Ukraine conflict: upholding the right to health for all

December 2014

“We have to be everywhere, beyond the lines. We have to deal with the local health authorities whoever they are,” says Dr Dorit Nitzan, WHO Representative for Ukraine, on Human Rights Day, 10 December.

The health situation in the conflict zone is “sad”, she adds. Her concerns are profound. As a doctor, she is particularly worried about the health of the sick, marginalized and vulnerable. This includes the very young and old, minorities such as Roma populations, the poor, persons with mental, physical or psychosocial disabilities, men who have sex with men and displaced persons. The very survival of these vulnerable populations is at risk when the right to health is forgotten.

Not just a humanitarian crisis

WHO unloads boxes of tetanus toxoid vials in Kyiv.
WHO/Konstantin Voznjuk

The statistics are daunting. No child has been vaccinated in the areas affected by conflict since September 2014, sending polio vaccine coverage down to less than 30-40%. About 40 patients in a mental health institution have reportedly died from hunger, cold and lack of care. In 60 villages located in between the front lines, there are no medical personnel left. People have been trapped and are not accessible as a result of the fighting. It is thought that in Luhansk city there are only 30% of the medical personnel left to care for the sick. In Donetsk Oblast there are 10-15% fewer medical personnel of the 85 000 that were based there before the crisis, straining health services needed for a substantial population. Ten health facilities have been damaged or physically destroyed through shelling. Hospitals are experiencing severe shortages of medicines and supplies and cannot provide the full range of pre-crisis services.

Restoring access to health care is an urgent need. WHO ̶ working with partners in the United Nations (UN) family of agencies, Ukrainian Red Cross, International Committee of the Red Cross and Red Crescent Societies, Doctors without Borders, International Medical Corps, and local non-governmental organizations ̶ has taken action in order to meet its responsibilities of protecting the right to health and saving lives in this difficult situation.

Rights Up Front

The UN, following its own recognition of shortcomings in Rwanda, Srebrenica and Sri Lanka, has strengthened its commitment to assisting people affected by conflict whose rights are being violated. The UN’s year-old concept called ‘Rights Up Front’ is triggered by any “threat of serious and large-scale violations of international human rights and humanitarian law.” It gives the UN teeth to navigate through the difficult politics present in a war zone to ensure that rights are protected.

Rights Up Front involves candidly informing national authorities, UN agencies and regional organizations of rights’ violations; leveraging capacities and creating coherent strategies for remedial action; helping countries implement strategies; and, importantly, speaking out publicly about the issues of concern. The UN’s country teams are its front line workers. They need to collaborate closely to achieve the highest possible impact in the protection of human rights.

Improving access to health

Access to health is a major issue in Ukraine. “Universal health care exists only on paper,” says Dr Nitzan, referring to the general situation in Ukraine. “People have to pay for a large portion of health services, procure their own medicines and there are no set prices for these essentials,” she says. The war and the financial crisis are making the poor even poorer, so they effectively have no access to health care, medicines or vaccines.

WHO is addressing these needs through a project involving Mobile Emergency Primary Health Care Units (MEPUs). The Units use computer tablet technology and Global Positioning System (GPS) mapping to link individuals to health services and patient-centred care. MEPUs will cover areas where internally displaced persons are living; they will also serve institutionalized people. Composed of one doctor, two nurses and a logistician, a MEPU will assess health and nutritional status, determine medical needs and refer/link patients with existing health services, as needed.

The units will provide medicines and supplies such as disinfectant, bandages and thermometers from WHO, the United Nations Children’s Fund (UNICEF) and United Nations Population Fund (UNFPA) health kits. They will link patients with primary health care, hospitals and laboratories. Follow-up is done on a weekly basis. WHO is also linking up with the World Food Programme (WFP) to ensure that food is provided to groups such as internally displaced persons in rural areas.

Meanwhile, urban areas are served by Emergency Primary Health Care Posts which provide health care directly to homes of returnees and the non-mobile, poor population. Infectious and noncommunicable disease surveillance and treatment, as well as emergency care, including, dentistry, are delivered. Doctors and nurses are trained in triage and treatment either on the spot or at a primary or secondary health care centre.

A message for Human Rights Day

“The right to health in this conflict is being violated particularly for the worst off with life-threatening consequences. On Human Rights Day my message to the world is: working together, we can diminish suffering and improve health status. When WHO and the UN are judged in relation to this conflict, we want to have done our very best in keeping the most at risk alive and well,” declares Dr Nitzan.