Ukraine

UKRAINE

It was only possible to obtain information on three specific events that impacted health care in Ukraine. Only these detailed events are included in the event count for Ukraine. However, various reports cited aggregate figures, which are presented in this chapter.

International security monitors found that 2017 was the most violent year since the beginning of the conflict between government and pro-Russian separatist forces in eastern Ukraine and was characterized by regular violations of the 2015 Minsk ceasefire agreement.[1] [2]The conflict has resulted in tremendous damage to civilian infrastructure in the region, as well as heavy losses of civilian life.[3] [4] [5] Violence is most frequent in the Donetsk province of Ukraine, one of the key areas held by pro-Russian separatist groups, along with the Luhansk region.[6]

According to the WHO, since the start of the conflict, 160 health facilities have been shelled on both sides of the contact line that divides Ukrainian and separatist-controlled territories; 130 of these facilities remain either partially or fully nonoperational. More than 400 facilities report insufficient stores of medicine and other supplies.[7] Dr. Nedret Emiroglu, director of the Division of Health Emergencies and Communicable Diseases at the WHO/Europe, stated, “In the midst of Europe we are leaving millions of people with poor or no health care; hundreds of health facilities without infrastructures and medicines; and health-care workers with the fear of being shelled or having to leave their country. This is the situation in eastern Ukraine today.”[8]

Disaggregated data on specific attacks in 2017, however, are largely unavailable. Two attacks, one that destroyed a hospital in the Donetsk region and another that killed a US health worker in the Luhansk region, were reported, along with continued disruptions to health facility operations due to heavy shelling in conflict areas.[9][10] [11] The Russian hybrid military force was responsible for the hospital attack,[12] using large-caliber weaponry.[13] Meanwhile, pro-Russian separatist rebels were suspected of committing a lethal attack on a health worker.[14] The perpetrators of the shelling are unknown but are likely linked to the conflict within the region.[15]

Access to health care, medications, and humanitarian aid for the more than four million people affected by the conflict was severely impeded by shelling along the contact line, landmines in the vicinity of the crossings, and restrictions on civilian and ambulance travel across the contact line. Some towns and villages have no health facilities remaining, and in others, there are no health practitioners left.[16] [17] [18]

In villages including Dolomitne, Nevelske, Novooleksandrivka, Opytne, Pisky, Roty, and Vidrodzhennia, no doctor or paramedic remains. Furthermore, Ukrainian Armed Forces or armed groups prevented ambulances from entering, or else the ambulance operators refused to enter at night because of security dangers. In areas where ambulances are not allowed, civilians must rely on military staff or members of armed groups to be transported to a hospital.[19]