LVIV, Ukraine — At the main train station in this western Ukrainian city, where the internally displaced jostle to get on trains to Poland or change for other destinations in Europe, few among the heaving crowd wore masks. As night fell, hundreds bedded down across crowded stone floors or curled up on the stairs, inhaling thick, muggy air.
For these Ukrainians, the focus is escaping the Russian invasion bearing down on their country — not on dodging diseases such as covid-19.
But as more than half a million people have fled Ukraine to neighboring countries, global health officials fear that Russia’s invasion of Ukraine will be the latest reminder of a grim lesson — that war and disease are close companions, and the humanitarian and refugee crises now unfolding in Eastern Europe will lead to long-lasting health consequences, exacerbated by the coronavirus pandemic.
As Russia’s military campaign accelerates, Ukraine’s hospitals are running out of critical medical supplies as travel is increasingly choked off by the conflict. The country’s health workers and patients are relocating to makeshift shelters, seeking to escape explosions. Meanwhile, officials at the World Health Organization, United Nations, U.S. State Department and other organizations warn of rising civilian casualties and new pressures on the region’s fragile health-care systems.
“What we’re dealing with now in Ukraine is a double crisis,” said Máire Connolly, a global health professor at the National University of Ireland Galway who has studied the link between conflict and disease. In an interview, Connolly said she was worried not just about threats from the coronavirus pandemic but also those from Ukraine’s polio outbreak, which global experts had sought to quell for months. She also said she fears the potential resurgence of tuberculosis during the current conflict.
“As we’ve seen in wars over the years, viruses and bacteria are happy to exploit those situations where human beings are put under pressure,” Connolly added, citing how refugees fleeing armed conflict can end up in overcrowded conditions and without sufficient water, food and sanitation. “These factors increase the risk of outbreaks among a population that are already dealing with the trauma of forced displacement.”
While covid cases in Eastern Europe have plunged in recent weeks, experts such as Connolly say they’re worried that the regional conflict will trigger new spikes. Ukraine experienced some of the world’s highest rates of coronavirus late last year, and is flanked by countries with some of the lowest vaccination rates in Europe — raising the prospect that the movement of thousands if not millions of refugees could lead to surges of illness in neighboring countries.
“I am heartbroken and gravely concerned for the health of the people in Ukraine in the escalating crisis,” Tedros Adhanom Ghebreyesus, director general of the WHO, said in a statement as the conflict began last week. The WHO leader also shared a video on Twitter of newborns in Ukraine being cared for in a makeshift bomb shelter, calling the images “beyond heartbreaking.” On Sunday, he warned that Ukraine is now dealing with a dangerous shortage of oxygen supplies needed to treat covid and other conditions.
“The majority of hospitals could exhaust their oxygen reserves within the next 24 hours. Some have already run out,” the WHO said in a statement. “This puts thousands of lives at risk.”
U.S. officials, Ukraine’s health minister and others have also accused Russian military forces of firing on the country’s ambulances and hospitals, and experts remain concerned the conflict could disturb radioactive waste being stored at the Chernobyl nuclear plant, sparking additional health and environmental disasters.
Global humanitarian organizations have moved to shore up Ukraine’s health safety net. The WHO, which began positioning additional medical supplies in Ukraine in November after Russian military forces began to mass on its borders, on Thursday made $3.5 million available in additional emergency funding. The U.S. Agency for International Development deployed a disaster response team to nearby Poland, intended to help coordinate the regional humanitarian response, and along with the State Department, will provide nearly $54 million in additional assistance. The White House also is seeking $6.4 billion for emergency aid to the region, much of which would go toward humanitarian assistance.
U.S. officials and outside experts say they’re bracing for further shocks. “Despite the immense, multinational efforts to prepare for this scenario, we know that many Ukrainians will needlessly suffer at the hands of Russian aggression,” USAID Administrator Samantha Power said in a statement on Friday.
Power, who spent time at the Poland-Ukraine border this weekend, said Monday that as many as 5 million refugees could flee Ukraine in coming weeks.
Humanitarian and health groups also had not anticipated an invasion from multiple directions; they expected it to be concentrated on the country’s eastern border, where they had positioned emergency supplies in advance, said Simon Pánek, CEO of People in Need, a humanitarian organization working to deliver aid.
“Until a few days before the war started, my colleagues and I didn’t talk about the possibility that there would be a direct offensive on Kyiv from the north, for example,” Pánek said in an interview from Prague, where he is based. “What we need most is safe transport to central and eastern Ukraine, but no one from outside can provide it,” Pánek added, saying his group had sent five trucks filled with supplies on Sunday and had planned to send more aid on Tuesday.
Meanwhile, the accelerating Russian military campaign has posed mounting challenges, with explosions across Ukraine’s major cities and more military forces pouring into the country.
A “health system cannot function during an active bombing campaign,” Rachel Silverman, a policy fellow at the Center for Global Development, wrote in a series of text messages from Germany. “They must evacuate patients from hospitals, all routine services will be put on hold, many facilities will be damaged and health workers will flee.”
Russia’s invasion of Ukraine also comes on the heels of a coronavirus outbreak that skyrocketed late last year and saw the region become a global hot spot. While Ukraine’s case numbers have fallen sharply, public health experts say large movements of people could spark new infections in Eastern Europe, where vaccination rates trail countries to the west. Only one-third of Ukrainians have received at least one dose of a coronavirus vaccine, according to the University of Oxford’s Our World in Data tracking project, compared with more than three-quarters of people in countries like France, Germany and Britain.
“Covid is understandably not top of mind for anyone” during an armed conflict, Silverman wrote in a message. “But having people in crowded subways, with no real access to health services, is a terrible situation. Even the mildest covid cases can be very problematic if you have no place to isolate/get care, and/or if you need to flee on foot.”
Many Ukrainians are now seeking shelter in neighboring Poland, which has waived its standard coronavirus quarantine and testing requirements for those refugees.
.@a_niedzielski: Persons crossing the border of the Republic of Poland with Ukraine in connection with an armed conflict on the territory of this country are exempt from the quarantine obligation and showing covid test results. https://t.co/8HILs1IDn9— US Embassy Warsaw (@USEmbassyWarsaw) February 25, 2022
Poland’s health minister also announced free coronavirus vaccinations for Ukrainians on Friday.
But like Ukraine, Poland has had a severe covid outbreak in recent weeks, and officials say its health system is dealing with a significant workforce shortage that has sparked walkouts and protests. About 59 percent of Poland’s population has received at least one vaccine shot. Poland is set to lift many of its remaining coronavirus restrictions on Tuesday.
Jarno Habicht, the WHO’s representative to Ukraine, told reporters that he was worried that the conflict would set back months of progress to vaccinate Ukrainians while escalating other regional health crises, such as the polio outbreak.
Russia’s invasion “will have implications across the whole country,” he said, adding that his team was rapidly pivoting to address a brand-new set of health challenges. “Our priorities have shifted to trauma care, ensure access to services, continuity of care, mental health and psychosocial support.”
Diamond reported from Washington. Max Bearak in Przemyśl, Poland, contributed to this report.