First the covid, now the war: Many of us have associated the invasion of Ukraine with the pandemic not yet over and the lack of time to recover from one tragedy before falling into another. But in truth, Ukraine, even before the coronavirus emergency, was already facing epidemics that are difficult to imagine for a country on the border with Europe: HIV, drug-resistant tuberculosis, hepatitis C, polio. Diseases that require constant pharmacological treatment and well-equipped health facilities, which have become impossible to find in Ukrainian cities under siege.
According to leaders from non-profit organizations, the WHO and the United Nations, the conflict threatens to undo decades of effort and progress in fighting these infections. Ukraine, and the neighboring countries that are hosting refugees, risk becoming the epicenter of new and less new health emergencies, in addition to CoViD-19.
Vaccines skipped. At least 64 attacks since the invasion of Ukraine have targeted hospitals and other medical facilities. Those left standing are caring for the injured and sick with light supply of life-saving drugs (such as insulin), oxygen starvation, lung ventilators and defibrillators, as long as water and electricity have not been cut.
Half of the three million Ukrainian refugees are children, and children under the age of six may have missed routine vaccinations or don’t know their vaccination status. In Ukraine, only 80% of children in 2021 were vaccinated against polio: at the end of last year, some cases of polio were identified in the country, because vaccination coverage is too low for herd immunity. In Europe, general coverage is 94% and polio was officially eradicated in 2002.
Measles in Ukraine also still poses a health risk, as double-dose vaccination coverage is stuck at 82% (the minimum target for herd immunity is 95%). Speaking of vaccines, with just 36% of the population immunized, Ukraine has one of the lowest rates of covid vaccination coverage on the European continent. In February 2022, a national vaccination campaign was launched which was abruptly stopped by the war.
Respiratory infections. Overcrowded shelters and the precarious hygienic conditions in which displaced people are forced to survive are an ideal spreading ground for respiratory diseases such as covid, pneumonia and tuberculosis: in Ukraine tuberculosis still represents an important public health problem, with about 30,000 new ones cases per year as well as one of the greatest incidences of drug-resistant tuberculosis, a condition that affected 29% of new cases in 2018 and that is widespread above all in the male population, who remained in the cities to fight. Ukraine also has one of the highest prevalences of tuberculosis and HIV co-infections.
HIV. For UNAIDS at the end of 2020 there were 260,000 people in Ukraine affected by HIV: in the country the virus at the origin of AIDS affects about 1% of the population between 15 and 49 years (in Italy 0.4%) and only 69% are aware of their state of health; only 57% were receiving antiretroviral therapy. The country was making progress in treatment and diagnosis but the conflict, with the disruption of medical supplies and the destruction of health networks, could turn the clock back 10 years.
More than one in four cases of HIV in Ukraine affects the approximately 350,000 people who use injectable drugs. Prior to the war, health policies had led to 17,000 drug addicts receiving substitution therapies for opiate addiction, such as methadone or buprenorphine. It is now estimated that the stocks of these drugs are running out and many of the Ukrainian refugees are headed to countries that depend on Russia for supplies of medicines. Opiate-based substitution therapy is illegal in Russia.
Diseases of poverty. Life in besieged communities favors the spread of cholera and diarrheal diseases (from Mariupol, for weeks without water and electricity supplies, there are testimonies of people forced to drink the water left in the radiators in order not to die of thirst). And among the chronically ill citizens forced to interrupt treatment we cannot forget those suffering from hepatitis C: a disease that is usually treatable but which affects about 5% of the Ukrainian population due to the lack of access to drugs and diagnostic tests. It was like this before the occupation of the country, now the situation has certainly worsened.