War in Ukraine: situation report from WHO Ukraine Country Office: issue No. 42, 25 January 2023

Issue No. 42 25 January 2023 17H00 CET WAR IN UKRAINE Situation report from WHO Ukraine country office BY THE NUMBERS (since 24 February): AFFECTED 17.7 M LEFT UKRAINE 17 688 845 (UNHCR) INJURED 11 415 (OHCHR) CONFLICT-RELATED DEATHS 7068 (OHCHR) WHO KEY FIGURESHIGHLIGHTS 2061 MT SUPPLIES PROCURED USD 4.3 BILLION FUNDING REQUESTED 192 HEALTH CLUSTER PARTNERS 11.5 MILLION TARGET POPULATION 747 VERIFIED ATTACKS ON HEALTH 1 176 NUMBER OF PERSONNEL DEPLOYED & REPURPOSED IN UKRAINE WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 1734 PATIENTS RECEIVED TRANSFER & MEDEVAC SUPPORT Source: ERCC NUMBER OF AMBULANCES DELIVERED Since 1 March 2022 59 NUMBER OF GENERATORS DELIVERED Since 1 March 2022 73 ▪ WHO has joined the United Nations (UN) interagency convoy to deliver much needed medical supplies to areas near Soledar in the Donetsk region. Financial support for the supplies was provided by the Bureau for Humanitarian Assistance of the ambulances equipped with oxygen tanks, defibrillators, ventilators and other medical equipment for transporting severely injured patients to health-care facilities. The delivery was made possible with funding support from the European Union. ▪ With financial support from the Government of Germany, over 2000 emergency medical service first responders and clinicians completed a chemical preparedness and response training organized and provided by WHO in Ukraine in collaboration with international agencies. ©UNOCHA United States Agency for International Development and the Embassy of Germany in Ukraine. ▪ The WHO Country Office (CO) in Ukraine handed over 26 ambulances to the Ministry of Health (MoH) of Ukraine to meet the urgent needs of patients affected by the war. The donation included six cars for transporting patients and 20 ©WHO SITUATION UPDATE 2 WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 WAR IN UKRAINE Situation report from WHO Ukraine country office Leadership & Coordination ▪ The WHO Representative (WR) in Ukraine continued high-level engagement with the MoH, authorities and partners in Kyiv. ▪ The WR attended WHO consultations to prepare for the 2023 Health Systems Conference in Tallinn. ▪ The WR conducted a field visit to the National Rehabilitation Centre for Spinal Cord Injuries in Rivne, supported by WHO, and held meetings with the Governor, local authorities and MoH representatives. Issue No. 42 25 January 2023 17H00 CET ▪ The WR met with the Minister of Health in Lviv to hand over ambulances to support health sector and emergency response. ©WHO ▪ The WR presented the experience of WHO in Ukraine during a launch of its Health Emergency Appeal 2023 on 23 January. ▪ The Incident Manager participated in the UN humanitarian interagency convoy and delivery of medicines to Soledar on 20 January and to Siversk on 24 January. ©OCHA ▪ On 20 January a UN convoy delivered humanitarian aid to Ukrainian territories near the front-line town of Soledar in the Donetsk region. “Our colleagues in Ukraine reached government-controlled areas close to Soledar in the Donetsk region this morning with a humanitarian convoy of three vehicles to support more than 800 people who remain in communities near Soledar. The vehicles delivered food, water, hygiene kits and medical supplies to people who remain there and are in dire need of humanitarian assistance,” stated UN spokesman Jens Lerke. Before the full-scale war, Soledar had a population of up to 10 000 people. ▪ The Minister of Health of Ukraine Viktor Liashko urged doctors to treat patients in accordance with approved protocols, and called on heads of health-care facilities to install and effectively use new equipment in a timely manner. Minister Liashko noted that in the past year 9000 units of new equipment with a total value of over 3.5 billion hryvnias were delivered to health-care facilities. ▪ As of the beginning of 2023, Ukraine is sufficiently supplied with routine vaccines, and the MoH monitors compliance with supply schedules and the availability of vaccines. Ukrainians can receive free of charge all the vaccines required for immunization in line with the National Vaccination Calendar. According to 2022 data, the level of vaccination coverage in Ukraine remains lower than recommended by the World Health Organization. ▪ Throughout the eleven months of the full-scale war, the MoH of Ukraine, together with the European Commission, continues to arrange evacuation flights for citizens who suffered as a result of the war. The main groups of patients transported to foreign clinics are children and adults with complex mine blast injuries and burn injuries, children with oncological conditions, as well as people with conditions that require complex specialized treatment. 3HEALTH INFORMATION Conflict-related health information ▪ As of 23 January 2023, the Office of the UN High Commissioner for Human Rights (OHCHR) recorded: • 7068 civilians killed (2800 men, 1895 women, 180 girls, and 223 boys, as well as 35 children and 1935 adults whose sex is yet unknown); and • 11 415 civilians injured (2504 men, 1779 women, 240 girls, and 325 boys, as well as 262 children and 6264 adults whose sex is yet unknown). ▪ According to the United Nations High Commissioner for Refugees, as of 17 January over 17.6 million cross-border movements to neighbouring countries, of whom just over 9 million and over 1.8 million crossed the border to Poland and Hungary, respectively. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 Local media monitoring WAR IN UKRAINE Situation report from WHO Ukraine country office Issue No. 42 25 January 2023 17H00 CET ▪ According to the Cabinet of Ministers, the Ukraine Recovery Plan will be the largest reconstruction project since World War II. Currently, the total amount for the recovery from already identified sources is about 110 billion hryvnias (US$ 3 billion). In total, this year Ukraine expects to receive US$ 17 billion for high-priority restoration of damaged and destroyed property. The government has identified four key sources of funding: confiscated Russian funds; funds from the state budget; funds from international partners; and funds from donors worldwide, collected via the United24 platform. ▪ The Verkhovna Rada of Ukraine ratified the agreement between Ukraine and the European Union on Ukraine’s participation in the EU4Health programme. The MoH has submitted applications for participation in direct grants and Joint Actions specifically for EU state institutions. ▪ More than 4000 migrant doctors have found employment in health-care facilities in other regions. The number includes 2014 doctors, 1523 specialists (nurses, midwives, paramedics, pharmacy assistants) and 795 technicians. ▪ Ukraine received another batch of 26 ambulances from WHO: six vehicles for transporting patients and 20 heavy-duty emergency vehicles for disaster medicine. The latter have the necessary equipment for transporting severely injured patients: oxygen tanks, defibrillators, transport devices for artificial lung ventilation, and other medical equipment. ▪ During a meeting with the leadership of the Lviv Regional State Administration, Minister Liashko stated that the three main criteria that must be ensured for patients are high-quality, available and free medical care. “For the past three years, through various mechanisms, we have provided additional financing from the state budget to medical institutions that were unable to pay the salaries of doctors with their own funds. During this time, the heads of hospitals had to make management decisions so that their hospitals could become financially independent and have funds to cover not only salaries, but also the purchase of medicines and the development of the facility. However, the situation at some medical facilities has not changed. Therefore, the issue lies not in the management decisions made at national level, but in the chaotic management of the system at regional level,” he concluded. ▪ The Medical Guarantee Programme 2023 includes 41 packages under which Ukrainians can receive medical care free of charge. Assistance during childbirth is free at all health-care facilities in Ukraine that have a contract with the National Health Service, regardless of where the patient is registered. COVID-19 and other communicable diseases ▪ As of 19 January, the average daily number of new COVID-19 cases is at 443 an increase from 387 per day in the previous week. The seven-day average daily polymerase chain reaction (PCR) tests performed increased to 2795 from 2115 in the previous week (compared to 42 460 in the last week before the war). A similar trend is observed with rapid diagnostic tests performed in laboratories and at primary health-care and hospital level. A comprehensive weekly COVID-19 dashboard can be found here. Surveillance from open-source intelligence WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 4 Surveillance WAR IN UKRAINE Situation report from WHO Ukraine country office Test Positivity rate (PCR) in private and state labs Trend in new cases 7-day average testing data as per 19 January Issue No. 42 25 January 2023 17H00 CET ▪ In the city of Lviv 4034 people contracted acute respiratory viral infections (ARVIs) in the second week of 2023, compared to 3090 in the first week of 2023. A 23.4% increase in the number of cases of ARVI and influenza has been observed. More information is available here. ▪ In the period of 6–12 January, the number of cases of influenza and other ARVIs in the Dnipropetrovsk oblast continued an upward trend for the third consecutive week. During the reporting week, 10 894 people sought medical care in the oblast’s health-care facilities, which is 13% more than in the previous week and 9.4% more than in the corresponding week of 2022. More information is available here. ▪ In the first week of 2023 the number of ambulance calls in the Poltava oblast increased to 850, of which one fifth were related to ARVIs. In previous weeks the oblast reported approximately 500–600 ambulance calls per week. For more information, click here. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 5 WAR IN UKRAINE Situation report from WHO Ukraine country office ATTACKS ON HEALTH Verified reports of attacks (1 January 2022 to date) For further information, click here. Operational Support and Logistics - OSL ▪ As of 22 January WHO warehouses in Kyiv, Kyiv Oblast and Lviv have received medical supplies with a value of over US$ 58.1 million and a total weight of over 2207 metric tonnes. They included Trauma and Emergency Surgery Kits (TESK) 2019, WHO trauma bags, Interagency Emergency Health Kits (IEHKs) and other items. ▪ On 6 -16-22 January 2023 medical supplies and equipment with a total value exceeding US$ 683 267 and a total weight of more than 27 metric tonnes were delivered to 17 oblasts across Ukraine. They included IEHKs, trauma/surgery supplies (TESK 2019, surgical instruments etc.), noncommunicable disease kits, personal protective equipment & communicable disease supplies. UKRAINE COUNTRY OFFICE ACTIONS Issue No. 42 25 January 2023 17H00 CET 0 50 100 150 200 250 M et ri c to n es Metric tonnes dispatched by Oblasts, Ukraine WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 6 WAR IN UKRAINE Situation report from WHO Ukraine country office Health operations – Emergency Medical Teams (EMT) UKRAINE COUNTRY OFFICE ACTIONS Issue No. 42 25 January 2023 17H00 CET It is highly important that health-care workers are fully prepared for any potential hazards during the war, and we are grateful to our international and national partners for their collaboration in this regard Dr Jarno Habicht, WHO Representative in Ukraine Health operations – Emergency Medical Services (EMS) ©WHO Ukraine Since the invasion of Ukraine by the Russian Federation on 24 February 2022, health-care workers have been trained in reducing injuries and mortalities in response to any potential incidents involving toxic chemicals among civilian populations. With financial support from the Government of Germany, more than 2000 emergency medical responders and clinicians have been trained in chemical preparedness and response, including proper use of personal protective equipment and decontamination of patients after exposure to toxic chemicals. WHO in Ukraine supports the efforts of the MoH of Ukraine to assess and build capacity to manage onsite operations related to incident response and chemical hazards. This is tied closely to the work of Ukraine’s emergency medical services and the Centre for Disaster Medicine in the area of incident response, mass casualty management, pre-hospital clinical management and evacuation. A national rehabilitation centre for spinal cord injuries is being launched on the basis of the Rivne Regional War Veterans’ Hospital. This facility was identified as a pilot hospital for a facility of a similar level. The centre was established at the initiative of the MoH with support from WHO and the British Government. The hospital already has an international team of specialists who help implement modern technologies and rehabilitation care procedures. In particular, the equipment and rehabilitation aids necessary for providing medical services to patients have already been identified. The Deputy Minister of Health Petro Yemets, together with the WHO Representative in Ukraine Dr Jarno Habicht and representatives of the local authorities, visited the hospital to evaluate the results of earlier work and determine the future needs in terms of the duration of rehabilitation for patients and ensuring the required number of specialists. At the beginning of 2023 the hospital joined the Medical Guarantee Programme and signed a contract with the National Health Service of Ukraine as part of the “Rehabilitation assistance for adults and children in hospital conditions” package. This means that the treatment and rehabilitation of war victims in this facility will be free of charge for patients, and the medical staff will be paid by the National Health Service for the services provided. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 7 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS National laboratories Issue No. 42 25 January 2023 17H00 CET ▪ WHO continues its assessment of the basic quality and biosafety requirements of clinical and diagnostic laboratories using the WHO Laboratory Assessment Tool for laboratories implementing COVID-19 testing. An assessment of the Centralized Clinical Diagnostic Laboratory, a structural unit of the Kyiv Oblast Clinical Hospital, was conducted on 18 January, looking at the competence of the personnel, the availability of a package of documents for accreditation of the laboratory according to ISO 15189, and the condition of the premises. Recommendations for conducting a risk assessment were given. ▪ On 16 January 2023 a one-day training on “Operating a 3-Diff automated haematology analyser” was held at the Ternopil Children’s City Hospital for 22 laboratory personnel members involved in the implementation of various stages of haematology testing. ▪ Sequencing and analysis of 76 SARS-CoV- 2 samples collected in late 2022 was performed at the Laboratory of Virology of the Public Health Centre of Ukraine. The following variants were identified: BA.5.1, BA.5.1.3, BA.5.2, BA.5.2.1, BA.5.2.20, BE.1.1, BF.11, BF.12, BF.14, BF.4, BF.7, XAZ, as well as variants BQ.1.1 and XBB.1 – identified in Ukraine for the first time. Sixty-six previously analysed genome sequences of SARS-CoV-2 samples were uploaded to the GISAID database. ▪ WHO continues to conduct assessments of capacity potential in hospital clinical diagnostic laboratories using the WHO Laboratory Assessment Tool for Clinical Diagnostic Laboratories (QPOOL). Six laboratories in the Ternopil oblast were assessed: Ternopil Municipal City Hospital No. 2, the Ternopil Regional Clinical Centre for Mother and Child, Ternopil Municipal Hospital No. 3, the Ternopil Regional Skin and Venereological Dispensary, the Ternopil Regional Clinical Oncology Dispensary, and the Regional Clinical Hospital. ©WHO Ukraine WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 8 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS Health Cluster/Partner updates ▪ Since its launch on 15 April the Health Requests, Planning and Response tool (HRPR) has been revised and upgraded, and 467 requests have been logged overall, with ten oblasts logging their largest numbers in the past two months. The oblasts with the largest number of requests were Dnipropetrovsk, Donetsk and Cherkasy. As of 20 January, 47 % of the requests have been matched with Partners who have supported HRPR requests. Pipeline data collected by the Health Cluster from Partners contributes to the intercluster effort to coordinate the delivery of supplies. As of 18 January, 31 Partners have contributed information on supplies delivered, to be delivered and ready for shipment, as well as the pipeline. ▪ On 18 January, the Health Cluster held its second National Coordination Meeting of the year: ➢ Geneva Call addressed key points relevant to the protection of health care during armed conflicts, key legal principles Issue No. 42 25 January 2023 17H00 CET Medicines, Medical supplies & Equipment Status Items Kits Metric tonnes USD Delivered 31 778 280 468 386 3 757 112.4M To be delivered 2 340 197 5 407 - 25K To be shipped - - - - according to international humanitarian law, and the consequences of non-compliance with these principles in a conflict. ➢ The Health Cluster presented the results of the second round of the Mobile Health Survey (November 2022– January 2023) to provide active members with more detailed mapping and inspire further collective reflection on the best ways to guarantee access to health care and build on the national health system. ➢ Ground Truth Solutions presented the quantitative and qualitative findings of the study of perceptions of humanitarian aid, conducted in Ukraine from September to December 2022. For more information, please see the Ground Truth Solutions December 2022 Bulletin. ➢ The WHO CO presented the key findings of the Premise Health Needs Assessment conducted in the Kharkiv oblast, which show that there has been a general improvement in access to health care after the Ukrainian Government regained control in areas that until recently had been beyond its control. However, insufficient financial means and availability rank as the highest barriers to access to health care. ➢ By the end of December 2022, Health Cluster Ukraine had collected 5W (what, where, who, when, why) data from 196 Partners who reported completed and/or ongoing activities in 968 Ukrainian settlements, reaching over 9.42 million people. The Health Cluster presented the 5W trend analysis and dedicated a chapter to the 5W analysis in the upcoming year-end December 2022 Bulletin. ▪ On 19 January the Health Cluster launched a revision process of the Technical Working Groups to ensure the most effective humanitarian health response in line with the strategic priorities of the Humanitarian Response Plan 2023. The process aims to ensure appropriate support to Partners for the year ahead, identifying areas of attention and solutions in a timely manner. ▪ The Ukraine Humanitarian Fund (UHF) 1st reserve allocation was launched by the UN Office for Humanitarian Affairs. This highly prioritized, accelerated allocation of UHF funds to a limited number of pre-identified humanitarian partner projects will support conflict-affected communities in the eastern and southern oblasts of Ukraine with the greatest severity of need, with sectoral assistance for the largest number of people in need, as identified in the Ukraine Humanitarian Needs Overview 2023. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 9 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS Vaccine-preventable diseases and Immunization (VPI) Issue No. 42 25 January 2023 17H00 CET ▪ During the reporting week, two in-person trainings on new COVID-19 vaccine products were conducted in the Kirovohrad Oblast Regional Immunization Training Hub for 44 health-care workers delivering COVID-19 vaccination services. ▪ The VPI team continues to support the MoH in injection waste management as part of the National Immunization Programme. From December 2022 to January, the WHO CO, in collaboration with the nongovernmental organization Infection Control in Ukraine, organized and conducted 51 monitoring visits in ten designated regions. The scope of the visits included: 1. assessing the current state of waste management activities following immunization in health-care facilities (determining if the persons in charge are well-acquainted with international guidelines and national legislation on medical waste management); and 2. assessing process in vaccination points (equipment, segregation, transport, occupational safety, medical waste storage area, storage of non-hazardous waste and documentation). Monitoring visit results and recommendations are being prepared for formal presentation to regions. ▪ On 21 January 2023 the VPI team lead attended a meeting of the MoH’s Task Force on Vaccine- preventable Diseases, where the MoH presented the Joint Plan on Partner Support for the 11 Priorities of the National Immunization Programme in 2023. The Plan summarizes results and inputs from a multi-partner coordination exercise initiated by the MoH since November 2022 and will serve as the basis for harmonizing Immunization Programme partners’ activities to be delivered at national, regional and community level. According to the MoH’s vision and the Plan, WHO is the main partner for the development of strategic and operational documents as part of the National Immunization Programme across all priorities, with an important role in supporting, monitoring and evaluating their implementation. Based on the Plan, the VPI team has initiated operational preparation for the implementation of assigned tasks in order to fulfill all commitments for 2023. ▪ In the reporting week, the WHO CO increased COVID-19 vaccination-related content in its social media channels to maintain awareness among the public and medical professionals of the complete course of vaccination against СOVID-19 and the possibility of combining different COVID-19 vaccine products in line with WHO recommendations. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 10 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS Poliomyelitis (Polio) Issue No. 42 25 January 2023 17H00 CET 122* Total Acute Flaccid Paralysis (AFP) 121 With Lab results 0 Not sent yet 0 En Route 4 In the lab *as of end of the year week (52) Some attribute of the “AFP Surveillance system” in the course of picking the 122 cases recorded last year in Ukraine Cases notified within seven days Cases investigated within 48 hours First stool samples collected immediately (within 1 day of onset) Second stool samples collected within 11 days from date of onset Hot cases (Reported within 7 days of onset had fever, asymmetric paralysis, zero dose, etc. 114 (93%) 122 (100%) 70 (57%) 114 (93%) 5 (4%) 0 2 4 6 8 1 3 5 7 11 13 16 18 20 23 26 28 30 33 35 37 39 41 44 46 48 50 52 2022 epi-curve of AFP cases Ukraine NP AFP Cases cVDPV2 ▪ At the end of the year (Week 52 of 2022), the number of confirmed cVDPV2 isolates in Ukraine remained at two from acute flaccid paralysis (AFP) cases, with 19 asymptomatic contacts from two oblasts (Rivne and Zakarpattya). ▪ A total of 122 AFP cases were reported last year (121 were negative while one is pending). ▪ As of Week 3 of 2023, four cases of AFP have been reported in four oblasts (Dnipropetrovsk, Odesa, Poltava and Rivne). ▪ Results of inactivated polio vaccine round two vaccination of children aged from six months to six years are pending. ▪ The polio risk assessment data tools have commenced in all oblasts. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 11 UKRAINE COUNTRY OFFICE ACTIONS WAR IN UKRAINE Situation report from WHO Ukraine country office Communications Issue No. 42 25 January 2023 17H00 CET From 16 to 20 January the WHO CO published nine Twitter posts and ten Facebook posts that received a total of 113 116 impressions on Twitter and a Facebook page reach of over 20 750, covering topics such as: WHO delivery of medicines to help to treat those injured following a strike on a residential building in Dnipropetrovsk; WHO psychological support for people affected by a missile strike in Dnipropetrovsk; report on health needs assessment of the adult population in Ukraine; a video on assistive technology for people who have been internally displaced as a result of the war; WHO training in chemical preparedness and response in Ukraine; vaccination of health-care workers against COVID-19 and influenza; WHO urging people to take booster doses of the COVID-19 vaccine; and deliveries of medical supplies to areas near Soledar in the Donetsk region. Social listening The following rumours are being monitored and evaluated. ➢ Lack of oncology medicines in hospitals due to stock management and purchase errors (increased retail prices of medicines due to stock shortages of imported medicines and their substitution with locally manufactured medicines at higher prices). ➢ Risks related to blackouts: - Increased motor vehicle fatality rates due to lack of street lighting. - Increased incidence of fires and thermal burns due to overvoltage in the power grid. ➢ COVID-19 discussion is being revived with a new wave of rumours related to post-vaccination topics, such as increased post-vaccination mortality rates and increased post-vaccination syndrome rates. ➢ War-related disease searches are being monitored (raw water usage from open natural sources without proper disinfection). Media News about 2000 first responders trained in chemical preparedness and response in Ukraine was published on the WHO/Europe website. Production Video from the Assistive Technology (AT10) rehabilitation project. WHO, in partnership with the MoH, provided assistive technology for people who have been internally displaced as a result of the war. Facebook UKR, Twitter ENG. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 12 UKRAINE COUNTRY OFFICE ACTIONS ▪ WHO Representative, Jarno Habicht, habichtj@who.int ▪ WCO Incident Manager, Emanuele Bruni, brunie@who.int ▪ WCO WHE Lead, Guillaume Simonian, simoniang@who.int WHO Ukraine Contacts Key links and useful resources ▪ Online courses & knowledge-transfer platform For updated interactive, web-based, online courses, click here. ▪ Emergency Medical Teams (EMT) For updated EMT network activities, click here. ▪ WHO Publications and Technical Guidance For updated WHO Publications and Technical Guidance on technological hazards and health risks in Ukraine, click here. WAR IN UKRAINE Situation report from WHO Ukraine country office Issue No. 42 25 January 2023 17H00 CET OpenWHO.org: Free online courses in Ukrainian supporting health emergency response Total number of Ukrainian language courses 22 Total number of enrolments in Ukrainian courses 5458 Total number of certificates issued in Ukrainian courses 1929 Total number of digital badges issued in Ukrainian courses 419 eLearning platform Ukraine Humanitarian Needs Overview 2023 (Issued December 2022) Published by the UN Office for the Coordination of Humanitarian Affairs (OCHA). Humanitarian Needs Overview Ukraine is an outcome of joint efforts by the Humanitarian Country Team and partners. It provides a shared understanding of the crisis, including the most pressing humanitarian needs and the estimated number of people who need assistance. It covers Ukraine’s 24 oblasts and the city of Kyiv, including areas under the control of the Government of Ukraine and areas under the temporary military control of the Russian Federation (without Crimea and Sevastopol). Full report can be downloaded in English and Ukrainian on OCHA´s web space ReliefWeb here. Document number: WHO/EURO:2023-5319-45083-68104 © World Health Organization 2023. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.