Forty-three days after the start of the Russian offensive in Ukraine, the displaced number in the millions… and health needs are accumulating. “It is an understatement to speak of massive displacement of populations, warns Joël Weiler, director general of Doctors of the World (MDM). There are 10 million displaced Ukrainians – that’s the equivalent of Sweden –, including 4 million outside the borders. And maybe at the end of the week, we will be at 12 million…”
A fear that says how much the situation of these populations, in Ukraine and in neighboring countries, is as changing as it is dramatic. Because women, children and, more rarely, men who have left their homes need physical, but also psychological care. On the 43rd day of the war, the medical NGO for international solidarity took stock, this Thursday, of the situation of Ukrainians thanks to its teams on the spot, in kyiv and in Moldova.
Different situations depending on the city
Irina Maslvoskaya has been coordinating Médecins du Monde’s actions in Ukraine from kyiv since 2018. “The needs are very great and differ according to the security situation in the cities,” she explains. Some are in dire straits, like Mariupol, where access to humanitarian workers is almost impossible. Negotiations are underway, but for the moment, the humanitarian corridor is not effective. “Others, like Sievierodonetsk are still under bombardment. “In these cities, it is still possible to act locally through local associations and NGOs. She confirms that the conflicts have intensified in the east of the country in recent days.
“It’s another reality for the recently liberated territories, especially in kyiv, where we discover the extent of the needs for the populations to start living again, to rebuild themselves, she continues. According to the United Nations, there are 80,000 km² of mined territory, which represents an additional risk. Especially for the inhabitants of kyiv who hope to find their homes. “Cities in the west and center are less affected by active fighting, but are bombarded and have to deal with an influx of displaced people,” continues Irina. This is an additional pressure on the hospitals in these regions. All this in a context of Covid-19, which must not be forgotten. These are essentially families, so care must be taken for young children and the elderly. »
But also to patients with chronic diseases. “We lack oncology treatments, insulin, list Irina. We lack everything”. Doctors of the World’s priority was first and foremost war medicine. “We received surgery and trauma kits by convoy to support the hospitals that receive the wounded,” she continues. For chronic diseases, there is a break in care: pharmacies are closed. The NGOs and some volunteers bring the drugs to the homes of these isolated people. “Groups of volunteers also communicate via Telegram to help midwives who give birth in the metro”, illustrates Irina.
Essential psychological support
Psychological care is also essential for these displaced people, who had to leave everything in a few minutes. And who have walked for miles or waited weeks in anguish to reach a bomb-free country. “Moldova has taken in 40,000 displaced Ukrainians,” notes Cristina Minana Planchart, general coordinator of Médecins du Monde on the spot. We offer them psychological first aid to help them cope with the situation. Most of them suffer from post-traumatic stress. We help them to contact their relatives in Ukraine and we identify those who will need specific psychological help. »
“The challenge is the language,” says David Annequin, head of the emergency unit at MDM. You have to be able to dialogue with Ukrainians, either through translators or by volunteers who speak Russian, which adds a constraint. »
Long-term care needs too
The NGO also stresses that beyond emergency care, this war will leave long-term psychological and physical scars. “Any conflict has a major impact on health because it disrupts all care,” insists Helena Ranchal, director of international operations. Infants will not get vaccinations, pregnant women will not have the right follow-up, all the chronically ill will not have their treatments. But there are also HIV patients, those who need dialysis… All the more so since healthcare personnel have left the country, healthcare facilities are targeted by bombardments, all drug supply chains are blocked. We will see these impacts in the months and years to come. For some, we can catch up, for others, not. »
And the longer this war lasts, the heavier the health consequences will be… and the more difficult it will be for health systems to cope. “The welcome can differ from one country to another: Poland is part of the EU, for example, while Moldova is not. And it is one of the poorest European countries, underlines David Annequin. But overall, it is correct: the refugees are given food and accommodation. And the medical care is good. Even if there are certainly gaps in terms of psychosocial support for traumatized people. But with time and the accumulation of the number of refugees, the risk is that it constitutes a burden for the health personnel. »