Bratislava, 28 April 2023
Amid the relentless war in Ukraine – now in its second year, and the refugee diaspora it has resulted in – health ministers, nongovernmental organizations (NGOs) and United Nations (UN) agencies came together in Bratislava this month to discuss the challenges, solutions and ways forward for addressing the health needs of Ukrainians who have sought temporary protection from the conflict in neighbouring countries.
The high-level consultation was organized by the Ministry of Health of the Slovak Republic and WHO/Europe. Senior health leaders from Czechia, Hungary, Poland, the Republic of Moldova and Romania travelled to Bratislava to meet with their Slovak hosts for the ministerial forum and consultation to discuss the lessons learned during the past years’ response to what has been the largest humanitarian emergency in the WHO European Region since the Second World War.
Since 24 February 2022, over 20 million people have left Ukraine to seek refuge in other countries. 8 million are currently hosted in neighbouring European Union (EU) countries – of which 5 million have applied for temporary protection – which grant them the same or similar access to health care as other citizens.
However, as the war grinds on, sustainable solutions are needed, particularly as existing health systems were unprepared for such an event and there is an acute shortage of health staff in the Region.
“Since the beginning of the war, almost 200 000 citizens of Ukraine came to Slovak territory alone, while more than 113 000 of them requested temporary protection. Many have needed primary health care and elementary treatment, as well as complex medical interventions or continuation of treatment,” explained Michal Palkovič, State Secretary of the Slovak Ministry of Health. “Unfortunately, we are not the first countries to face challenges related to displacement of this scale. Only through mutual support and cooperation can we manage this difficult situation together. Our neighbours from Ukraine undeniably deserve our help.”
Some common challenges were identified by several Member States during the consultation. These included a lack of preparedness, due to the unprecedented nature of such a large crisis in a continent that has enjoyed decades of peace. This meant that legal provisions were initially not adequate for the response. Humanitarian law had to be applied nationwide and special laws enacted to ensure that adequate financial and resource management were in place. Crisis management and resource allocation were major issues in the early phase of the crisis, with multisectoral coordination needed.
In many countries, WHO has worked with ministries of health to lead the coordination of health sector partners in the response. The lack of precise data, such as patient health data and vaccination records as well as information on access to health care, have proved an impediment in providing effective services and equitable access to health and social care.
However, despite the immense and exponential health needs of the new arrivals, governments and agencies were often able to adopt creative and practical methods to help those in need. The EU Temporary Protective Directive was essential for access to health care but required swift legislative changes. With the crisis in its second year, sustainable solutions will need to be sought, such as including Ukrainian refugees in national health insurance schemes. Practical solutions include better IT systems, such as for translations, information delivery, communication and appointment booking systems.
Collaboration between stakeholders has been critical to strengthen the response, with national governments, the EU, UN agencies, NGOs and communities all playing their part. Stronger links with the Ukrainian health authorities are seen as key to better understand health care barriers and cross-border health data, and ensuring effective medical evacuations and repatriations are implemented. Engaging refugees in the response will also help to build capacities and trust and empower refugees.
The importance of this way of working was stressed by Dr Gerald Rockenschaub, Regional Emergency Director for WHO/Europe, “In the refugee-receiving and -hosting countries we work hand-in-hand with ministries of health and our partners to address the health needs of families fleeing Ukraine to facilitate a comprehensive end-to-end approach. We do that to ensure access to primary and specialized health care and to strengthen mental health and chronic disease services.”
“We know that priorities for those within and outside Ukraine’s borders will continue to include tackling mental health needs, ensuring physical services and rehabilitation are maintained, and rebuilding the country’s health system,” added Dr Rockenschaub. We will continue to advocate for access, so we can address the humanitarian health needs of all people in Ukraine. We all wish for this war to end. But we must face the reality that it may not do so anytime soon, and its impact might be felt for years or decades.”
One area of particular focus was the temporary inclusion of the Ukrainian health workforce into the national health systems of host countries. There are benefits for both the host and refugee populations: More health workers will ease the staffing crisis and enable Ukrainian staff to maintain their skills, and refugees can also be treated by medics speaking their language. However, health professionals need to be granted permission for medical practice and have language skills to temporarily work in host countries. UN agencies are working closely with ministries of health to help streamline that process.
The need for continued support was widely recognized, including the necessity of using learnings and examples of good practices from the Ukraine refugee response and other emergencies to inform future actions. Long-term planning is seen as key to a sustainable solution to refugees’ health needs.
The outcomes of the meeting will inform future policy and strategic approaches in the Region. These include the development of strategies and tools for addressing refugees’ health needs and rights. Additionally, the outcomes will contribute to the identification of next steps for longer-term strategic planning and sustained efforts by refugee-hosting countries, including cross-country collaborations and partnerships, which will ultimately contribute to the development of sustainable health service delivery for the host and refugee communities.
The findings will also inform the new regional action plan for refugee and migrant health in the European Region 2023–2030 that will be presented to Member States at the next WHO/Europe Regional Committee in Kazakhstan in October 2023.
The Ukrainian Ambassador to Slovakia, Mr Myroslav Kastran, expressed the urgent need to help his country’s citizens who have sought sanctuary abroad. “Ukrainians cannot be sure they will wake up tomorrow,” he said. “The war is the reason that Ukrainian parents are forced to look for safe places for their children. We need to find ways to help people in this context. We wish to thank the Slovak people for making this country feel like home. We will never forget it.”