We pay a high price: Viktor Lyashko, Ukrainian Health Minister, on the impact of the war on the medical system and Ukrainians and the effectiveness of WHO

Katerina Khoroshchak, Ukrayinska Pravda, June 10, 2022

– WHO is one of the international organisations that is being criticised for its activities or inactivity concerning the war in Ukraine. How do you assess the impact of WHO on the situation in the country at the local and international levels?
– When we talk about the situation after Russia’s full-scale invasion, perhaps we all expected WHO to take faster actions, a faster condemnation of Russia’s aggression. But you need to understand how this organisation is built, what bureaucratic processes it goes through before doing something or saying something.
Therefore, we expected such cooperation. We asked them for some things, but then we started doing them ourselves. For example, issues about sending our citizens abroad for medical treatment. At first, WHO had to deal with this. After two weeks of organisational processes on the part of WHO, we took this initiative to the Ministry of Health. Now they are helping us, but they are not the drivers of the process. We communicate directly with the European Commission about health issues, through their directorate, and with each Minister of Health, from the countries, which have joined this initiative.

– Are there any things that WHO doesn’t do for Ukraine because of Russia’s influence?
– Issues of organisation of humanitarian corridors and delivery of medicines, for example, to the territory of Kherson region or to the south of Zaporizhia. So what do we have today? It’s getting harder and harder to get there and to deliver medicines.

– So WHO assistance in this matter is not enough?
– Yes. I think WHO together with the Red Cross, Doctors Without Borders could have done it during 100 days of a full-scale war.

– Let’s talk about the pressure on the medical system then. What about the medical system in the territories affected by the shelling or occupied today? What losses are we talking about?
– They’re approximate now. We have 672 damaged or robbed health facilities. Of these, we estimate that 115 medical facilities have been destroyed and cannot be restored. Only 34.4 billion hryvnias are necessary to restore damaged objects. This is without taking into account 64 more objects out of the 672 to which we do not have access. 15 billion 211 million is needed to restore the destroyed facilities. It’s only about restoration, not modernisation. 426 pharmacies have also been destroyed or robbed. 33 of them cannot be restored.

– How many institutions are being restored now?
– 30 institutions have already been fully restored. Other work is also being done, but it all depends on the level of complexity. Somewhere glazing is done, somewhere roof repair, and somewhere doors are inserted. … Separately, we have launched fundraising for the construction of a primary health care centre in Makarov, which was burned to the ground.

– What is the situation with doctors? Are there enough of them?
– Now there is no critical shortage of doctors, because we have a queue of foreign doctors ready to come to Ukraine. We are also open, but we say that it is better to come when we send a request, indicating whom a hospital needs, for example, an anaesthesiologist or traumatologist. Then we ask– come with your team, we’ll tell you to which hospital.
But the situation depends on the place in question. The west of Ukraine, the centre is one thing. Another thing is a territory where hostilities take place and the territory where Russia is trying to establish an occupation regime.

– Is the situation with the immigration of doctors common?
– Yes, first of all, these are women with children who were forced to leave Ukraine to ensure the safety of their children. Therefore, such a situation exists. Is it critical for us now? No. Communication with frontline doctors indicates that most of the medical staff remains in the workplace.

– What is the statistics on the injured medical staff and those who died?
– 12 are killed by the Russian occupiers and 47 seriously wounded. These are verified figures. Potentially there are more, but there is no confirmation yet.

– What do you know about the situation with hospitals in the occupied territories?
– We periodically communicate with everyone, but it’s getting harder and harder because of Internet problems. Communication with chief physicians becomes more complicated every day. The key thing for us is whether the funds paid by the National Health Service of Ukraine reach the bank cards of doctors, if there are necessary medicines for emergency aid and whether there is access to fuel. …

– What’s the situation in Mariupol?
– The situation in Mariupol is more complicated. A large number of health care institutions have been destroyed due to chaotic shelling and targeted shelling.

– From the stories of paramedics who left Mariupol, it looks like it is almost impossible to work there, because the occupiers threaten to shoot ambulances. Do you have any statistics on Miriupol, how many doctors are left there?
– It’s hard to determine. There’s no access there now, the chief physicians don’t get in touch.

– And what medicines are in deficit in the occupied territories?
– In hospitals, it was possible to provide the supply of Ukrainian drugs, which were delivered already during the hostilities. But in the pharmacy segment, in particular, there are problems with drugs to reduce blood pressure.
Hospitals have problems with drugs for people who have undergone organ transplantation. Problems with physical solutions are also beginning to appear.

-Do you supply medicines to the occupied territories now? How systematic is it?
We have no regular supplies. We have no humanitarian corridor. The Russian Federation has not opened territories where the occupation regime has been established for the supply of medicines. These are all partisan actions that we do together with volunteers, volunteers with us, and we try to deliver everything we can and as much as possible. In any way, in which we can succeed.

– What is the situation with emergency contraception?
– It’s a delicate topic. We talked to an American company about drugs with a longer period of use, not the first few weeks, but longer. But we must realise that this is a topic that is talked about, but is little used.

– Do you assume that some raped women simply do not talk about it and, accordingly, it is impossible to provide this emergency contraception?
– Of course. And we find out about cases of rape after de-occupation in most cases.

– So it’s also a problem of inability to deliver these drugs?
– The problem with logistics, of course. Who needs them here in Kyiv?

– What does the war mean today for the future of medicine and the medical system in Ukraine? What are its long-term consequences?
– We pay a fairly high price for maintaining democracy around the world, and for giving all the countries in the world an opportunity to be independent and free. Therefore, we must use this price as a chance. And we immediately developed a plan not only to restore the destroyed facilities, but also a plan for recovery with the prospect of development, the introduction of future technologies. We don’t have to buy the cheapest medical equipment so as to simply have it.
We must move forward strategically. But such equipment is expensive, so it is necessary to ask everyone for support, because the economy of Ukraine, affected by the war, will not afford buying innovative equipment and constructing new medical centres.