War in Ukraine: situation report from WHO Ukraine country office. Issue No. 41, 18 January 2023

Issue No. 41 18 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 11 327 (OHCHR) CONFLICT-RELATED DEATHS 7031 (OHCHR) WHO KEY FIGURESHIGHLIGHTS 2011 MT SUPPLIES PROCURED USD 4.3 BILLION FUNDING REQUESTED 192 HEALTH CLUSTER PARTNERS 11.5 MILLION TARGET POPULATION 747 VERIFIED ATTACKS ON HEALTH 1 175 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 33 NUMBER OF GENERATORS DELIVERED Since 1 March 2022 64 ▪WHO delivered medicine to help victims of a missile strike on a residential building in Dnipropetrovsk that killed and injured dozens of civilians on 14 January. Financial support was provided by the Embassy of Switzerland in Ukraine / Посольство Швейцарії в Україні and the Embassy of Canada to Ukraine. ©WHO Ukraine SITUATION UPDATE 2 WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 WAR IN UKRAINE Situation report from WHO Ukraine country office Leadership & Coordination Issue No. 41 18 January 2023 17H00 CET ▪ A hospital in Ochakiv was heavily damaged due to shelling on 9 January. ▪ The Zakarpattya oblast blood transfusion station is in dire need of blood of all types. ▪ In Severodonetsk in the Luhansk oblast, the mortality rate has increased fivefold due to lack of critical infrastructure. ▪ Kherson came under attack on 15 January as the Russian forces fired at a hospital. The Kherson Regional Military Administration (RMA) stated that the region was attacked 76 times in a 24-hour period. There are also reports of two deaths due to a landmine left behind by the Russian military, as landmines remain a major threat in the region. On 15 January Kherson residents were asked not to leave their shelters. ▪ United Nations Under-Secretary-General for Political and Peacebuilding Affairs Rosemary DiCarlo stated that the Russian military carried out 745 attacks on health-care facilities in Ukraine, the largest number of such incidents among all wars in 2022. As a result of the attacks, half of all health-care facilities in the Donetsk, Mykolayiv, Zaporizhzhya and Kharkiv oblasts are currently unusable. ▪ Health-care facilities are increasingly being repurposed to treat Russian military personnel, as reported by the National Resistance Center. The tuberculosis dispensary captured by the Russian forces in the city of Kakhovka in the Kherson region is no longer serving civilians and is being used to treat the Russian military forces. ▪ On 16 January the Russian forces attacked a high-rise building, a boarding school and a children’s hospital in Kherson, killing one person. Overall, in the region, a total of four people were killed on that day, as reported on Telegram by Head of the Kherson RMA Yaroslav Yanushevich and Deputy Head of the Office of the President of Ukraine Kyrylo Tymoshenko. “This time the shelling of the children’s [hospital occurred – ed.], as a result of which about 30 windows in the neonatal (six-story) building were broken. The building is empty. There is no information about the victims,” Tymoshenko stated. ▪ The WHO Representative (WR) in Ukraine continued high-level engagement with the Ministry of Health (MoH), authorities and partners in Kyiv on the health agenda, holding numerous discussions to reflect on the last year and plan for 2023. ▪ The WR attended a high-level meeting with UN agencies, international partners and nongovernmental organizations on humanitarian coordination, security and other intercluster decisions on priority support in 2023. ▪ The Incident Manager (IM) coordinated WHO presence in a UN-led interagency convoy to the recently retaken areas in Kherson as part of the UN Humanitarian Operation Planning and Coordination team. ▪ The IM conducted an immediate assessment in Dnipropetrovsk following a strike on a residential building on 14 January, and coordinated the response and delivery of medicines in collaboration with the Department of Health. 3HEALTH INFORMATION Conflict-related health information ▪ As of 16 January 2023, the Office of the UN High Commissioner for Human Rights (OHCHR) recorded: • 7031 civilians killed (2784 men, 1875 women, 177 girls, and 221 boys, as well as 35 children and 1939 adults whose sex is yet unknown); and • 11 327 civilians injured (2472 men, 1764 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 3 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. 41 18 January 2023 17H00 CET ▪ Ten hospitals in the recently retaken areas and frontline territories received back-up generators from the WOG gas station chain. WOG transferred more than 7 million hryvnias for their purchase from its own profit as a result of the “Donate in Black” campaign, which was held online until Black Friday. This effort was implemented as part of the comprehensive “Generators of Light” project by the MoH of Ukraine and WOG, aimed to provide back-up generators to hospitals throughout Ukraine. ▪ No new strain of Omicron XBB.1.5 has been detected in Ukraine so far. However, there are eight coronavirus strains known to be circulating in the country. “The predominant strain currently circulating in Ukraine is the Omicron B.1.1.529 strain. We are also monitoring the situation involving the emergence of the new XBB.1.5 strain. As of today, it has not been found in Ukraine,” said Chief State Sanitary Doctor Ihor Kuzin. He also added that laboratory and epidemiological studies are being conducted to determine the severity of this variant compared to previous strains. ▪ Due to the war, many Ukrainians sustain injuries and undergo complex operations, after which they need rehabilitation. Considering the great importance and need for this service, the 2023 Medical Guarantee Programme includes the Inpatient rehabilitation assistance for adults and children package. As part of this package, assistance is free of charge for patients, as the state will pay the health-care facilities involved for the services provided. ▪ The Government has set minimum salaries for pharmacists, health-care workers and rehabilitation specialists of state- and communally-owned health-care facilities for 2023. The resolution was adopted during the meeting of the Cabinet of Ministers on 13 January. The minimum wage for health-care workers, pharmacists and rehabilitation specialists of state-owned and communal health-care facilities for a full monthly (hourly) rate of work is established at a minimum of 20 000 hryvnias for people holding medical positions at health-care facilities (except medical interns), as well as pharmacist positions at health-care facilities (except pharmacy interns), positions of professionals in the field of health care at health-care facilities and positions of professionals with a higher non-medical education in the field of health care; 13 500 hryvnias for people who hold positions at health-care facilities classified by the uniform qualification requirements for specialist positions (except for medical interns and pharmacy interns). ▪ Summing up the 324 days of the war, Minister of Health Viktor Liashko stated in a television interview that about one thousand Ukrainian medical facilities have been damaged or destroyed, of which 163 are completely destroyed and cannot be restored. COVID-19 and other communicable diseases ▪ As of 12 January, the average daily number of new COVID-19 cases is at 387 a decrease from 424 per day in the previous week. The seven-day average daily polymerase chain reaction (PCR) tests performed decreased to 2115 from 2223 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 12 January Issue No. 41 18 January 2023 17H00 CET ▪ In the Dnipropetrovsk oblast, 9631 cases of acute respiratory viral infection (ARVI) were reported in the period of 30 December 2022 to 5 January 2023, including suspected cases of the coronavirus. Compared to the previous week, there has been a 34% increase in cases. ▪ Cases of ARVI are on the rise in two hromadas in the Lviv oblast. An epidemic situation has been observed in the Peremyshliany hromada, where 435 cases per 100 000 people were reported. In addition, 365 cases per 100 000 people were also reported in the town of Boryslav in the Lviv oblast. ▪ In the first week of 2023 in the Donetsk oblast, there was a 26% increase in the number of influenza/ARVI cases from the previous week (1640 cases, 151 per 100 000 people). In addition, in the period of 30 December 2022 to 5 January 2023, the number of COVID-19 cases increased by 21% – 118 confirmed cases were recorded, with a rate of 7 cases per 100 000 people (per the communique of the Donetsk Oblast Center for Disease Control and Prevention (OCDC)). 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 16 January WHO warehouses in multiple locations have received medical supplies with a value of over US$ 50.8million and a total weight of over 1900 metric tonnes. They included Trauma and Emergency Surgery Kits (TESK) 2019, WHO trauma bags, Interagency Emergency Health Kits (IEHKs) and other items. ▪ On 6 -16January 2023 medical supplies and equipment with a total value exceeding US$ 181 177 and a total weight of more than 5.9 metric tonnes were delivered to 12 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. 41 18 January 2023 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 National laboratories Issue No. 41 18 January 2023 17H00 CET ▪ WHO supports the high-throughput PCR mobile laboratory at the Ternopil OCDC. The entrance platforms and stairs were designed, manufactured, and installed to ensure safe and convenient use of the laboratory. The constructions are light and foldable, allowing rapid transportation along with the laboratory. ▪ WHO supported large procurement and distribution of the equipment, reagents, and consumables for the microbiological testing of drinking-water in the oblasts most affected by the war. This donation will allow for the rapid testing of a large number of drinking-water samples and ensure the highest quality of the results. ▪ Whole-genome sequencing was performed, followed by the analysis of 72 SARS-CoV-2 samples. The following variants were identified: BA.5, BA.5.1, BA.5.1.10, BA.5.1.23, BA.5.1.3, BA.5.1.5, BA.5.2, BA.5.2.1, BA.5.2.20, BA.5.2.3, BA.5.2.6, BE.1.1, BF.14, BF.6, BF.7, and XAZ. Sixty-eight previously sequenced and 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: the Ternopil Oblast Phthisiopulmonology Medical Centre, the Ternopil Municipal Emergency Hospital, the Kremenets Support Hospital, the Pochaiv Hospital, the Zolochiv District Hospital, and the Terebovlya City Hospital. ▪ On 12–13 January a two-day workshop titled “Operating a 3-Diff automated haematology analyser” was held at the Ternopil Municipal Emergency Hospital Laboratory for 62 participants – laboratory personnel from various hospital laboratories in the Ternopil oblast. ©WHO Ukraine WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 7 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 461 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 Mykolayiv, Dnipropetrovsk and Khersonska. ▪ To respond to the devastating impacts of the missile strike on a residential building in Dnipropetrovsk on 14 January, Health Cluster Partners moved fast to support the emergency response and provide critical services on the ground. Their efforts included donating mass casualty kits and medicines to help to treat those injured, assessing the needs in shelters and heating points provided for the residents, complementary medical presence (doctors, nurses) on site to support the Department of Health response, and deploying mobile medical teams to provide the necessary services (such as mental health and psychosocial support, non-food items, etc.). ▪ On 16 January the Health Cluster launched a call for expression of interest to become Health Cluster subnational co- coordinators for Partners. The aim of the engagement of a subnational co-coordinator through a Partner organization is to improve ownership of the operational response by Partners and local authorities and encourage meaningful involvement in co-leading an effective humanitarian response, adapted to the local context and implemented in strong collaboration with local communities and other stakeholders. ▪ The distribution of generators to health facilities to ensure continuity of care remains a key priority for the Health Cluster. As of 16 January Partners have distributed 378 generators to health facilities across Ukraine. The largest number was distributed in the Kyiv (360), Kharkiv (65) and Kherson (44) oblasts. Issue No. 41 18 January 2023 17H00 CET WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 8 WAR IN UKRAINE Situation report from WHO Ukraine country office UKRAINE COUNTRY OFFICE ACTIONS Vaccine-preventable diseases and Immunization (VPI) Issue No. 41 18 January 2023 17H00 CET ▪ Since the beginning of 2023, the VPI Country office has supported capacity building of the immunization personnel in Ukraine. In the first week of January the team finalized the development of the mid-level managers’ immunization programme education platform with the initial three modules adapted, and submitted it for official review to the Public Health Centre of the MoH. ▪ The VPI CO continues to support the MoH by adapting, releasing and promoting the informational materials on COVID-19 vaccines and vaccination developed by the WHO Collaborating Centre for Vaccine Safety (WHO CC). As of the beginning of January 2023, the Ukrainian version of the WHO CC webpage and YouTube channel are up to date, contain more than 130 video and text materials, and fully correspond to their respective English versions. To provide better information coverage, the WHO Country Office (CO) launched a promotional campaign on social media and platforms in autumn of 2022, targeting priority groups for vaccination. During the first two weeks of 2023 nearly 1270 people used the platform, which is the best result out of 16 countries in the reporting period. ▪ In addition to the IT equipment procured and delivered for National Immunization Programme managers and regional training hubs in the years 2021–2022, WHO, at the request of the MoH, provided 35 more sets consisting of laptops, monitors, multi-function devices, screens and projectors for the immunization programme personnel in the MoH’s OCDCs. This support has been delivered in partnership with the European Union (EU). ▪ Despite multiple missile strikes and significant damage to infrastructure, resulting in unstable power supply, the National Immunization Programme continued its efforts to vaccinate the most vulnerable population groups in December 2022. With direct technical and operational support from the VPI CO, public health specialists and vaccination teams from eight regions visited 102 collective centres for displaced people, providing information on vaccine-preventable diseases (VPDs) and vaccination to more than 50 964 displaced persons and delivered 3624 vaccinations, of which more than 2000 were against COVID-19. Overall, from the end of April 2022 to the end of December 2022, with WHO support and in partnership with the EU and USAID, approximately 200 facilities for displaced people were visited, with more than 42 000 people informed and consulted per month on average, and a total of 41 000 vaccinations were delivered to protect against COVID-19, diphtheria, measles and other VPDs. ▪ On 10 January 2023 a VPI CO team member participated in a national stakeholders’ meeting initiated by the Public Health Centre of the MoH on immunization programme planning for 2023, and provided recommendations on the forecasting of immunization target groups and vaccines, covering the issue of verifying data obtained from different sources, among other things. ▪ On 11 January 2023 a VPI CO team member attended a NITAG meeting, sharing the latest WHO SAGE recommendation on COVID-19 vaccination, focused on booster doses and heterologous vaccination strategy, and provided feedback on other issues covering targeted VPDs and immunization schedules. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 9 UKRAINE COUNTRY OFFICE ACTIONS WAR IN UKRAINE Situation report from WHO Ukraine country office Communications Issue No. 41 18 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 5382 Total number of certificates issued in Ukrainian courses 1906 Total number of digital badges issued in Ukrainian courses 418 Health care workers are the top users of WHO’s free online learning platform in Ukraine, representing 61% of OpenWHO.org learners in the country. This is 36 percentage points higher than the platform average, suggesting that OpenWHO courses are being utilized to respond to the expanded health demands of the Ukraine crisis. Across all countries, 25% of OpenWHO learners are health care professionals. Students comprise the second largest group of learners from Ukraine, representing 14% of Ukraine users compared to a 39% average across the OpenWHO platform. In total, OpenWHO hosts more than 12 100 enrolments from Ukraine. 6 in 10 OpenWHO learners in Ukraine are health care professionals eLearning platform From 9 to 13 January the WHO CO published 10 Twitter posts and five Facebook posts that received a total of 18 806 impressions on Twitter and a Facebook page reach of over 5000, covering topics such as: WHO CO vacancies, risk assessment for winter in Ukraine by the WHO Regional Office for Europe, information on health attacks, and deliveries of essential medical supplies and medicines to Kupiansk in the Kharkiv region. Social listening The following rumours are being monitored and evaluated. ➢ 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. - An increase in the rate of suicides due to post-traumatic stress disorder (official data has not been publicly available since February 2022). ➢ 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. WHO UKRAINE COUNTRY OFFICE WHO ERF GRADE 3 10 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 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. 41 18 January 2023 17H00 CET The full-scale invasion of Ukraine has caused a deterioration in the level of access to health-care services and medicines in the country, particularly for people living in regions close to the front line and areas that are not partially or fully controlled by the Government of Ukraine, and for people who have been internally displaced. Cost and time constraints involved in getting to and from health facilities, as well as limited transportation options were the main barriers to accessing essential health-care services. At the same time, the findings show that the country's health system remains resilient and that overall access to health services is fairly high. This report is based on data collected through a quantitative cross-sectional survey of self-reported health needs of the general population in Ukraine. It presents results of the first round survey conducted in September 2022 and could help to address the specific health-care needs of the population groups concerned. Full report can be download here. Document number: WHO/EURO:2023-5319-45083-68040 © World Health Organization 2023. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.