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Kim HJ, Bruni E, Gorodetska G, Van den Bergh R, Bezer L, Artykutsa S, Andriamiseza N, Habicht J. Typology and implications of verified attacks on health care in Ukraine in the first 18 months of war. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003064. [PMID: 38781240 PMCID: PMC11115218 DOI: 10.1371/journal.pgph.0003064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/13/2024] [Indexed: 05/25/2024]
Abstract
Attacks on health care are part of the spectrum of threats that health care endures during conflict. Protecting health care services against attacks depends on understanding the nature and types of attacks that occur during conflict. The World Health Organisation has implemented the Surveillance System for Attacks on Health Care (SSA) in Ukraine since 2020, and the system has continued to monitor and report on attacks on health care during the war in Ukraine. This study aims to analyse the data reported through the SSA for the first 18 months of the war. This paper involves a retrospective, descriptive study based on the analysis of publicly available SSA data of all incidents of attacks on health care in Ukraine reported through the SSA between February 24th 2022 and August 24th 2023. Out of the 1503 verified attacks, 37% occurred in the initial six weeks of the war. Attacks involving violence with heavy weapons were among the most common incidents reported (83%). The reported attacks were associated with a total of 113 deaths and 211 injuries among health care workers and patients: 32 (2%) attacks were associated with a death of a health care worker or patient, and 63 (4%) were associated with an injury. Health transports facing attacks had a higher probability of experiencing casualties than other health resources (p<0.0001, RR 3.1, 95%CI 1.9-4.9). In conclusion, the burden of attacks on health care in Ukraine was high and sustained over the course of the first 18 months of the war. Reported casualties were not homogenously distributed among attack incidents, but occurred in a set of high-casualty incidents. Health transports were found to be particularly vulnerable. In addition to continued calls for a cessation of hostilities, prevention, protection, mitigation, and reconstruction strategies are urgently required.
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Affiliation(s)
- Hyo-Jeong Kim
- Attacks on Health Care Initiative, WHO, Geneva, Switzerland
| | | | | | | | - Lamia Bezer
- WHO Country Office for Ukraine, Kyiv, Ukraine
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Haque U, Bukhari MH, Fiedler N, Wang S, Korzh O, Espinoza J, Ahmad M, Holovanova I, Chumachenko T, Marchak O, Chumachenko D, Ulvi O, Sikder I, Hubenko H, Barrett ES. A Comparison of Ukrainian Hospital Services and Functions Before and During the Russia-Ukraine War. JAMA HEALTH FORUM 2024; 5:e240901. [PMID: 38758566 PMCID: PMC11102023 DOI: 10.1001/jamahealthforum.2024.0901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/14/2024] [Indexed: 05/18/2024] Open
Abstract
Importance Since the full-scale Russian invasion, hospitals in Ukraine have been compelled to close or operate at reduced capacity due to inadequate supplies, damage, or destruction caused by war. Objective To analyze hospital services in Ukraine during the period before and after the Russian invasion. Design, Setting, and Participants Of the 450 hospitals currently functioning in Ukraine, a cross-sectional survey was carried out with the participation of 74 hospitals from 12 oblasts. Hospital administrators responded to an online survey with questions on the use of hospital services. Data were abstracted from hospital databases for the prewar period (before February 23, 2022) and during the war (February 23, 2022, to May 30, 2023). Main Outcomes and Measures Hospital services (including emergency services, preventive services, screenings, laboratory tests, obstetrics, telehealth, pharmacy, and rehabilitation services) were compared during the prewar and war periods. Results Of 450 Ukrainian hospitals in operation, 74 hospitals (16.0%) across 12 oblasts provided data for the current analyses. During the war, daily emergency admissions increased to 2830, compared with 2773 before the war. At the same time, hospitals reported reduced laboratory testing (72 [97%] vs 63 [85%]), tobacco education (52 [70%] vs 36 [49%]), cancer screening (49 [66%] vs 37 [50%]), gynecological services (43 [58%] vs 32 [43%]), rehabilitation services (37 [50%] vs 27 [36%]), pharmacy services (36 [49%] vs 27 [36%]), and telehealth programs (33 [45%] vs 21 [28%]). Hospitals reported additional difficulties during the war, including disruptions in the supply chain for essential equipment and pharmaceuticals, shortages of laboratory test kits, delays in the delivery of crucial medications, and problems around appropriate medication storage due to power outages. Conclusions and Relevance The ongoing war has inflicted profound devastation on Ukraine's hospitals. The findings of this cross-sectional survey offer valuable insights into the formidable challenges that hospitals confront in war-affected regions and underscore the pressing necessity for bolstering support to sustain and enhance hospital services during wartime.
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Affiliation(s)
- Ubydul Haque
- Rutgers Global Health Institute, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, New Jersey
| | | | - Nancy Fiedler
- Department of Environmental and Occupational Health and Justice, School of Public Health, Rutgers University, Piscataway, New Jersey
| | - Shanshan Wang
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth
| | - Oleksii Korzh
- Department of General Practice—Family Medicine, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Juan Espinoza
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Miraj Ahmad
- Cell Biology & Neuroscience, School of Arts and Sciences, Rutgers University, Piscataway, New Jersey
| | | | - Tetyana Chumachenko
- Epidemiology Department, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Olga Marchak
- Overseas Council–United World Mission, Rivne, Ukraine
| | - Dmytro Chumachenko
- Mathematical Modelling and Artificial Intelligence Department, National Aerospace University, Kharkiv Aviation Institute, Kharkiv, Ukraine
| | | | - Ifthekar Sikder
- Department of Information System, Cleveland State University, Cleveland, Ohio
| | - Hanna Hubenko
- Department of Public Health, Sumy State University, Sumy, Ukraine
| | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, New Jersey
- Department of Environmental and Occupational Health and Justice, School of Public Health, Rutgers University, Piscataway, New Jersey
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Mamontova TV. An analysis of COVID-19 vaccination campaign in Ukraine. Eur J Public Health 2024; 34:156-162. [PMID: 38085983 PMCID: PMC10843935 DOI: 10.1093/eurpub/ckad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The Coronavirus disease (COVID-19) pandemic is still an important problem of concern in Ukraine. The rapid deployment of the vaccination program is a key event for the formation of herd immunity and helps to prevent negative outcomes, overloading the public health system. METHODS The object of the retrospective-archival study was a depersonalized database of open panels on the management of the COVID-19 situation from the Ministry of Health of Ukraine. RESULTS The total number of COVID-19 cases in Ukraine as of 25 December 2022 amounted to 5 314 388 individuals (12.83% of the population), and COVID-19-related deaths reached 110 029 individuals (0.26% of the population). The overall number of COVID-19 vaccinated persons in Ukraine as of 16 January 2022, with one dose was 36 198 per 100 000 persons (36% of the population), and with two doses, it was 34 703 per 100 000 persons (35% of the population). It was shown a decrease in the number of COVID-19 vaccinated persons among men and persons over the age of 70. In the dynamics of COVID-19 vaccination with one and two doses, an increase in the number of persons vaccinated with Pfizer/BioNTech and CoronaVac was noted. CONCLUSIONS Despite the significant increase in the morbidity and mortality rates of COVID-19, the coverage of vaccination among the population remained insufficient in Ukraine. The effective COVID-19 vaccination strategy should include appropriate management and ensuring the public health system capacity, implementation of information technologies to address logistics issues, and clear communication strategies to maintain public trust.
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Vancini RL, Andrade MS, Knechtle B, Weiss K, DE Lira CA. Could war among nations decrease physical activity levels? J Sports Med Phys Fitness 2024; 64:211-212. [PMID: 37987712 DOI: 10.23736/s0022-4707.23.15625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Rodrigo L Vancini
- Center of Physical Education and Sports (CEFD), Federal University of Espírito Santo (UFES), Vitória, Brazil -
| | - Marilia S Andrade
- Department of Physiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Katja Weiss
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Claudio A DE Lira
- Section of Human Physiology and Exercise, Faculty of Physical Education, Federal University of Goiás (UFG), Goiânia, Brazil
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Fel S, Jurek K, Lenart-Kłoś K. The relationship between socio-demographic factors and depression: a cross sectional study among civilian participants in hostilities in Ukraine. Sci Rep 2023; 13:21897. [PMID: 38082045 PMCID: PMC10713780 DOI: 10.1038/s41598-023-49289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
There is still a gap in scientific knowledge in relation to civilian participants in hostilities. This is despite the fact that there is an extensive body of literature on major depressive disorder (MDD) in individuals who have experienced armed conflict. The purpose of this article is to identify socio-demographic factors which are related to levels of depression among civilian participants in the war in Ukraine, based on a cross-sectional study that was conducted in 2019 from a convenience sample of 314 Ukrainian adults (235 males). Depression was assessed via the Beck Depression Inventory. Multiple regression analyses were conducted to identify possible predictors of depression. Significant predictors were: loss of a loved one, place of residence, age, health insurance, financial situation, and marital status (F (6, 224) = 10.515, p < 0.001, R2 = 0.21; Adjusted R2 = 0.19). They also show that symptoms of depression resulting from the loss of a loved one due to war can be reduced through participation in an educational system. Having children is associated with a risk of more severe depression. Specialists are encouraged to engage in face-to-face interviews and to maintain a supportive and safe environment for participants in hostilities, e.g., in the area of education.
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Affiliation(s)
- Stanisław Fel
- The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Krzysztof Jurek
- The John Paul II Catholic University of Lublin, Lublin, Poland.
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Nikitin BM, Bromberg DJ, Pykalo I, Ivasiy R, Islam Z, Altice FL. Early disruptions to syringe services programs during the Russian invasion of Ukraine. Front Public Health 2023; 11:1229057. [PMID: 38074770 PMCID: PMC10702598 DOI: 10.3389/fpubh.2023.1229057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction The widespread HIV epidemic in Ukraine is concentrated among people who inject drugs (PWID), making access to sterile injection paraphernalia (SIP) like sterile needles and syringes a critical method of HIV/AIDS prevention; however, the Russian invasion has threatened to disrupt the operations of syringe services programs (SSPs), creating a risk of HIV outbreaks among PWID. Methods We conducted 10 semi-structured interviews with outreach workers from SSPs. Interviews were purposively sampled to cover three prototypic regions of Ukraine: temporarily Russian-controlled, frontline, and destination. Qualitative results from interviews were then compared against a standardized, nationwide harm reduction database. Results We found that the Russian invasion triggered both supply and demand challenges for SSPs. Demand increased for all regions due to client transitions from pharmacies that closed to SSPs, increases in illicit drug use, greater client openness to NGO support, and displacement of clients to destination regions. Supply decreased for all areas (except for remote destination regions) due to battle-related barriers like curfews, roadblocks, and Internet disruptions; diminished deliveries of SIP and funding; and staff displacement. Time series plots of the number of unique clients accessing harm reduction services showed that an initial decrease in service provision occurred at the start of the war but that most regions recovered within several months except for Russian-controlled regions, which continued to provide services to fewer clients relative to previous years. Conclusion To ensure continued scale-up of SIP and other HIV prevention services, the SyrEx database should be leveraged to serve as a streamlined harm reduction locator that can inform workers and clients of open site locations and other pertinent information.
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Affiliation(s)
| | | | - Iryna Pykalo
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Roman Ivasiy
- Yale School of Medicine, New Haven, CT, United States
| | - Zahedul Islam
- International Alliance for Public Health Ukraine, Kyiv, Ukraine
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Wilczek NA, Brzyska A, Bogucka J, Sielwanowska WE, Żybowska M, Piecewicz-Szczęsna H, Smoleń A. The Impact of the War in Ukraine on the Epidemiological Situation of Tuberculosis in Europe. J Clin Med 2023; 12:6554. [PMID: 37892699 PMCID: PMC10607046 DOI: 10.3390/jcm12206554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/22/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Ukraine is at the forefront of one of the largest outbreaks of tuberculosis (TB) in Europe, including multidrug-resistant tuberculosis. Due to the ongoing armed conflict in this area, there is a significant number of refugees from Ukraine to other European countries. The aim of the study is to emphasize the essence of the problem of the increased incidence of tuberculosis, taking into account the impact of the armed conflict in Ukraine, resulting in the intensification of migration movements. A descriptive epidemiological method was used as the research method. The material was collected by analyzing source statistical data from WHO and statistical yearbooks of selected European countries. Particularly, Ukrainian refugees in Poland, Germany, the Czech Republic, and Slovakia are at higher risk of contracting tuberculosis due to factors like migration stress, poor nutrition, and comorbidities. Epidemiological data from these countries show a rise in tuberculosis cases among foreigners, emphasizing the need for European specialists to be more vigilant in this unique situation, focusing on refugees and other vulnerable populations. More research and collaborative efforts are essential to closely monitor and prevent the severe outcomes of tuberculosis transmission.
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Affiliation(s)
- Natalia Anna Wilczek
- The Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, 20-081 Lublin, Poland; (A.B.); (J.B.); (W.E.S.); (M.Ż.); (H.P.-S.); (A.S.)
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Hodgetts TJ, Naumann DN, Bowley DM. Transferable military medical lessons from the Russo-Ukraine war. BMJ Mil Health 2023:e002435. [PMID: 37402486 DOI: 10.1136/military-2023-002435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023]
Affiliation(s)
| | - D N Naumann
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - D M Bowley
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
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