Widad Akrawi, a Kurdish health expert and human rights activist, wrote in the preface of the 2014 publication on Toxic Remnants of War that ‘Global efforts to assist fragile countries to recover from armed conflicts are hampered by a lack of accountability for environmental and public health damage caused by conflict and military activity.’ 1
History has repeatedly explained how war zones are home to various contagious infections. When people flee war, there is a high chance of the spread of infections leading to the birth of various known and unknown illnesses. There is an inexorable loss of access to food, water, and sanitation which further increases the risk of contracting communicable diseases such as TB and HIV/AIDS. Control programs such as vaccination drives, or vector control are severely hampered due to the collapse of public health infrastructure, lack of health services, and lack of trained professionals. Consequently, there is an increase in vaccine-preventable diseases such as measles. Before 1979 when the dissension in Afghanistan began, malaria was well under control; however, after the conflict, the disease has resurfaced with an approximate increase of 2 - 3 million cases per year since the discord. Reference Connolly and Heymann2
The unpredictability that comes with COVID-19 leaves us to question whether war situations during this deadly pandemic will lead us to an even greater cataclysm. Even before the invasion of the Russian troops in Ukraine, the 2 countries were already wrestling a major battle with COVID-19 as each of their cases soared up to approximately 180 000 and 35227 respectively on February 17, 2022. Reference Khan3 With the ongoing war situation, the people of Ukraine are being forced into an infectious war zone as there is a high possibility that soldiers invading Ukraine could bring along the virus worsening the situation in the country. Along with Covid-19, the country has been fighting a polio outbreak since October 2021, and has a high rate of HIV among its population (0.9% - 1.0%) leading to increased stress on the health system. Reference Zaliska, Oleshchuk and Forman4
Another reason attributed to the rise in COVID-19 cases in Ukraine along with the invasion is their poorly vaccinated population, issues with the vaccine supply chains in eastern Europe, and the spread of misinformation for which Russia is to be given credit. Reference Khan3
The early strategies deployed in war are annihilation, exhaustion of resources such as disruption of essential utilities, cuts to communication, destruction of civilian infrastructure, and the most concerning of them all is restrictions on access to medicine and healthcare along with brutal destruction of the health infrastructure. A similar scenario in Ukraine has resulted in several deaths and injuries among the healthcare staff, forcing medical professionals to flee their homes, further leading to medical staff shortages, and limited medical supplies. Reference Lawrence and Leonard5
Other than Covid-19, the various public health effects that the Russia-Ukraine war has include the deterioration of the Ukrainian population’s mental health as people face traumatic events and stress from acute conflict. Maternal and neonatal health is also at risk due to increased attacks around maternity hospitals, leading to reduced access to maternity care thereby leading to rising maternal and neonatal mortality and morbidity. More than 2 million children younger than 5 years of age and pregnant women in Ukraine are in dire need of nutrition. Reference Zaliska, Oleshchuk and Forman4
These pressing circumstances call for action from countries across the world. International organizations must give humanitarian health help to Ukraine, including vaccines and medications, hospital reconstruction, humanitarian corridors, and health worker training and support to deal with large numbers of traumatic injuries.
Along with holding countries like Russia accountable for their grievous acts, there is a need to better address people affected by war with a long-term plan in terms of healthcare facilities. Diplomatic efforts must be employed to end the war so that countries can rebuild and focus on treating people in need. Reference Khan3
