Russian-occupied regions of Ukraine at risk of infections and epidemics

Around 20% of Ukraine is currently under Russian occupation. In addition to the urgent military and human rights issues this creates, Russia’s continued invasion has also produced a host of public health issues that require urgent international attention.

One of the main problems facing the Ukrainian authorities is the lack of access to information. Unfortunately, the Ukrainian Ministry of Health no longer has a complete picture of the medical situation in the occupied regions of the country. It is therefore difficult to obtain information and assess the extent of health problems in areas under Russian control. Nonetheless, assessments of the available evidence and an awareness of the general situation in Russian-occupied Ukraine can help identify key priorities for Ukrainian and international healthcare professionals.

One of the biggest risks comes from the possible spread of pathogens. As temperatures reach seasonal highs in July and August, human contact with bloodsucking insects and ticks becomes more common. This often leads to the spread of infectious diseases.

Another major problem is the limited access to drinking water. This increases the risks posed by contaminated water and also makes it difficult for people in occupied regions of Ukraine to maintain desirable standards of personal hygiene and sanitation. This can cause massive outbreaks of diarrhea, hepatitis A, cholera and other infections.

Due to the Russian military strategy of carpet bombing Ukrainian cities into submission, basic infrastructure was badly damaged in much of southern and eastern occupied Ukraine. Many regions now have limited access to safe drinking water, while the remaining water supplies often do not receive normal treatment.

The risk of a cholera outbreak would be particularly high in Mariupol, a Russian-occupied Ukrainian port city in Donetsk Oblast with a pre-war population of nearly half a million that was largely reduced to rubble in a brutal Russian siege. According to the municipal authorities of Mariupol, the city’s 22 pumping stations were all destroyed during the fighting, while the sewage treatment and drainage systems are also unable to function properly. Large numbers of corpses remain trapped under the rubble and decomposing, further complicating the city’s precarious health situation.

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Russia’s invasion has displaced millions of Ukrainians and brought together large numbers of people in a way that creates the potential for health emergencies. Concentrations of children with different vaccination status during evacuation procedures risk fueling outbreaks of vaccine-preventable diseases such as measles and diphtheria.

COVID-19 also remains an issue. Before the Russian invasion, only 35% of the Ukrainian population had been vaccinated, which is one of the lowest rates in Europe. A sharp rise in COVID cases could lead to overcrowding in hospitals at a time when health facilities are desperately needed to treat wounded military and civilians.

In the meantime, potential delays in the diagnosis and treatment of TB are of considerable concern. In particular, if patients stop taking their medications due to restricted access to medical care in occupied regions of Ukraine, this may lead to an increase in cases of antibiotic-resistant tuberculosis.

Likewise, people living with HIV cannot afford to stop taking their medication. Skipping doses can lead to the re-emergence of treatment-resistant strains that pose a high risk not only to current patients but also to those who may contract the disease in the future.

Large numbers of abandoned livestock further complicate the health care situation in wartime Ukraine and increase the threat of animal-borne diseases. The uncontrolled movement of animals or their undisposed carcasses, as well as the destruction of wildlife habitats, can lead to the spread of pathogens among humans as well as wild and domestic animals.

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International support for Ukraine has so far focused on the supply of weapons as well as humanitarian aid efforts for those displaced by the fighting. For the future, it is essential that Ukraine’s partners also contribute to solving the growing health problems created by the Russian invasion.

The list of medical items currently required by Ukraine is long. This includes diagnostic kits, rapid deployment field hospitals, immunobiological drugs for the treatment of diseases such as diphtheria, tetanus, botulism and malaria, as well as vaccines for routine immunization (including against hepatitis A and cholera), disinfectants, portable water treatment systems, and pest control tools.

In order to set up a health system capable of responding to epidemic risks, the Ukrainian parliament will finalize the second draft law on public health, which has more than 850 proposals from deputies and 400 proposals from international experts.

In preparation for the second reading, experts from WHO, USAID, the Ukrainian Ministry of Health and the Ukrainian Center for Public Health are participating in the finalization of the bill. Considerable revisions remain to be made before this law can be implemented. This considerable task will require additional support from the international community.

Ihor Kuzin is Ukrainian Deputy Minister of Health and Chief State Medical Officer.


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The opinions expressed in UkraineAlert are solely those of the authors and do not necessarily reflect the opinions of the Atlantic Council, its staff or its supporters.

The Eurasia Center mission is to strengthen transatlantic cooperation in promoting stability, democratic values ​​and prosperity in Eurasia, from Eastern Europe and Turkey in the West to the Caucasus, Russia and the Central Asia to the East.

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Image: Natalia, 57, stands by her son’s grave in a cemetery outside Mariupol. May 22, 2022. (REUTERS/Alexander Ermoshenko)

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