Miten Ukrainan murskaaminen valtiona ja kansana tapahtuu yhtäkkiä nähden yhdessä- kahdessa viikossa ?
WHO alkaa analysoida tulosta rutiinisti kuten esim . jonkin muun genosidin kohteena olevan alueen Etelä-Sudan, Ruanda ym. joilla ei ollut naapruivaltioissa sen suurempia puolustajia sielläkään.
https://www.who.int/publications/m/item/emergency-in-ukraine---situation-report-1
Priority public health concerns
• Conflict related trauma and injuries exacerbated by lack of
access to health facilities by patients and health staff due to
insecurity and lack of access to lifesaving medicine and supplies.
•
Excess morbidity and death from common illnesses due to disruption in
services such as non-communicable diseases (cardiovascular, diabetes,
cancer etc.) and acute maternal, newborn and child illnesses.
•
Spread of infectious diseases such as COVID-19, measles, polio, TB,
HIV and diarrheal diseases due to widespread destruction of water and
sanitation infrastructure, inadequate vaccination coverage, lack of
access to medicines and medical care, safe water, adequate sanitation
and hygiene as well as population movements and crowding.
•
Mental health and psychosocial health - due to significant stress due
to acute conflict and two years of COVID-19
WHO Actions
• Coordinating the health response in support of the Ministry
of Health in Ukraine and surrounding countries.
• Conducting
public health risk and health facility and service assessments.
•
Scaling-up surveillance and health information to detect and respond
to outbreaks early and to better understand health needs, health
threats, and the functionality and availability of health services.
•
Providing WHO technical support and surge staff to manage the
priority health concerns as well as mobilizing partners through
Emergency Medical Teams (EMT), the Global Outbreak Alert and Response
Network (GOARN) and the Global Health Cluster, among others.
•
Providing health supplies and logistic capacity to deliver medicines,
diagnostics and preventive supplies.
• Monitoring attacks on
health care.
• Ensuring the safety and security of WHO staff
and our implementing partners.
On 24 February 2022, an escalation of military operations in
Ukraine triggered a humanitarian emergency affecting Ukraine and
surrounding countries. One week after the escalation, the overall
situation continues to deteriorate across Ukraine. To date, over 18
million individuals have been affected by the conflict, over 1
million refugees have arrived in neighboring countries, with UNHCR
estimating that this could rise to 4 million by July 2022.
OHCHR: Between
24 February and 2 March 2022, OHCHR recorded 802 civilian casualties
in Ukraine, including 249 deaths. The human cost is likely much
higher as access and security challenges make it difficult to verify
the actual number of deaths and injuries. Reports of attacks on
health are increasing. WHO has verified 5 attacks on health since 24
February.
UNHCR: According to the latest government data compiled by
UNHCR, over one million of the refugees have now left Ukraine to
surrounding countries, with the majority in Poland.
An
additional 96 000 people moved to the Russian Federation from the
Donetsk and Luhansk regions between 18 and 23 February.
People affected 18 million
Internally displaced persons
160 000
Refugees 1 209 976
Injuries among civilians
553
Deaths among civilians 249
Current Risk Assessment and priority public health concerns
1. Access to health care
The Ministry of Health (MoH) and National Health System of
Ukraine (NHSU) continue to operate, but humanitarian access across
borders is still being negotiated as of 4 March 2022. There are
significant access barriers due to active hostilities, martial law
(curfew), medicine (availability, access to pharmacies, cost), health
care facilities (distance, damage to roads, transportation, lack of
mass transport, fuel shortages, restricted movement through military
checkpoints, safety concerns in facilities, lack of specialized beds
and equipment, few disability accommodations, limited telemedicine,
health workforce shortages). Many isolated settlements do not have
pharmacies or medical centres.
These barriers to access are further compounded by a health system
already strained by the COVID-19 pandemic, suffering from a lack of
maintenance and aging medical equipment, shortages of medicines and
medical supplies, understaffing, and disruptions to management due to
recent health reforms and decentralization.
Health facilities
are focused on treating trauma patients; and there are already dire
warnings concerning the availability of beds for both trauma and
other conditions.
At least three major oxygen plants in Ukraine have closed, and supplies are dangerously low, hampering treatment of a number of medical conditions, including COVID-19.
As of 3 March, based on the
shifting context, more than 200 health facilities have found
themselves along conflict lines or in changed areas of control.
There
are reports, both verified and under investigation, of health
facilities being damaged or destroyed.
The Ministry of Health
(MoH) suspended all scheduled hospitalization and elective procedures
to allow health care facilities to respond to emergency medical care.
International trauma referrals are being set up in the meantime,
including a Regional "Humanitarian Hub" in Poland.
COVID-19 call centers are being repurposed to manage conflict-related health emergencies, including trauma care and access to health services.
There will likely be staff shortages at health facilities for security reasons and displacement of some staff, either internally or to neighbouring countries. Accessibility of health services is likely to be severely disrupted within areas of active conflict.
2. Main health risks and needs
A detailed assessment of the main health needs and threats can
be found in the Public Health Situation Analysis published by the
Ukraine Health Cluster on 3 March 2022.
An update on a few main health priorities is provided below.
2.1. Crisis related trauma and injuries
Between 24 February and 2 March 2022, OHCHR recorded 802 civilian casualties in Ukraine, including 249 deaths. For the same period, the MoH estimated over 2000 casualties; the real toll is likely higher, with immense needs for trauma and injury support. Priority actions include provision of rapid refresher training, supplies, staffing through mobilization of medical teams
2.2. Non communicable diseases (NCDs) and urgent medical care
2.3. Epidemic prone and other infectious diseases
POLIO and MEASLES. Recent outbreaks of polio and measles
threaten the health of populations with suboptimal vaccination
coverage (80% and 82% respectively in 2021), and the prevalence of
HIV and tuberculosis, including multidrug resistant tuberculosis, are
among the highest in Europe. Urgent actions are to re-start or
continue preventive measures through vaccination and continued
treatment for TB and HIV and to scale up surveillance, early
detection and response systems for epidemic-prone diseases.
A
polio outbreak (circulating vaccine-derived poliovirus type 2)
was confirmed in the country in 2021, with two paralytic cases
(detected in October and December 2021), and a total of 21
individuals in two oblasts (Rivne and Zakarpattya) who had positive
isolation of cVDPV2 in stool specimens. As a result, a nationwide
vaccination campaign targeting all under-vaccinated children (those
having only zero or one dose) aged between 6 months and 6 years that
began in February 2022. This campaign has been suspended because of
the conflict, increasing the risk of further spread.
COVID-19: Over 240 000 weekly cases and 1300 deaths were reported for COVID-19 in the week 21-27 February. While this is a 43% decrease in cases compared to the previous week, testing rates have also declined sharply since the start of the conflict, with a likely significant undetected ongoing transmission. The ongoing high incidence levels of COVID-19 poses a significant risk of severe disease and death, particularly given the low vaccination coverage in at-risk population groups. Critical shortages of oxygen further impact on the ability to treat patients with severe COVID-19, and many other conditions.
Beds occupied by COVID-19 patients were repurposed for trauma injuries and critical illnesses.2.4. Mental Health and Psychosocial support
To help cope with this emergency, the conflict-affected
population is also in urgent need of mental health and psychosocial
support services (MHPSS). Exacerbation of chronic mental health
problems and high levels of Post-Traumatic Stress Disorder (PTSD),
depression and anxiety are likely among affected population of all
ages. The Health Cluster’s MHPSS working group maintains online
maps of MHPSS and prevention of gender-based violence services and a
list of hotlines available in Ukraine.
3. Supply chains
The supply chains for medicines, medical supplies, and common
goods have been disrupted in Ukraine, creating urgent need. Many
distributors are not operational, and many government and
humanitarian stockpiles are inaccessible due to ongoing military
operations. Lifesaving and essential medicines, such as oxygen and
insulin, personal protective equipment, surgical supplies,
anaesthetics, and safe blood products, are reported in short supply.
WHO has been working with partners to alleviate some of these
shortages.
Over 1 million refugees have been displaced to neighbouring
countries, with UNHCR estimating that this could rise to 4 million by
July 2022. Many conditions linked to population displacement (such as
poor shelter, inadequate sanitation, overcrowding, lack of health
care access) are risk factors for disease or exacerbation of existing
conditions. Displaced populations (including internally displaced
people (IDPs) and refugees) are at increased risk of communicable
diseases (e.g., COVID-19, measles, polio) and TB and HIV primarily
due to closer and more intense social mixing as well as vaccination
coverage gaps, disrupted surveillance systems, lack of access to
health care, poor quality shelter and WASH (water, sanitation, and
hygiene) conditions, and greater exposure to the elements including
the cold winter weather.
The risk of noncommunicable disease (NCDs, e.g., hypertension,
diabetes) and maternal, new-born, child health and sexual and
reproductive health concerns is increased by the limited access these
populations have to essential health services, particularly primary
health care, and medications. NCDs are particularly prevalent in the
older persons; many of whom have not been able
to flee the
hostilities due to reduced mobility and financial means.
Providing safe shelter, adequate water, sanitation and hygiene, vaccination and prevention measures for displaced or crowded settings, health services upon entry and to access to emergency and primary health care in surrounding countries free of charge
