Exhausted by war, Ukraine health care workers gird for another COVID winter

Health care workers in Ukraine are exhausted. 

The war is in its sixth month and shows no signs of ending, with Russia now occupying about a fifth of the country’s territory. The conflict has driven over 6 million refugees to other European countries, with a further 6 million internally displaced.

An army of staff on the ground are fighting fatigue to maintain health services despite the ongoing violence and attacks on health care — all during a pandemic.

“The front line is moving forward, my team out in the east is seeing almost daily shelling outside their window. They are working 24/7 for the last six months, they’re getting exhausted and the situation is not getting any better,” Heather Papowitz, emergency coordinator for the World Health Organization’s Ukraine response, told POLITICO.  

Since February 24, there have been 414 attacks on health care in Ukraine, resulting in 85 deaths, according to the WHO’s surveillance system. Very few, such as a Russian airstrike on a maternity hospital in the southern city of Mariupol in March, make the headlines. There has been a total of 595 attacks on health care worldwide this year. 

“It’s just an unbelievable amount,” said Papowitz from Copenhagen, having just returned from Ukraine, her own trip cut short as all armored vehicles were with field teams. “It really reduces their access to health care.” 

Still, staff are doing what they can to stave off the looming specter of a fall and winter surge in COVID-19 cases.

But it’s difficult to even sketch the scope of the problem now. As in much of the world, testing for COVID-19 is down significantly, and in a time of war the pandemic’s urgency has slipped down many people’s list of concerns.

“If you’re thinking of your priorities and your access to care, you’re probably going to get your diabetes medicine versus getting a test,” Papowitz said.

Coping strategies

The war’s disruption of testing and treatment, compounded by low vaccination rates for COVID — an estimated 36 percent for one dose — increases the risks of severe disease and death for the most vulnerable. 

It’s no surprise health care workers are putting their weight behind prevention. But promoting the vaccine is “still challenging,” Papowitz said, citing ongoing COVID vaccine skepticism, combined with people prioritizing access to food, water and other health care needs.

But Ukraine is no stranger to coronavirus surges.

Back in February, over 31,000 patients were in hospital with suspected and confirmed COVID-19, while during the previous wave last November that figure reached more than 53,000. Though COVID hospitalizations are currently lower — at around 1,000, according to a health ministry tracker — there’s concern that the stress on health services would make it harder to cope with another surge.

Ukraine has registered more than 5 million confirmed COVID cases since January 2020, with over 108,000 deaths reported to the WHO.

Whatever comes, those on the ground want to be ready. They’ve helped fix up an oxygen plant and stocked up on other materials like oxygen concentrators and personal protective equipment, Papowitz said.

They’re also looking to scope out the capacity of the country’s health services to treat patients with COVID and other illnesses, she said. Ukraine has low immunization rates for all vaccine-preventable diseases, so in addition to COVID, the fear of a winter measles outbreak lingers, too. There are also concerns about the potential for a surge in influenza cases based on what countries in the Southern Hemisphere are seeing. 

The current response — and the preparations for the months ahead — are all happening after a number of health care workers have left the contested Donbas in the east and other hard-hit regions.

Those still on the ground have to contend with less support and bigger health risks.

“I’ve been a doctor in some seriously dangerous situations,” said Papowitz, who is an internal medicine and public health doctor and has worked in places like Kosovo during the war and in the midst of gang wars in Chicago.

“I can’t even imagine how they feel after all of this time, working in this context.”