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Endless health repercussions: World Refugee Day and the conflict in Ukraine

LSHTM experts reflect on the untold impact of the conflict in Ukraine on the healthcare needs of millions of refugees
Neha Singh: "Conflict can have devastating health repurcussions on refugee populations."

Marked every year on 20 June, World Refugee Day is an opportunity to understand the life-threatening plight of refugees, recognise their resilience, and offer support by giving refugees a platform, raising awareness of their situations and calling for their rights – for safety, asylum, protection – to be upheld.  

Russia escalated its invasion of Ukraine at the end of February this year. This has created 6.8 million refugees who have fled to Poland, Romania and Hungary among many other countries. These refugees have complex health needs, influenced by their experiences before fleeing their home, during transit, or after arrival in other countries. These range from untreated infectious diseases to chronic conditions that need managing, as well as maternal care and mental health issues.

As we enter the fourth month of the conflict, we want to look for solutions to help those in need. In terms of LSHTM, these include supporting our staff and students who have been affected by the conflict, continuing to raise awareness of the situation, using our expertise in humanitarian research to contribute to and improve the current response, as well as evaluating what is being done.

Public and international health experts from LSHTM reflect on the growing health needs of refugees amid the Ukraine conflict.

Neha Singh, Associate Professor of Health Systems and Policy:

“Conflict can have devastating health repercussions on refugee populations: on mental health, access to medications, managing chronic conditions, sexual and reproductive health, child health, violence against women, spikes in infections, missed vaccinations, living with old and new disabilities in unfamiliar surroundings.”

Bayard Roberts, Professor in Health Systems and Policy:

“The war in Ukraine is likely to have major long-term impacts on the mental health of many Ukrainian refugees who are having to deal with loss and trauma, and ongoing stressors in their host countries such as finding accommodation, security, education, jobs and health care.

“Pre-existing mental health disorders may also be exacerbated, and there are also women and girls who have experienced sexual violence who will need specialist mental health support.

“Mental health and psychosocial services need to be urgently scaled-up in host countries to support refugees and ensure they can access timely and relevant care. From our previous research with people displaced by conflict in Ukraine, we found a high burden of poor mental health and very limited access to mental healthcare.”

Michelle Lokot, Research Fellow:

"This World Refugee Day, we emphasise the need for our research with refugees to be decolonised. This means ensuring refugees themselves are involved in designing research, prioritising refugee perspectives and not just 'experts' from outside the context, and seeking to address power hierarchies throughout the research process.

“When we, as academics and researchers, are thinking about research with people affected by conflict – including war in Syria, Yemen or Ukraine – this should be at the forefront of our minds."

Adrianna Murphy, Associate Professor of Health Services, Research and Policy:

“Non-communicable diseases (NCDs), especially cardiovascular disease, diabetes, cancer and respiratory diseases, are the leading causes of death, illness and disability globally. Managing these conditions requires regular drug treatment or medical appointments, both of which can be severely disrupted in conflict situations. For the many people who flee conflict, reliable access to medicines and care is uncertain, and there are often administrative, language or financial barriers to overcome. Those who stay in conflict-affected countries also face significant challenges as supplies of medication are disrupted, healthcare facilities are destroyed and health systems are forced to focus on acute conflict-related injuries.

“An estimated 22% of the global population people live with one or more NCD. In Ukraine, this would mean around nine million people. NCDs are the leading cause of premature deaths in the country. Refugees from Ukraine have been given access to national healthcare systems in neighbouring host countries but ensuring continuous care is not straightforward. Caring for refugees with cancer is particularly complicated, as specialised treatments are not standardised across countries. Refugees seeking care for other NCDs encounter challenges in navigating a new healthcare system or paying for medicines.

“Within Ukraine, the situation is even more precarious. While many medicines and medical supplies have been donated to the country, they rely on supply chains that are now heavily disrupted by active conflict. For the over two million people with diabetes in Ukraine, for example, reliable access to insulin, oral hypoglycaemics, glucose metres and test strips, and other supplies is a matter of life or death.

Claire Dooley, Assistant Professor:

“A lack of data makes responding to humanitarian crises incredibly difficult, whether this be numbers of refugees fleeing across borders or people displaced within their own country.

“When the war in Ukraine broke out, we reacted immediately to the need for population data, producing and publishing estimates which can be used by a range of organisations responding to the humanitarian need caused by the ongoing conflict.” 

Joy Lawn, Susannah Mayhew, Debra Jackson, Kerrie Stevenson, Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH):

“This emergency is very different from many we have seen. Within Ukraine, women are struggling to access the healthcare they need: contraception and other medications are running low, healthcare facilities have been attacked, abortion services may have stopped, many women will give birth in facilities that are no longer safe, well-equipped or appropriately staffed. According to the UNFPA, an estimated 80,000 women were expected to give birth between March and June 2022. For many of those, giving birth will now be a life-threatening experience.

“Of the approximately six million people who have fled Ukraine, a large proportion will be women and children, as many men have remained to fight. These new refugees have a whole host of different health needs and concerns. 

“Many are crossing to EU countries with good healthcare systems, however we still need better data to understand these refugees’ needs. Many may have been subject to gender-based or sexual violence and need specialist care and mental health services not available in their native language. There is also a severe increase in risk of trafficking for women and children, particularly children travelling alone – often for sexual exploitation.

“Pregnant women who have been separated from their partners indefinitely may no longer feel that these pregnancies are viable. Ukraine has liberal abortion laws, but many of its neighbours, like Poland, do not.

“There are still many unknowns, but the short and long-term impact of this conflict on women and children’s health will undoubtedly be significant.”  

Finn McQuaid, Toyin Togun, TB Centre:

“Ukraine already has one of the highest rates of drug-resistant (DR) tuberculosis (TB) worldwide, which requires months of treatment using expensive, potentially toxic drugs, with a low likelihood of success. The Russian invasion of Ukraine will have a significant influence on the country’s TB care and prevention efforts and could result in rates of DR-TB soaring both in Ukraine and among the flood of refugees fleeing.”

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