The war in Ukraine has had profound and widespread impacts on the health, human rights, and the environment. Civilians and civilian infrastructure, including healthcare facilities and water treatment plants, have been frequently targeted. Over 12 million people have been forcibly displaced. As of March 27, 2023, the Office of the UN High Commissioner for Human Rights reported 8,401 civilians killed and 14,023 injured since the Russian invasion began in February 2022. These data are major underestimates of the actual numbers. Based on many other recent armed conflicts, the number of indirect deaths, largely caused by forced displacement and damage to civilian infrastructure, will likely outnumber direct deaths, mainly caused by explosive weapons. In addition to injuries, civilians have suffered from communicable diseases, malnutrition, exacerbation of noncommunicable diseases, maternal and infant disorders, and psychosocial trauma. As of February 1, 2023, Ukraine’s Prosecutor General stated there had been more than 65,000 Russian war crimes since the start of the invasion. including indiscriminate shelling of civilians, willful killing, torture, sexual violence, looting, and forced displacement on a massive scale. Impacts on the environment have included contamination of air, water, and soil from explosions, fires, and damage to industrial facilities; radiation exposure from damaged nuclear power plants; widespread presence of landmines and unexploded ordnance; and damage to the built environment. After the war, many Ukrainians will likely suffer from long-term physical and mental health effects of the war.

Context: The full-scale Russian invasion of Ukraine in February 2022 significantly burdened the healthcare system that was undergoing reform processes. Data-driven humanitarian and development assistance requires evidence from the beneficiary level about current needs. USAID Health Reform Support conducted an assessment to identify health service delivery gaps, healthcare facilities’ needs, and priorities to support the restoration of health service delivery.

Methods: From December 2022 to January 2023, an assessment of healthcare providers was conducted in three de-occupied regions of Ukraine: Zhytomyr, Kyiv, and Chernihiv oblasts. The response rates were 78.5% for primary healthcare (PHC) providers and 86.0% for specialized healthcare (SHC) providers. Online surveys were done via the Deloitte Survey tool using questionnaires that the team developed and piloted. All respondents provided informed consent and were guaranteed anonymity and confidentiality.

Results/Outcomes: Power generators and fuel were among the top needs for both PHC and SHC facilities, while lack of water was a considerable risk to the continuity of facility operations. Office and blackout equipment were in high demand and critical to preserving medical equipment used in service provision. Many PHC providers needed basic medical supplies. Diagnostic equipment was in the most demand for SHC facilities. Kyiv hospitals often reported the need for surgical and trauma equipment, while Chernihiv facilities were more likely to request telemedicine equipment.

Conclusion: For modern healthcare systems, reliable power supply and Internet connectivity were the highest priority needs for healthcare providers in the emergency state. Facilities’ emergency preparedness and response plans should prioritize alternative supply mechanisms.

Issue

Yemen has been in civil war since 2014. Influences of Gulf states and Iran have significantly complicated the situation. The economy is divided, human rights abuses are abundant, the health care system is devastated, and famine consumes most of the country. Around 80% of the population is in poverty, and over 20.7 million people need humanitarian assistance. Women and children carry a significant burden of this conflict. The purpose of this assessment is to identify and analyze major health indicators and needs of pregnant women and children under age 5 living in Yemen.

Description

The Multi-Cluster Initial Rapid Assessment Framework was used to guide this assessment. This is used to gather data on population needs amid conflict, and inform humanitarian efforts. Data was collected from multiple sources, including UN organizations, WHO, World Bank, and Integrated Food Security Phase Classification. To support this evidence and provide timely data, interviews were conducted with leadership from multiple organizations currently providing relief in Yemen.

Lessons Learned

For pregnant women, leading health indicators include anemia, antenatal care, and maternal mortality. For children under age 5, leading health indicators include anemia, and malnutrition, including wasting, stunting, and underweight. In comparative analysis to the U.S. and neighboring Oman, pregnant women and children under age 5 in Yemen led across all indicators.

Recommendations

1. Oppose the Saudi blockade in Yemen, and increase pressure to lift it.
2. Increase aid to combat food insecurity
3. Increase aid to improve access and quality of maternal health care
4. Improve international organization data collection

The movie Oppenheimer opened-up a welcome conversation about the existential dangers of the nuclear arms race that had generally receded to the background of mass-consciousness until recently reawakened by the brutal Russian invasion of Ukraine. While focusing on the dramatic events surrounding the detonation of the first atomic bomb test in the New Mexico desert in July 1945, the film provides only a cursory view of the profoundly destructive health impacts of the Trinity test and is mostly silent about the public health consequences of research and development, testing, and use of nuclear weapons. As Tina Cordova, co-founder of the Tularosa Basin Downwinders Consortium, has eloquently stated about the movie, “A new generation of Americans ... won’t hear much about how American leaders knowingly risked and caused harm to the health of their fellow citizens in the name of war. My community and I are being left out of the narrative again.”

This presentation will provide a coda to the film, tallying the public health consequences of nuclear weapons and describing the global movement aimed at eliminating nuclear weapons – the only reliable pathway to preventing Armageddon. APHA has called for addressing these very present dangers in its 2020 policy statement, the "Toward a World Free of Nuclear Weapons" and the unprecedented 2023 coordinated publication of the editorial "Reducing the Risks of Nuclear War" among the leading medical journals echoed these imperatives, and underscored the urgent need for all health professionals to join this civilization-saving effort.