A recent report from the World Health Organization says that over 8.2 million refugees left Ukraine between the start of Russia’s invasion on February 24 and June 28, most of them going to Poland (52%), then Russia (17%) and Hungary (10%). More than 4,700 Ukrainian civilians have been killed and 5,900 have been injured.

While 6.2 million people remain internally displaced in Ukraine, more than 5.5 million people who left their homes during the war have now returned home, according to the WHO’s latest external situation report.

AICM Ukraine, an NGO that has been active in Ukraine since 2006, reports that 12.1 million Ukrainians are considered in need of humanitarian health care, as the country’s health care system has been severely impacted by months of active conflict. WHO has noted 323 Russian attacks on Ukrainian health care infrastructure including facilities, transport, warehouses, and patients, in addition to broken supply chains, restricted mobility, and mass displacement.

 With the diminished capacity of the national health care system, WHO has identified priority public health concerns including conflict-related trauma, maternal and newborn health, chronic disease care, mental health care, food security, potential communicable disease outbreaks,  potential nuclear and chemical hazards, human trafficking and sexual violence.

In May, WHO European Regional Director Dr. Hans Kluge said at least 3,000 people in Ukraine have died since Russia’s invasion due to a lack of access to chronic disease medication.

According to the NCD Alliance, a global nonprofit focused on non-communicable disease issues, about 9 million people in Ukraine are living with chronic diseases such as diabetes, cancer, cardiovascular diseases, chronic respiratory diseases, and mental and neurological conditions.

AICM Ukraine pointed out that another vulnerable group includes older adults. About 20% of the Ukrainian population is 60 years and older, making it one of the highest proportions of elderly people in a humanitarian crisis location globally.

“People with disabilities, children and youth, women and girls, health care workers, and internally displaced persons, which AICM Ukraine, notes, are all distinct vulnerable populations with their own humanitarian health care needs,” said Dr. Christian Carrer, a French physician who co-founded AICM and AICM Ukraine, in an email.

As noted by AICM Ukraine, many of the social determinants of health, such as access to clean water, sanitation and hygiene (WASH), food security, shelter, security, and restriction of movement, impact the health of displaced and nondisplaced populations.

Given the deteriorating state of such factors, WHO has noted the elevated risk for an outbreak of cholera, noting that residents of Mariupol have been forced to drink from puddles, as the water supply has been severely impacted. Prior to the war, there was a polio outbreak in the country, which the WHO fears could expand, along with Covid-19, measles, and diphtheria, as access to clean water, sanitation and hygiene have been decreased. The close proximity of people in bomb shelters is also of concern.  

In Poland, which has accepted over 4.3 million refugees, there have been almost four times as many chickenpox cases this year as in the corresponding time period last year. Other areas of concern identified by the WHO include low vaccination rates for polio (56%) measles, mumps, and rubella (68%) among refugee children. Only 40% of all respondents said they were vaccinated against Covid-19. WHO said major impediments to care in Poland among Ukrainian refugees are language barriers, cultural differences, and a general lack of information, while also noting that the lack of specialized services available for people with disabilities is a “major issue.”

“Having an understanding of the status of these determinants gives context to the health issues faced by those affected and can help inform intervention planning,” said Carrer.

In an effort to help optimize aid delivery for its own operations and those of other NGOs which are responding, Direct Relief is contributing to the WHO situation reports through its partnership with a crowdsourcing company called Premise. Direct Relief’s Research and Analysis team has helped them shape a series of data collection efforts about health and medical needs both within Ukraine and throughout the refugee receiving countries so as to receive novel data of relevance to the response.

Among other research and development projects, including mobility and refugee movement dynamics and analyzing a $10 million grant program for refugees in partnership with Pelion in Poland, Direct Relief collaborated with Premise to develop two surveys on health care and pharmacy needs in Ukraine, as well as another on refugee reception centers in Poland.

“We have been involved in helping to collect data on pharmacies, displacement, and attitudes towards refugees in order to understand the scope and dimensions of this unprecedented crisis as it affects the people of Ukraine, the health system, and the host communities in neighboring countries,” said Andrew Schroeder, vice president of research and analysis at Direct Relief.

Since the war began, Direct Relief has sent 800 tons of aid and over $13.6 million in grants to respond to the humanitarian crisis in Ukraine and neighboring countries.