Covid-19, remains critical. There is an urgent need to restart or continue preventative measures through vaccination and continued treatment of tuberculosis and HIV, alongside scaled-up surveillance, early detection and response systems for epidemic-prone diseases.
According to the UN Population Fund (UNFPA), more than 4,300 births have occurred in Ukraine since the start of the crisis. There were around 2,65,000 pregnant women in Ukraine, around 80,000 of whom are expected to deliver over the coming three months. Access to perinatal and maternal hospitals and their services has been largely disrupted. Sexual and reproductive health services must continue to be accessible and scaled-up. The supply of lifesaving medicines (e.g., antiepileptics and insulin) is also disturbed.
Attacks on healthcare and health workers directly impact people’s ability to access essential health services – especially women, children and other vulnerable groups. For example, we have already seen that the healthcare needs of pregnant women, new mothers, younger children and older people inside Ukraine are rising, while the violence severely limits access to services. According to WHO, “The healthcare system in Ukraine is clearly under significant strain, and its collapse would be a catastrophe. Every effort must be made to prevent this from happening”.
Evacuation assistance is urgently needed for vulnerable groups and their families, including the more than 2.7 million people living with disabilities – 164,000 of whom are children – and around two million people living with rare diseases in Ukraine.
Armed conflict is a significant cause of injury and death worldwide, but we need better measurement methods and conceptual clarity to estimate its impact adequately. For most human history, armed warfare between warring states and within states has been a primary cause of illness and mortality. Conflict causes deaths and injuries on the battlefield, but it also has health repercussions due to population relocation, health and social services breakdown, and the increased risk of disease transmission.
Despite the size of the health consequences, military conflict has not received the same attention from public health research and policy as many other causes of illness and death. Political scientists have long studied the causes of war but have primarily been interested in the decision of elite groups to go to war and not in human death and misery.
Conflict-related death and injury are significant contributors to the global burden of disease. Information systems break down during conflict, leading to significant uncertainty in the magnitude of mortality and disability. Improved collaboration between political scientists and experts in public health would help measure, predict and prevent conflict-related death.
Healthcare services must be secured from all kinds of conflicts. The Covid-19 pandemic has already put public health systems and health workers under strain. The conflicts can be more devastating for the civilian population. Attacks on healthcare infrastructure must end for the sake of health workers all citizens of Ukraine who require lifesaving services.
Julian Sheather (2022) Opinion: As Russian troops cross into Ukraine, we need to remind ourselves of the impact of war on health. BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o499 (Published 25 February 2022) BMJ 2022;376:o499
William H. Wiist, Kathy Barker, Neil Arya, Jon Rohde, Martin Donohoe, Shelley White, (2014) The Role of Public Health in the Prevention of War: Rationale and Competencies. American Journal of Public Health. June 2014, Vol 104, No. 6
Wiist, W. H., Barker, K., Arya, N., Rohde, J., Donohoe, M., White, S., Lubens, P., Gorman, G., & Hagopian, A. (2014). The role of public health in the prevention of war: rationale and competencies. American journal of public health, 104(6), e34–e47. https://doi.org/10.2105/AJPH.2013.301778
Oliver Razum, Henrique Barros, Robert Buckingham, Mary Codd, Katarzyna Czabanowska, Nino Künzli et al.(2019) Correspondence. Is war a man-made public health problem? | Vol 394, Issue 10209, P1613, Nov 02, 2019. https://doi.org/10.1016/S0140-6736(19)31900-2
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Dr Joe Thomas is Professor of Public Health, Institute of Health and Management, Victoria, Australia. Opinions are personal.