War in Ukraine: situation report from WHO Ukraine country office: Issue No. 26, 5 October 2022

©WHO Ukraine Issue No. 26 5 October 2022 17H00 CET WAR IN UKRAINE Situation report from WHO Ukraine country office BY THE NUMBERS (since 24 February): AFFECTED 17.7 M LEFT UKRAINE 13 379 780 (UNHCR) INJURED 9132 (OHCHR) CONFLICT-RELATED DEATHS 6114 (OHCHR) WHO KEY FIGURESHIGHLIGHTS 1028 METRIC TONNES SUPPLIES DELIVERED USD 4.3 BILLION FUNDING REQUESTED 155 HEALTH CLUSTER PARTNERS 11.5 MILLION TARGET POPULATION 550 VERIFIED ATTACKS ON HEALTH 1 142 NUMBER OF PERSONNEL DEPLOYED & REPORPOSED IN UKRAINE WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 1000 PATIENTS RECEIVED TRANSFER & MEDEVAC SUPPORT Source: ERCC  In Kharkiv, WHO delivered life-saving medical equipment that will cover up to 80 000 people in the region. The WHO Representative (WR) met with Minister of Health (MoH) Viktor Liashko and international organizations to discuss the provision of humanitarian assistance to the newly accessible territories in Ukraine. For further information, click here. WHO emphasizes the importance of timely vaccination. Mobile immunization teams are working at centres for internally displaced persons, which provide support for anyone in need of vaccination against infectious diseases, including diphtheria, mumps, and COVID-19. For further information, click here. Supported by the Asia-Europe Foundation, WHO held a webinar on the “Basics and principles of using BiPAP – Bilevel Positive Airway Pressure” on 29 September. The webinar, addressed to anaesthesiologists, physicians, therapists, specialists working with COVID-19 patients, rehabilitation professionals, medical staff, and health-care providers, was attended by 150 participants. For further information, click here. • With support from the European Civil Protection and Humanitarian Aid Operations (ECHO), WHO donated three multipurpose tents and one interconnecting modular tent to the State Emergency Service of Ukraine (SESU) to help mobile medical points and provide emergency medical care during the war. The tents will be distributed to areas most affected by the war, located in the eastern and southern regions, such as Kharkiv, Zaporizhzhya, Odesa and Mykolayiv. For further information, click here. SITUATION UPDATE 2 WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 WAR IN UKRAINE Situation report from WHO Ukraine country office Issue No. 26 5 October 2022 17H00 CET  For the upcoming epidemiological season, Ukraine expects to receive more than 340 000 doses of the influenza vaccine. Based on the current health and medical indicators, the MoH estimates that influenza vaccination is recommended for 4.7 million Ukrainians. However, due to the war and limited financing of state procurements, the critical level needed for the vaccination of higher-risk groups is set at 250 000 doses. For further information, click here.  On 27 September a fourth case of monkeypox was reported in Ukraine. According to a statement by the chief sanitary doctor, Ukraine will not be facing a monkeypox epidemic. Diagnostic test kits that cover monkeypox have been provided to all centers for disease control and prevention. For further information, click here.  In parts of the country that were severely affected by the conflict, such as Kharkiv, the availability of medicines and medical services for the population has not yet been fully restored, in particular, due to the lack of sufficient contracting of pharmacies by the National Health Service of Ukraine. In other regions, such as the Kyiv, Chernihiv, and Sumy oblasts, medicines have not been dispensed under the “Affordable Medicines” programme since February. For further information, click here.  The International Atomic Energy Agency is arranging new equipment deliveries to Ukraine to ensure nuclear safety and security during the ongoing conflict. Five entities in the country, including the State Nuclear Regulatory Inspectorate of Ukraine and national nuclear operator Energoatom, will receive radiation monitoring equipment, mobile phones, portable power systems and other requested items. For further information, click here.  The MoH, the Ministry of Social Policy, and the Medical Forces Command of Ukraine are developing mechanisms to simplify access to rehabilitation services and eliminate bureaucratic barriers when obtaining prostheses. “Due to the war, the number of people who need prosthetics and rehabilitation services is increasing dramatically. Therefore, we must help Ukrainians to access rehabilitation services as fast as possible, and the services themselves must be higher-quality,” said Viktor Liashko. For further information, click here. Leadership & Coordination  The WHO team visited Odesa to review WHO programs supporting the resilience of southern Ukraine’s health systems. After seven months of the war, WHO continues to work with national authorities to restore the health system. For further information, click here.  The WHO team met with the MoH and coordinate with partners on the winterization plan for health.  The WHO representative (WR) spoke on the health consequences the health consequences of the war in Ukraine at University College London.  The WR continued high-level engagement with MoH, authorities and partners in Kyiv on health, international affairs and security. ©WHO Ukraine 3HEALTH INFORMATION Conflict-related health information  As of 2 October 2022, the Office of the UN High Commissioner for Human Rights (OHCHR) recorded: • 6114 civilians killed (2380 men, 1633 women, 162 girls, and 193 boys, as well as 35 children and 1711 adults whose sex is yet unknown); and • 9132 civilians injured (1912 men, 1382 women, 196 girls, and 268 boys, as well as 226 children and 5148 adults whose sex is yet unknown).  According to the United Nations High Commissioner for Refugees, as of 27 September over 13 million Ukrainians crossed the border to neighbouring countries, of whom just over 6.4 million and over 1.4 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. 26 5 October 2022 17H00 CET  In the newly accessible settlements of the Kharkiv region, 36 emergency medical teams (EMTs) continue to provide medical care. For the past seven months, residents have had no access to medical care due to the extensive damage to medical and health facilities. For further information, click here.  In the city of Kharkiv, Clinical Hospital #13 has started seeing an increase in the number of patients with COVID-19 in the last two weeks. Currently, 59 patients are being treated at the facility. Most of those hospitalized are experiencing moderate illness. However, there are eight patients in the hospital’s intensive care unit. Four of them are on high-flow oxygen, while the rest are on oxygen concentrators. For further information, click here.  The National Health Service of Ukraine stated that the state guarantees several free medical services for the elderly. They are aimed at preventing illness, starting treatment, or managing chronic disease. To receive the medicine free of charge, the patient must consult their family doctor, who will provide a prescription for the medicine as part of the “Affordable Medicines” programme. This applies to medications for managing chronic conditions. Elderly and internally displaced persons can receive care at any medical facility that has a contract in place with the National Health Service. For further information, click here.  The first 18 rapid response vehicles purchased through the UNITED24 fundraising platform have arrived in Sumy, Kharkiv, Mykolayiv, Chernihiv, and Rivne. The subsequent 17 ambulances will go to the Zaporizhzhya, Mykolayiv, Rivne, Sumy, Kharkiv, and Odesa regions. The vehicles are equipped with oxygen tanks, cardiac monitors, defibrillators, electrocardiographs and ventilators. For further information, click here. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 4 ATTACKS ON HEALTH Verified reports of attacks (as of 28 September 2022) For further information, click here. Based on matched HFs names, as of 19 September 2022 there are 412 attacks on health facilities in 14 oblasts (including Kyiv city), 203 health facilities were attacked, on average around 370 thousand patients were treated per month in these health facilities according to pre-war data from eHealth. WAR IN UKRAINE Situation report from WHO Ukraine country office Issue No. 26 5 October 2022 17H00 CET WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 5 COVID-19 and other communicable diseases  As of 3 October, the average daily number of new COVID-19 cases is at 6115, an increase from 6305 per day in the previous week. A total of 202 deaths were reported during Reporting Week 39, compared to 161 in the previous week. The seven-day average daily polymerase chain reaction (PCR) tests performed increased to 5915 from 5432 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  According to the Lviv Regional Centers for Disease Control and Prevention, following the seven cases of diphtheria in a children’s boarding school, 165 contacts were identified, of whom 78 were staff members. Samples were collected from all contacts for bacteriological analysis. Additionally, 106 pupils and employees from the institution were vaccinated with the TdaP vaccine. Other epidemiological measures have also been implemented.  On 16–23 September, 8556 people reported to health-care institutions in the Dnipropetrovsk oblast with acute respiratory infections (including COVID-19), which is 38% more than in the previous week and 50% less than in the corresponding week of 2021. For more information, click here.  In August 2022 the number of COVID-19 cases in the Chernihiv oblast increased eightfold compared to July 2022: from 72 to 593 cases. For more information, click here. Surveillance Number of new COVID-19 cases: May - September Daily testing data for 2 October WAR IN UKRAINE Situation report from WHO Ukraine country office Test Positivity rate (PCR) in private and state labs Issue No. 26 5 October 2022 17H00 CET WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 6 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS Health operations – HIV/TB OpenWHO training OpenWHO.org: Free online courses in Ukrainian supporting health emergency response Total number of Ukrainian language courses 18 Total number of enrolments in Ukrainian courses 3905 Total number of certificates issued in Ukrainian courses 1180 Total number of digital badges issued in Ukrainian courses 305 Issue No. 26 5 October 2022 17H00 CET Health operations – Health Cluster/Partner updates Medicines, Medical supplies & Equipment* Status Items Kits Metric tonne USD Delivered 30 972 268 131 242 3573 12.3M To be Delivered 3 660 183 239 043 186 1.3M To be Shipped 2 415 952 811 264 9.5M  Since its launch on 15 April 2022 the Health Requests, Planning and Response tool (HRPR) has been revised and upgraded, and 335 requests have been logged since the launch.  As of 29 September, Health Cluster (HC) partners have reported completed and/or ongoing activities in 591 Ukrainian settlements reaching 8.6 million people. HC had collected 5W data from 155 partners, 137 partners reported completed and/or ongoing status of health activities, 16 reported planned activities. For further information, click here.  Pipeline data collected by the Health Cluster from Partners contribute to the inter-Cluster effort to coordinate the delivery of supplies. As of 28 September, 30 Partners have contributed information on the status of supplies in the pipeline (delivered, to be delivered and ready for shipment).  The WHO Country Office (CO) in Ukraine, in cooperation with the WHO Regional Office for Europe, commenced the national programme review of HIV, TB and opioid substitution treatment (OST). Supported by the Global Fund, the review is scheduled to take place on 3–14 October 2022. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 7 UKRAINE COUNTRY OFFICE ACTIONS WAR IN UKRAINE Situation report from WHO Ukraine country office Issue No. 26 5 October 2022 17H00 CET Health operations – Emergency Medical Teams (EMT)  There are currently 19 EMTs from nine organization. The supporting EMT are broken down as follows:  4 type 1 mobile health teams  2 type 1 fixed teams  2 specialised surgical teams  1 type 2 (inpatient pending)  3 training teams  4 specialised patient transfer and medevac teams  4 rehabilitation teams  EMTs are operating in ten oblasts, mainly in the east and northeast, south and the western hub. The main areas of activity continue to be:  trauma care (inpatient & outpatient)  rehabilitation (including burns and spinal cord injury)  mobile health  patient transfer and medical evacuation  Trainings  EMT activities committed to more medium- to longer-term programme implementation activities will transition into support packages under essential health services, e.g. rehabilitation.  Surge support services for the Kharkiv oblast are frequently assessed in close collaboration with the national head and regional head of the Centre for Disaster Medicine, the State Emergency Service, and the head of the Department of Health (DoH) in the area. Additional EMT supports were requested and approved by the MoH for a Type 2 field hospital to support health services in the newly accessible areas in the Kharkiv oblast. It has 30 inpatient beds (2 x ICU and 4 x high- dependency beds) and a dedicated operating theatre.  The head of the Kharkiv Department of Health visited the Type 2 field hospital on 3 October to complete a quality assurance check before it opens to patients. This facility will gradually transition to being managed and operated by the local health services while they await the rapid rehabilitation of their own facility. The local emergency medical services will begin to refer patients to this facility using the local patient transfer services and available ambulances, through agreed referral pathways.  The emergency response strategy continues to involve using national capacity as first-line surge support for emergency medical services (EMS).  WHO continues to provide advocacy to the MoH on pressing the European Commission to put forward an EU-based solution in support of repatriation requests.  WHO provided resources to the MoH to ensure the operational capacity and capability of the central and oblast-level medical evacuation unit until the end of the year.  WHO is establishing the wider workplan activities of the national EMT concept, which activated earlier than expected due to the need for surge support services for the Kharkiv oblast. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 8 UKRAINE COUNTRY OFFICE ACTIONS Health operations - Vaccine-preventable diseases and Immunization (VPI) WAR IN UKRAINE Situation report from WHO Ukraine country office Issue No. 26 5 October 2022 17H00 CET  WHO, jointly with the Ukrainian Public Health Centre (UPHC) of the MoH, conducted two webinars on diphtheria for medical workers from the Lviv oblast on 29 and 30 September, attended by 300 participants. The event was held in response to a request from the regional Centers for Disease Control and Prevention.  In the month of September WHO supported a total of nine two-day in-person trainings on COVID-19 vaccines with a total of 204 health workers participating.  During the reporting period WHO finalized the distribution of 4000 additional booklets answering questions related to COVID-19 vaccines. The booklets were developed together with the WHO Collaborating Centre for Vaccine Safety and distributed to the Kharkiv, Chernihiv, Sumy, and Zaporizhzhya oblasts. This brings the total number of printed educational materials on vaccination distributed to oblasts in August and September to 27 500.  WHO launched a dedicated Ukrainian-language YouTube channel with all the videos developed by the WHO Collaborating Centre for Vaccine Safety. Additionally, WHO launched an advertising campaign on social media to promote these materials. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 9 UKRAINE COUNTRY OFFICE ACTIONS WAR IN UKRAINE Situation report from WHO Ukraine country office Health operations – National Laboratories Health operations – Polio  Two new AFP cases were reported this week.  The polio response team at the UPHC continues with capacity building for health-care workers in Rivne. The total number of participants trained was 244.  While in Rivne, the polio team also visited the communities of Dubno and Ostroh to supervise environmental surveillance sample collection. This was followed by visits to polyclinics providing routine vaccination services.  At the Regional Children’s Hospital, the team toured a newly renovated children’s rehabilitation treatment centre for young patients with paralysis and other mobility impairments. 87 Total Acute Flaccid Paralysis (AFP) 83 With Lab results 0 Not sent yet 0 En Route 4 In the lab Family Doctors Epidemiologist Infectionist Neurologist Pediatricians Others 135 39 18 16 35 1  The number of confirmed cVDPV2* isolates in Ukraine remains at two from acute flaccid paralysis (AFP) cases, with 19 asymptomatic contacts from two oblasts (Rivne and Zakarpattya). Issue No. 26 5 October 2022 17H00 CET  WHO supports the professional competence of Ukrainian laboratory specialists involved in next- generation sequencing. On 26 September–7 October four laboratory staff (two virologists and two bacteriologists) from the UPHC participated in the Thermo Fisher Scientific Next-Generation Sequencing training at the customer experience centre in Darmstadt, Germany. The training was organized by the United States Defense Threat Reduction Agency. WHO specialists took an active part in developing the training agenda, assessing the background of the participants, coordinating the event, as well as translating the training materials and test tasks into Ukrainian and editing them.  WHO continues to develop a tool for assessing the laboratory capacity and economic efficiency of laboratories in Ukraine. A series of meetings was held with representatives of the MoH of Ukraine and the Kyiv School of Economics, during which the final version of the tool was presented and priority oblasts were identified for conducting WHO trainings and assessing laboratory capacity. The priority oblasts include the Lviv, Ivano-Frankivsk, Vinnytsya and Kharkiv oblasts​.  The webinar “Haematopoiesis: changes in the morphology of cells in pathology” was conducted on 30 September. The webinar, attended by 58 laboratory specialists from Ukraine, concluded with a Q&A session.  WHO supports construction of the multifunctional high-throughput mobile laboratory which will be donated to Zhytomyr Oblast Center for Disease Control and Prevention of MoH; the handover is planned for end of October. Being able to perform around 1000 PCR and/or ELISA tests per day, the mobile laboratory will significantly scale up testing and enhance surge testing capacity in Ukraine. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 10 UKRAINE COUNTRY OFFICE ACTIONS Operational Support and Logistics - OSL  As of 30 September WHO warehouses in multiple locations have received medical supplies with a value of over US$ 214 531 and a total weight of over 23 metric tonnes.  On 16–23 September medical supplies and equipment with a total value exceeding US$ 203 571 and a total weight of more than 11 metric tonnes were delivered to 19 oblasts of Ukraine.  A meeting was held with the Kharkiv Department of Health to plan future operations in the newly accessible areas and assess the needs. WAR IN UKRAINE Situation report from WHO Ukraine country office  The delivery of WHO kits to the newly accessible areas in Balakliya has concluded. WHO has initiated the delivery of WHO kits to Donetsk and generators to the city of Mykolayiv.  A three-month warehouse lease in Odesa has been approved.  WHO continues to coordinate the repatriation of vehicles, 11 Automated Vehicle (AV) from Organization for Security and Co- operation in Europe (OSCE) and 4 AV from from the ASC International station in the Republic of Moldova and in Chernivtsi.  Coordination meetings on Izyum needs are continuing among the Area Security Management Team, Incident Management Team, OSL coordinator and a Kharkiv MoH representative.  Security risks and conditions are worsening after the annexation of four oblasts by the Russian Federation. WHO has decided to put all missions and visits (training on the prevention of sexual exploitation, abuse and harassment; Health Cluster visit to Kharkiv and Poltava) on hold until 8 October, when the situation will be reassessed. Data updated as of 26 September 2022 Issue No. 26 5 October 2022 17H00 CET ©WHO Ukraine WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 11 UKRAINE COUNTRY OFFICE ACTIONS Communications From 26 September to 2 October the WHO CO published 17 Twitter posts and 10 Facebook posts that received a total of 77 475 and 82 394 impressions, respectively, covering topics such as: results of the 1st Health Hackathon in Ukraine; a video about monkeypox; trainings on stress management “Self- Help Plus” for Ukrzaliznytsia personnel; health attacks; a visit to Odesa to review WHO programmes to support health system resilience in the south of Ukraine; delivery of life-saving medical supplies to Kharkiv; WHO’s donation of multipurpose tents to the SESU to ensure continued provision of life- saving medical care during the war; Jarno Habicht’s speech at University College London, London’s leading multidisciplinary university, about the health consequences of the war in Ukraine; delivery of life-saving medical supplies to Balakliya in the Kharkiv region; a video about COVID-19 vaccination from the WHO Collaborating Centre for Vaccine Safety. Social listening  Rumours concerning a third case of monkeypox announced by the MoH generated heightened interest among social media users. Potential risks of stigma and discrimination are being monitored and evaluated.  Bill No. 4142 on public health is being widely discussed regarding the vaccination obligations and penalties it would carry.  Potential risks of blackouts as a result of damage to infrastructure facilities during fighting affecting a nuclear power plant and their impact on the health-care infrastructure are being discussed.  COVID-19 discussion is taking place, with a new wave of rumours related to the post-vaccination syndrome and increased mortality rate.  War-related disease searches are being monitored. The frequency of online discussions about cholera is diminishing. Risk Communication and Community Engagement  Interim advice on monkeypox RCCE for health authorities, RCCE tool for event organizers, RCCE guidance on addressing the stigma related to monkeypox, social media tiles and posters and videos available in Ukrainian and disseminated through partners.  Engaging with Civil Society Organizations to develop responses that are accepted by members of the most at-risk groups. Production Photo coverage of the visit to Odesa to support health-care systems: Facebook and Twitter. Photo and video coverage of the delivery of life-saving medical supplies to Kharkiv: Facebook and Twitter. Photo and video coverage of the tent delivery to the SESU with ECHO financial support: Facebook and Twitter (1 and 2). Event WHO conducted a visibility event on WHO’s donation to SESU of three multipurpose tents and one interconnecting tent modular tent with the support of ECHO Facebook & Twitter (1,2). WAR IN UKRAINE Situation report from WHO Ukraine country office Issue No. 26 5 October 2022 17H00 CET WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 12 UKRAINE COUNTRY OFFICE ACTIONS  WHO Representative, Jarno Habicht, habichtj@who.int  WCO acting Incident Manager, Emanuele Bruni, brunie@who.int  WCO WHE Lead, Guillaume Simonian, simoniang@who.int Document number: WHO/EURO:2022-5319-45083-66414 © World Health Organization 2022. Some rights reserved. This work is available under the CC BY- NC-SA 3.0 IGO license. 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. 26 5 October 2022 17H00 CET