Joining forces to meet unprecedented need: How Bulgaria has responded to the Ukrainian refugee crisis

The war in Ukraine, from which millions have fled, has presented neighbouring countries with unprecedented challenges. Since February 2022, more than half a million Ukrainian refugees have crossed the border into Bulgaria alone, with some staying and others passing through. To meet their multi-faceted needs and provide coordinated support, the WHO Country Office in Bulgaria has joined forces with Bulgarian civil society, the Government of Bulgaria, United Nations Children's Fund (UNICEF), United Nations High Commissioner for Refugees (UNHCR), International Organization for Migration (IOM), the Bulgarian Red Cross and other international non-governmental organizations (NGOs). 

Dr Skender Syla, WHO Country Representative in Bulgaria, understands more than most what Ukrainian refugees are going through. 23 years ago, he came to North Macedonia from Kosovo* (in accordance with UN Security Council resolution 1244 (1999)) as a refugee, together with his parents, wife and 2 small children.

“I know how it feels to leave everything behind that you have built up over your life course, to leave your relatives, your loved ones,” he says. “But I remember very well what it means to be offered the hand of support at the most difficult time in your life, in your time of greatest uncertainty.”

In his role as a WHO representative, he searches for a common language and dialogue between Bulgarian state institutions and NGOs to find solutions to the health problems of Ukrainian refugees in the country.

“The health issues that we are facing are numerous and wide-ranging, from children that need routine immunizations and child care services; to pregnant women that need medical and supportive care during pregnancy, childbirth and after birth; to older people who might have hypertension, diabetes or other chronic diseases,” he says. “We also have a variety of communicable diseases to contend with, including HIV/AIDS, tuberculosis and hepatitis.”

When refugees first arrived in the country, the Bulgarian Red Cross leapt into action, mobilizing paid staff and volunteers to provide practical help to people seeking refuge, food, medical and hygiene products, and clothing. 

“We all put in approximately 34 000 hours of volunteer work,” says Dr Nadejhda Todorovska, Vice General Director of the Bulgarian Red Cross. “Around 5000 volunteers got involved, not just in the capital Sofia, but at all the access points for refugees within our country.”

The government quickly set up a coordination body to address issues ranging from health care to education, psychosocial support, shelter and food. Dr Dancho Penchev, a public health specialist within Bulgaria’s Ministry of Health, is proud of how the institutions rose to the challenge. 

“What we showed was our ability to adapt,” says Dr Penchev. “Our system reacted to the challenges, and there was great cooperation between the institutions, which was vitally important given the problems we were dealing with.”

Dr Angel Kunchev, General National Health Inspector within Bulgaria’s Ministry of Health, helped to organize the refugee response. “My biggest task was coordinating all the players. A lot of agencies and ministries are involved. If one refugee agency is involved, that’s great, but there are so many ministries; internal affairs, education, health, not to mention the border police who are our first point of contact with the refugees themselves.”

“There was a key moment where we realized that non-government actors were best placed to provide information directly to Ukrainian refugees, as they meet and connect with them every day,” Dr Kunchev recounts. He notes that despite Bulgaria’s experience with dealing with previous waves of refugees, primarily from the Middle East, arrivals from Ukraine include many more elderly people, women and young children. 

“People arrive in a really bad state,” adds Dr Kunchev. “Mothers arrive with their own children, but also often with their family’s and friends’ children too – sometimes 5 to 10 of them. They need daily assistance: the children with schools, the adults with jobs.”

For its part, the WHO Country Office in Bulgaria is supporting the Red Cross to offer refugees greater access to medical care and medication, when and where they need them. Having implemented one successful project in the capital Sofia, they plan to expand work into the cities of Varna and Burgas, where most Ukrainian refugees have been placed.

Although refugee numbers have almost halved since their peak, Dr Skender knows they face a long road. “We have to hope for the best but prepare for the worst. The situation is very uncertain, unpredictable. We are coming to the winter months, which means we might also have an increase in the number of COVID-19 and influenza cases, and that's why we are working together with the Bulgarian government agencies and NGOs on a contingency plan for the coming period, to anticipate different scenarios based on the number of people that could arrive into the country.”

Dr Michail Okoliyski, an officer with the WHO Country Office in Bulgaria, adds, “We are organizing mental health training for all professionals working with refugees from Ukraine in the 4 cities where the main services for migrants are concentrated – Varna, Burgas, Plovdiv and Sofia.  We will also support the work of the Red Cross helpline for psychosocial support in its work with vulnerable Ukrainians by hiring Ukrainian-speaking psychologists. They can support refugees affected by the traumatic events that led to their displacement. We are also expanding the helpline into 5 more regions.”

WHO/Europe is providing support for all these activities through its emergency hub for the Ukraine response in Krakow, Poland.