In war, disease kills more than bombs. Our past teaches us this and the present reminds us, in spite of ourselves. “The war between Russia and Ukraine is a disaster for Ukrainian and Russian health care, and in general for a large part of Eastern Europe”, confirms Stefano Vellainfectious disease specialist and professor of Global Health at the Catholic University of the Sacred Heart in Rome. “First of all Covid, but also polio, diphtheria, measles, tuberculosis and HIV, are among the most urgent emergencies to deal with”, he adds. Walter Ricciardithe consultant of the Ministry of Health and professor of Hygiene allCatholic University of the Sacred Heart of Rome.
Even before the war resistant tuberculosis and HIV
Even before the war, the health situation in Ukraine, but also in Russia, was certainly not among the best. “Ukraine is lagging behind with vaccinations for children, such as measles and polio,” says Vella. “In addition, there is an enormous prevalence of cases of tuberculosis in the country and, due to a lack of attention to therapies, multidrug-resistant strains have developed – he continues -. In addition, Ukraine has the largest number of new HIV cases at the world, almost more than Botswana, linked above all to the high rate of intravenous drug addiction “. What is worrying is the impact on the health of Ukraine’s neighboring countries. “The reception of huge numbers of refugees in neighboring countries, such as Romania, Bulgaria, Moldova, Poland, can put already complicated situations at serious risk”, underlines Vella.
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The gatherings in shelters and the fear of Covid
Healthcare like the Italian one is certainly stronger and more resistant and, according to the readiness with which the Italian health authorities responded at the beginning of this crisis, our country has long been ready to welcome refugees fleeing the war in safety. “But there is a more immediate threat that no country is ready to face yet, including Italy: it is Covid – says Ricciardi -. To protect themselves from bombing, people have gathered and crowded in basements, underground stations and in temporary shelters where the transmission of the Sars-CoV-2 virus becomes easier. “Not to mention the fact that, even before the war, Ukraine had among the lowest rates of anti-Covid vaccination in the world“, underlines Ricciardi.
Ukraine among the lowest rates of Covid vaccination
In fact, when the attack on Russia began on February 24, Ukraine was just emerging from the worst phase of the Omicron wave, which had peaked that month. Since then, the number of Covid-19 tests performed has collapsed, which means that there are probably a lot of undetected cases, as he declared a few weeks ago by Tedros Adhanom Ghebreyesusgeneral manager of the World Health Organization (WHO). Across the country, Covid-19 vaccination rates are dangerously low – around 65 percent in Kiev, but up to 20 percent in some regions, he said. Jarno Habicht, head of the WHO office in Ukraine. This overwhelming distrust of vaccines has also hampered the immunization process against other preventable diseases, such as measles and polio. Furthermore, without water and without adequate sanitation, experts expect a significant increase in cases of diarrheal diseases.
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Polio epidemics are feared
According to the magazine Nature, outbreaks of polio and measles are feared. Even before the war, Ukraine was struggling with an outbreak of polio: last year there were two cases in the west of the country, the most recent in December. The poliovirus was also isolated in 19 healthy contacts. Because poliovirus causes paralysis in only one in about 200 people it infects, the outbreak could be much larger than you think.
The conflict then caused the interruption of a targeted vaccination campaign, which began on February 1, which aimed to immunize nearly 140,000 children. Not only. Surveillance was also affected, so the virus could spread undisturbed and unnoticed, according to a warning issued by the Global Polio Eradication Initiative, based in Geneva. It seems to take a dip in the past. Because now measles can also become threatening due to its high contagiousness.
“Measles is a prime concern in any humanitarian crisis,” he said James Goodson, a measles expert in the US Centers for Disease Control and Prevention (CDC). Ukraine experienced a major measles outbreak in 2017, which continued to remain “on” until 2020, with over 115,000 cases. By 2020, national coverage with two doses of the measles vaccine had reached 82 percent, according to the CDC. This is a big improvement, but still not high enough to prevent deadly outbreaks. More worrying still is the fact that vaccination coverage is less than 50% in some “oblasts”, such as Kharkiv, where huge numbers of people are fleeing the conflict. “For this reason, in Italy, a clear indication was given to vaccinate all children upon their entry into Italy: in case of doubt, vaccinations, such as that against polio or measles, will be repeated”, underlines Vella.
The emergency tuberculosis
But the most alarming and urgent emergency, according to experts, is tuberculosis. “Ukraine also has one of the highest burdens of multidrug-resistant tuberculosis in the world,” confirms Vella. Around 32,000 people across the country are estimated to develop active tuberculosis each year. In addition, about one third of all new TB cases are drug resistant. In Ukraine, 22% of people with TB are also HIV positive, and TB is the leading cause of death among those living with the virus.
Host countries and care
The disease, which can be aggravated in crowded and poor situations, is caused by Mycobacterium tuberculosis which slowly destroys the lungs and spreads through respiratory droplets. “Drug-resistant tuberculosis – explains Ricciardi – occurs when people do not adhere to the therapy they have to follow every day – explains Ricciardi -. It will be up to the host countries to ensure that they provide care to the refugees”. Any interruption of treatments can favor the onset of drug resistant forms. Not to mention that after 5 years without treatment, 50% of people with pulmonary TB can die, while in the meantime it continues to unknowingly infect other people. “For this reason, special screening protocols for arriving refugees have been established in Italy”, Vella emphasizes.
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HIV control with antiretroviral therapy
Another big threat is HIV. Ukraine was already the second country with the highest HIV / AIDS burden in Eastern Europe. It is estimated, in fact, that about 1% of the population is infected, but the incidence is much higher in risk groups: 7.5% in men who have sex with other men and almost 21% of people who they inject drugs. Antiretroviral therapy can keep HIV under control and support the essential immune defenses against opportunistic infections, such as tuberculosis; prevent people at risk of contracting HIV; and prevent mother-to-child transmission.
Adherence to warfare therapies is not a priority
However, adherence to treatment is no longer considered a priority in warfare. According to UNAIDS, around 260,000 people in Ukraine were living with HIV at the end of 2020. Of these, only 69% were aware of their state, 57% were following treatments and 53% had achieved viral suppression. The country was making progress, but this war threatens to frustrate efforts and set Ukraine back ten years.
Amidst the indiscriminate bombing, people may not be able to collect their medicines. People fleeing to safety may have a supply of drugs for a month, or two weeks or less. Finally, there is the problem of drug addiction. Replacement therapy such as methadone may be out of reach for addicts, many of whom are living with HIV. Situation that makes Vella say: “It is a dramatic situation that does not concern a single country or a single people, but all of us”.