Statement Renewed focus on health critical as Ukraine approaches third winter amid full scale war

Statement by WHO Regional Director for Europe, Dr Hans Henri P. Kluge

As I wrap up my sixth visit to Ukraine since early 2022, my key message today is simple and urgent. Ukraine is approaching its third winter amid full-scale war, likely its most challenging yet. A renewed focus on health is more critical than ever, from government, WHO and donors ­- a renewed focus along the lines of response, recovery and, not least, reform.

As of today, WHO has confirmed close to 2000 attacks on health in Ukraine, including on hospitals, health workers and patients.

In just the past 6 months, targeted attacks have damaged Ukraine's energy infrastructure. Frequent summertime power outages are already taking a toll, with danger signs for the winter, for example, jeopardized storage and distribution of vaccines. If vaccine stocks cannot be used, we could see a rise in vaccine-preventable diseases.

Furthermore, water systems could be compromised as water distribution sites depend on uninterrupted power supplies. This could lead to increased waterborne and foodborne diseases. A lack of wintertime heating and ventilation systems could contribute to a rise in respiratory infections, from influenza to COVID-19.

In addition - this is critical - the threat of antimicrobial resistance (AMR) is very real within the context of war and humanitarian disaster. As the Ukraine war drags on, with wounded people needing urgent treatment, there are rising concerns over drug resistance through possible antibiotic misuse. We have stories of wounds that simply will not heal as a result of AMR - a situation with possible consequences well beyond Ukraine if drugs are rendered useless.

In response to concerns over power supplies, WHO and health authorities are accelerating efforts to install generators and other crucial equipment at health facilities nationwide. For example, recently we launched a heating unit at Chuhuiv Central Hospital in the Kharkiv region, a facility near the war's frontline, severely damaged in 2022, which I visited this week. This is just one of 15 such heating units that WHO is installing in 8 regions.

To tackle the danger of AMR in the short term, Ukraine now has 100 laboratories carrying out surveillance on drug-resistant bacteria, compared to just 3 in 2017. But consistent monitoring is key. I will be addressing this issue at the upcoming United Nations Global High-level Meeting on AMR in New York in less than 2 weeks.

Another wintertime concern in Ukraine is the risk of heightened mental health challenges. Already, an estimated 10 million people are at risk of mental health problems, ranging from mild to severe. With the war approaching the 3-year mark, such challenges are only increasing, and the realities of the winter season could worsen the situation. The national mental health programme - led by First Lady Olena Zelenska and supported by WHO - has been scaling up rapidly, but demand still far outweighs supply.

Moving from immediate response to longer-term recovery - our latest health needs assessment in Ukraine shows that 8% of households do not currently have access to a primary health-care facility.

Access to medicines is another challenge. More than 80% of households say they encounter problems in obtaining the medicines they need, with 6% saying they do not have access to essential medicines. One third of respondents say they do not have enough money to buy medicines.

Now, ahead of winter, primary health care is being prioritized to bring care to where people are living, including communities near the frontline. This week, WHO launched a prefabricated primary health-care clinic in Chohodarivka, a rural area of the Odesa region, to provide basic services to almost 2000 people and to improve the medicine supply chain despite persistent challenges.

By year's end, we will have installed around 40 such clinics in 6 regions. It is a true example of response and recovery going hand in hand, as the facilities ensure primary health-care services will be available for the coming years.

I also visited an inspiring physical rehabilitation unit in Poltava, supported by WHO, where well trained therapists are providing life-transforming services to patients of all ages. Ukraine's national rehabilitation programme has made impressive progress in a relatively short time. Unfortunately, the longer the war continues, the more need there will be for prosthetics and physiotherapy.

Another example I witnessed this week was in the frontline city of Kharkiv, where the regional government is speeding up health system recovery. Health facilities crippled by war are being refurbished, including with enhanced security measures to adapt to constant shelling. New services are also being added to address a range of noncommunicable diseases, from cardiovascular diseases to cancers. Truly, this is an example of building back better.

The immediate response to wintertime needs and longer-term health system recovery are ultimately tied to Ukraine's ongoing health reforms. The process began well before February 2022 and, remarkably, the country has managed to push ahead despite the war.

Health reforms feed into Ukraine's stated goal of European Union accession. Under this, a range of indicators must improve, including those linked to tobacco control and efforts to tackle AMR; these are just 2 priority areas in which the Ministry of Health is pushing ahead.

To conclude, let me stress again how vital it is that Ukraine's health system withstand and surmount the challenges of the impending winter, including attacks on health which are a clear violation of international humanitarian law.

Ukraine needs health and security - security from attacks, from vaccine-preventable diseases, from AMR, from a range of issues that compromise health and well-being. Health is truly the glue that holds societies and countries together.

I end with heartfelt thanks to all donors and partners who support Ukraine's quest for health for all - no matter what. Ultimately, our gratitude is to the heroic health-care workforce of Ukraine - and to the Ministry of Health under Minister Viktor Liashko - for demonstrating what determination and courage are all about.

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