History also teaches that strategic escalations wreak greater havoc on health, health systems, and the social determinants of health. The first months after Russia's February 2022 invasion of Ukraine provoked much concern from global health experts, including those at the World Health Organization. These concerns deepened as the invasion stalled and a war of attrition began with terrible health consequences in Ukraine and beyond—both direct harms (for example, damage to the physical and mental health of injured and displaced people and to medical services within the country) and indirect threats (for example, disruption of food and other agricultural supplies to low-income countries).
A shroud is settling over the dreams many of us had at the end of the 20th century.
More than 8 million refugees have fled Ukraine in what the World Health Organization describes as "the largest movement of people in the European Region since the Second World War." Many have been involuntarily relocated by Russia. Others have put a strain on resources, as well as schools and hospitals, in Poland and Germany.
Russia's invasion is leaving a toxic trace on Ukrainian soil, contaminating crops and posing a serious long-term risk to human health.
Over the past 12 months the people of Ukraine have lived through a full-blown Russian invasion, with all the horrors you might expect. Those who lived in conflict zones, have had to flee or witness death and destruction on a massive scale. Many have either witnessed or experienced war crimes – including sexual violence. Millions have lost their homes and possessions, while thousands are mourning lost loved ones.
Beyond day-to-day health care access, the conflict has impacted clinical trials, medical education and services for cancer, diabetes, cardiovascular conditions and perinatal care.
Even before the war, the country struggled with epidemics of H.I.V., tuberculosis and hepatitis. The conflict threatens to undo decades of progress.
The conflict has forced millions of Ukrainians to flee their homes — including an estimated two-thirds of the country's children. With so many people displaced inside the country and even more escaping to other countries, "this is the largest human displacement crisis in the world today," according to the United Nations refugee agency.
The Russian invasion of Ukraine has caused an abhorrent situation that represents the antithesis of all that medicine and public health strive to achieve. Physicians and other health professionals, who are dedicated to healing and preserving life, are once again on the forefront of emergency aid and humanitarian relief efforts during war.
'They don't have political power, but they have a lot of moral authority and, as we have seen in Ukraine, mothers and grandmothers carry a lot of influence'.
War is creating the perfect conditions for an outbreak.
They are Ukraine’s “medical angels,’’ a roving band of bright yellow ambulances with blue and khaki signage that rush to the front lines at the first hint of something amiss.
“I can’t imagine how it would be in Russia’s interest to allow any facilities at Chernobyl to be damaged,” Edwin Lyman, of the Union of Concerned Scientists, told the Associated Press.
Gee what’s the best thing that you can do for the world right now in the middle of the Covid-19 coronavirus pandemic? How about invade another country, especially one that’s already been struggling with Covid-19 and polio?
The invasion of Ukraine has been described as the first social-media war, and a key aspect of President Volodymyr Zelensky’s leadership has been his ability to rally his country, and much of the world, via Facebook, Telegram, TikTok, and Twitter. At the same time, war photographers in Bucha, Irpin, and beyond are working—in the tradition of Mathew Brady at Antietam or Robert Capa on Omaha Beach—to capture the grisly realities of what Vladimir Putin insists that his people call a “special military operation.”
"The people of Ukraine need urgent action and support from the rest of the world to ensure its health care is functioning and protected so further loss of life is prevented," said Anil Soni, CEO of the WHO Foundation. "I urge anyone who can to donate to ensure all those in need of basic health care, as well as those wounded and directly affected by the conflict, have safe access to lifesaving care."
Wars are complex health emergencies. They lead to the breakdown of society, cause considerable damage and destruction to infrastructure, create insecurity and have a significant economic impact. They also exacerbate pre-war issues.
The four-week war has also forced Ukraine to repurpose hospitals to care for the wounded, disrupting the provision of basic medical services to the rest of the population.
“War is an infectious disease’s best friend,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It challenges every public health program you can possibly have. It limits the medical care available for those who might be seriously ill, and often fosters transmission when so many people are crowded into bomb shelter locations and on trains. This is going to be the perfect storm of one serious challenge after another.”
Humanity’s greatest political achievement has been the decline of war. That is now in jeopardy.
The war has entered a more dangerous phase with grim portents for health.