As winter begins in earnest, people in many parts of Ukraine are facing the prospect of a bitter season without heating, power or running water. With temperatures in some parts of the country due to plummet to -20 ˚C, and thousands of homes and buildings badly damaged by shelling, leaving is the only option for millions of people if they are to survive the coming months.
On a recent visit to Ukraine, Dr Hans Henri P. Kluge, WHO Regional Director for Europe, warned of the challenges to public health: “We expect 2–3 million more people to leave their homes in search of warmth and safety. They will face unique health challenges, including respiratory infections such as COVID-19, pneumonia and influenza, and the serious risk of diphtheria and measles in under-vaccinated populations”.
At the start of the war, waiting for the cessation of hostilities seemed to be the only practical option for many families with a member with severe impairment. The challenges of moving a loved one with complex needs to another country can be overwhelming, particularly when faced with language barriers and unfamiliar health systems in addition to physical factors.
However, 10 long months into the conflict, the resilience and coping methods of these families have been depleted. Although fewer Ukrainian refugees are arriving in Poland at the moment, many of those arriving today have more severe functional impairments and much more complex health needs.
When the war started in February, 56-year-old Nelia Sniehurskyi was determined to stay. Her son, Kostiantyn, was born with Edwards Syndrome, a genetic disorder that causes severe disability. Many children with the syndrome die in infancy, but 35-year-old Kostiantyn is one of a small percentage who survive into adulthood.
Kostiantyn needs 24-hour care, so Nelia looks after him full-time and cannot obtain paid work. In their small village near Odesa the family had a wide support network and Kostiantyn was entitled to help from the Ukrainian health service. Although life was challenging, Neila, supported by her 59-year-old husband, Leonid, and 21-year-old daughter Olena, had been able to care for Kostiantyn at their family home.
Although many other families in their village quickly left when the shelling started, Nelia felt that it would be too disruptive to move, and the family decided to stay. “We did not want to leave our home, but our village was under constant bombardment. We spent almost 3 months hiding in the basement among howling sirens and falling bombs, with no electricity or running water. My family’s health began to deteriorate, some of our neighbours were killed, and we could not continue living in such a dangerous place.”
With no end in sight to the conflict, and their health suffering from being forced to shelter in a damp basement, the family concluded that it was no longer feasible to stay in their village and that their best prospect was to flee to a neighbouring country. On arrival in Kraków, Poland, the family were faced with meeting their immediate needs in a foreign country where they did not speak the language.
After the family were accommodated together in host community facilities, they were faced with the issue of making ends meet. Olena has been able to find some freelance work, but without a permanent job, money is a constant worry. Kostiantyn’s disability means that the family is entitled to receive food parcels through charitable food banks. However, as economic pressures continue to grow in Poland, donations to private food banks have dwindled, meaning that this kind of support is not guaranteed to continue.
Nelia has also had to navigate the Polish health-care system to find the necessary care for Kostiantyn. “Everything is new here, at the very beginning I didn’t know how to register Kostiantyn as having a disability. My daughter saw a poster for Ukrainian refugees at the railway station about how to access health-care in Poland, but when I saw the doctor, I struggled to explain Kostiantyn’s health problems and understand what he was saying in Polish.”
The WHO Country Office in Poland is helping refugees like Nelia and her family to navigate the health system. After a Russian-speaking doctor was identified, a member of the WHO team was able to accompany Nelia and Kostiantyn to the local hospital and ensure that he was able to access specialized care.
The Country Office in Poland has also been working with the government and other health partners to provide emergency health services, and has distributed posters in Ukrainian and other languages to provide guidance on how to access treatment and medicine, as well as information on additional services, such as mental health support and COVID-19 vaccinations, which have been disrupted due to the conflict.
The services provided to Kostiantyn and other refugees with disabilities are part of an effort by the Polish government to ensure that all barriers within the health system and society are removed for people with disabilities. As with several other governments in the WHO European Region, the highest level of political commitment has been made to strengthen disability-inclusive health systems to protect and promote the health and well-being of people with disabilities of all ages and across all contexts.
Ensuring that people with disabilities can access the care they need is at the heart of WHO/Europe’s first-ever “WHO European framework for action to achieve the highest attainable standard of health for persons with disabilities”. Adopted by all 53 Member States of the European Region, encompassing Europe and central Asia, the framework outlines how countries can build inclusive health systems and societies.
Dr Paloma Cuchί, WHO Representative in Poland, sums up why the programmes and services for refugees with disabilities are crucial: “Ensuring the health and well-being of all people lies at the core of WHO’s mandate. The United Nations Convention on the Rights of Persons with Disabilities states clearly that people with disabilities have the same rights as all other people. Ensuring proper health care means that people with disabilities receive inclusive services, helping to prevent their isolation from society. We, as WHO, are mandated to support the health and well-being of all”.