Ukraine Health Crisis 2022-23: Would Global Health Diplomacy Be A Panacea? – OpEd


War has always been having far-reaching consequences that can be long-term or short-term. Soldiers in general and women and children, in particular, used to suffer a variety of atrocities during times of war along with healthcare challenges. Another legacy of these conflicts is the widespread trauma caused by these atrocities and the suffering of civilians, which results in significant emotional and psychological stress in general and losses/damages of overall healthcare personnel, services and infrastructure in particular. 

The destruction of much of the healthcare system during World War I left the Soviet Union vulnerable to devastating epidemics and other health crises. Semashko, the People’s Commissioner of Health, was established Soviet medicine with the objectives that the government should pay for everyone’s medical expenses, provide access to good healthcare for all, and make efforts to keep people healthy. Population in the German states was reduced by about 30 percent during Europe’s Thirty Years’ War. According to census data 1860, about 8% of white American males between the ages of 13 and 50 were killed in the American Civil War (Lambert, Craig (May–June 2001).  During World War I, 8 million European soldiers died, 7 million were rendered permanently disabled, and 15 million were seriously injured (Kitchen, 2000). As per some estimates, about 20 million soldiers and 40 million civilians were died in World War II.  The Soviet Union lost 27 million people, half of all World War II casualties. 

Russia has also exercised tight control over the Ukrainian healthcare system. Few healthcare decisions, including those involving resources and staffing, were left to state or local governments. Many hospitals in Ukraine were bombed and destroyed during World War II, and many Ukrainian medical professionals were either killed or deported. After the war, medical infrastructure needed to be repaired, and concurrent epidemics had to be dealt with. This health system grew rapidly, allowing everyone to get the healthcare they needed and dramatically enhancing the health of the population as a whole. 

Russia-Ukraine War/Conflict 

The conflict between Ukraine and Russia, began in February of 2014. Countries in the North Atlantic Treaty Organisation (NATO) are backing Ukraine, while China and others are backing Russia. After the Revolution for Dignity in Ukraine, Russia annexed Crimea and supported pro-Russian separatists in the Donbas conflict against the Ukrainian military. Naval skirmishes, cyberattacks, and heightened political animosity also occurred during the first decade of conflict. Russia launched a full-scale invasion of Ukraine on 24 February 2022.

Beginning with the Euromaidan protests in early 2014, the Revolution for Dignity ultimately led to the ouster of pro-Russian Ukrainian President Viktor Yanukovych (2010-2014). Following this, pro-Russian protests erupted in the east and south of Ukraine. Simultaneously, masked Russian soldiers invaded the Crimean peninsula of Ukraine and took command of several strategically important buildings. Russia has quickly annexed Crimea after a contentious referendum. In April 2014, pro-Russian separatists seized government buildings in Ukraine’s eastern Donbas region and declared the independence of the Donetsk People’s Republic (DPR) and the Luhansk People’s Republic (LPR).

The internal dynamics were exacerbated by external factors and actors, particularly the United States, the European Union, and NATO. Russia’s communist ideology stands in stark contrast to the Western principles upheld by the European Union and the United Nations, which have both been implicated in the current crisis in Ukraine. Russia views the liberal democratic position held by the European Union, NATO, the United Nations, various non-governmental organisations, and the United States as a direct threat to its ability to maintain its current level of power and influence. While a tangled web of alliances attempts to rein in the spread of Western ideology in countries that were formerly part of the Soviet Union, the Kremlin had to act against that.

Russia, alarmed by NATO’s growing meddling and influence in the region, began a major military buildup in early 2021 along its borders with Ukraine and other countries like Belarus. The Russian government, however, has repeatedly denied reports that it plans to invade Ukraine (Taylor, Adam; 24 February 2022). However, Russian President Vladimir Putin has voiced opposition to NATO expansion and has argued that Ukraine should be barred from joining the alliance. Furthermore, he expressed irredentist viewpoints and questioned Ukraine’s very existence (Düben, Björn Alexander: 1 July 2020). The Russian government officially recognized the DPR and LPR as independent in February 2022.

The invasion of Ukraine was preceded by President Putin’s declaration of a “special military operation” in that country. Following Putin’s announcement of a “special military operation” aimed at “demilitarizing and denazifying” Ukraine on the morning of February 24 (Waxman, Olivia B.: 3 March 2022), Russia began its invasion over Ukraine. Following the aforementioned incident, multiple cities across Ukraine, including Kyiv, were hit by missile and airstrikes. 

The international community generally disapproved of the Russian invasion because it amounted to an act of war. The UN General Assembly adopted a resolution demanding Russia to pull all of its troops out of the area. Russia was also kicked out of the Council of Europe because of its invasion of Ukraine, and the International Court of Justice issued an order to Russia to halt its military operations. Economic sanctions were imposed and enforced by the US, European Union, and many other countries had devastating effects on economies all over the world, including Russia’s.

Ukrainian Health Crisis 

The present health crisis of Ukraine can be attributed primarily to the ongoing conflict, which has led to the destruction of infrastructure, displacement of millions of individuals, and a notable decrease in the accessibility of medical supplies and healthcare services. The healthcare services provided by the government have been constrained due to the economic crisis in Ukraine, thereby exacerbating the health crisis.

The ongoing conflict since its beginning i.e.,  24th February, Ukraine has been turned into health crisis. The escalation of mental health problems has emerged as a noteworthy health concerns resulting from the conflict. The experience of displacement and residing in a war-torn area has resulted in a surge in cases of depression, anxiety, and post-traumatic stress disorder (PTSD) among individuals of all ages. Furthermore, the conflict has resulted in restricted availability of mental health services, as numerous healthcare facilities have been impaired or demolished.

The protracted conflict have led to a marked degradation/damage/destruction of the healthcare infrastructures in Ukraine. The crisis is marked by a dearth of medical resources, restricted availability of healthcare services, and escalated fatality ratios. The impact of the health crisis has been observed across all domains of the healthcare system, encompassing primary care, hospital care, and emergency services.

The ongoing conflict has led to a deficit of medical resources, encompassing crucial pharmaceuticals and apparatus. Numerous medical facilities situated in regions affected by conflict have been demolished, and the ones that remain operational are encountering difficulties in rendering fundamental healthcare amenities owing to the dearth of resources. The insufficiency of medical resources has resulted in a noteworthy escalation in the expenses of healthcare provisions, rendering it unattainable for a substantial number of individuals.

The conflict has resulted in restricted availability of healthcare facilities, particularly in regions that have been adversely impacted by the conflict. The destruction of infrastructure, displacement, and insecurity have resulted in a significant portion of the population being unable to avail healthcare services. The ongoing conflict has caused a notable dearth of healthcare personnel, particularly in the regions that have been affected by the conflict, thereby exacerbating the already limited availability of healthcare services. The ongoing conflict has led to a rise in mortality rates, particularly among the elderly and the most vulnerable segments of the population. The insufficiency of medical resources and restricted availability of healthcare services has led to numerous avoidable fatalities. The ongoing conflict has resulted in a noteworthy surge in mental health issues, encompassing post-traumatic stress disorder (PTSD), anxiety, and depression. About 8,317 and 13,892 civilians have been killed and injured respectively. From 1-9 March 2023, there were a total 113 fatalities; 356 injuries.

About 17.6 million people were affected seriously by the ongoing war. As of the 20th of March, there had been over 19.7 million border crossings from Ukraine to the neighbouring countries, with just over 10.1 million having crossed the border into Poland and over 2.3 million having crossed the border into Hungary, respectively (UNHCR). All these issues has paralyzed the entire healthcare system of Ukraine.  

Global Health Diplomacy is a Panacea?  

The term Global Health Diplomacy (GHD) refers to the application of diplomatic approaches and strategies to resolving international health issues. To achieve this goal, public health and foreign policy players, including national governments, regional/international organizations, and other stakeholders have been working together. In light of the increasing recognition that health issues are increasingly interwoven with political, economic, and security concerns, the notion of GHD has evolved over the years. Health crisis on account of war/conflicts, pandemics, infectious illnesses, healthcare inaccessibility, and environmental health concerns are global in scope. It is required multilateral cooperation by striking a balance between national interests and global health priorities along with concerted actions through a wide variety of regional and international organizations.

The World Health Organization (WHO) has been working proactively for Ukraine’s health crisis, helping with both urgent health issues and the healthcare system’s eventual rebuilding. Dr. Jarno Habicht, WHO Representative in Ukraine argued that recovery and reconstruction initiatives of healthcare infrastructure and services in Ukraine must prioritise mental and physical health issues. WHO has submitted a revised request for $147.5 million US dollars to aid for the amelioration of healthcare, and humanitarian situation in Ukraine. Eighty million dollars of this amount is required for work within the country, such as the provision of medicine and healthcare in the coming time. It is estimated that refugee-receiving and hosting nations, such as Poland, the Czech Republic, Moldova, and Romania, would require additional funding of US$ 67.5 million.

The WHO has increased the number of its staff and redirected resources, such as its logistics infrastructure, to meet the new demands of healthcare in Ukraine. The biggest need is in the country’s eastern, southern, and northern oblasts, where a total of 543 metric tonnes of medical supplies and equipment have been delivered. Trauma surgical equipment, ambulances, Ukrainian-made ventilators that can operate even without power, electric generators, and oxygen equipment, such as the construction of oxygen plants have provided by the WHO to the Ukraine authorities. Since February 24th, WHO has trained over 1300 healthcare professionals of Ukraine to attend the healthcare needy people. Together with the Ukraine Public Health Centre, WHO has been working to restore immunization programmes and basic health services, as well as boost disease surveillance and laboratory diagnostics. WHO collaborates with more than 40 EMS units to supplement the existing health care infrastructure (WHO, 3 June, 2022).

As far as health crisis is concerned, the EU has not been pursing proactive health diplomacy towards Ukraine. With a budget of €485 million, the Commission has funded humanitarian aid operations in Ukraine to be carried out by humanitarian partners on the ground. In addition, EU and partners have shipped over 84,000 tonnes of in-kind aid worth an estimated €516 million to Ukraine through the EU Civil Protection Mechanism. Over €36 million in shelter, medical, and specialized equipment for public health concerns like chemical, biological, radiological, and nuclear threats provided to Ukraine as part of the rescEU emergency reserves. European Commission offered extraordinary support package for Ukraine of up to €18 billion for 2023. It is provided in the form of highly concessional loans. This aid package would allow Ukraine to continue paying salaries and pensions as well as sustain the critical public services including healthcare, education etc. EU has also received millions of Ukrainian refugees. The EU started the Temporary Protection Directive to give almost 4 million war refugees access to jobs, housing, education, and healthcare services (European Commission, 29 March, 2023).  The EU has also successfully organized over 1,700 medical evacuations of Ukrainian patients to provide them with specialized healthcare in hospitals across Europe.   

In conclusion, it is argued that the health crisis of Ukraine (2022-23) is a very complicated issue that requires immediate attention and responses on part of GHD. While GHD has the potential to play an essential role in tackling the issue, however, after examining the role of the regional and international organization like WHO and EU towards the Ukraine health crisis, it seems that still there is a lot to do for the same. A number of elements, including political will, financial resources, and effective coordination across multiple stakeholders, will determine either GHD is successful or not in resolving the health crisis of Ukraine. To improve healthcare outcomes and to overcome health crisis of Ukraine, GHD can be an important approach, but it cannot be a panacea.

Dr. Bawa Singh is an Associate Professor, Department of South and Central Asian Studies, School of International Studies, Central University of Punjab, Bathinda, India

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