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WHO Regional Director for Europe: When people are forced to flee their homes because of violence, their health needs move with them.

Interview for Interfax news agency of Dr. Hans Henri P. Kluge, WHO Regional Director for Europe

- How does the war in Ukraine affect Europe’s overall health care system?

- About 6 million Ukrainians are now refugees because of war. Most of them are in neighboring countries. While they have been welcomed with open arms, they are also adding considerable strain onto the health systems of host countries.

WHO is supporting neighboring countries to address the main health issues among refugees including mental health and psychological assistance as well as treatment for diseases including TB, HIV and cancer.

When people flee conflict and other humanitarian disasters, they need access to a spectrum of health services and medicines. There are several ways in which host countries can ensure that these services are provided to all.

WHO has released new guidance on how host countries can adjust health financing to meet the needs of people fleeing conflict, to ensure that incoming refugees can access a full range of health services quickly and without financial or administrative barriers.

Reception centres that offer compulsory or voluntary health checks are often the first places where new arrivals can get information on local health systems and secure access to health services. Many countries in the WHO European Region, including Austria, Czechia, Estonia, Finland, Hungary, Italy, Lithuania, Norway, the Republic of Moldova and Romania, are performing health checks in reception centres.

Several countries in Europe provide only limited entitlement to publicly financed health services to refugees and asylum seekers. Countries should consider extending entitlements to people fleeing conflict and ensure that the process of obtaining and maintaining coverage is simple and rapid.

When people are forced to flee their homes because of violence, their health needs move with them. WHO/Europe encourages all countries to continue providing the full range of health services to all people crossing their borders, whether they are applying for temporary protection, seeking asylum or being registered as refugees.

- How critical is the medical system in European countries that receive Ukrainian refugees?

- The health systems of most refugee-receiving countries are coping well. The likely challenge may come not from the volume of refugees but adjusting the health care delivery system to the special needs of refugees and making sure they can easily get access. WHO has issued guidance for refugee-receiving countries on this and continues to support them wherever needed.

- How many Ukrainian migrants receive medical care from the budgets of European countries?

- WHO does not collect this type of information.

- How long will European resources be enough?

- This is a purely political decision. European countries and the EU can allocate sufficient resources to meet the health care needs of refugees. Meeting the health care needs of the population in Ukraine is a much greater challenge and external resources will be required to secure continuity of care for the population in Ukraine. WHO is wholly committed to Ukraine, now and in the future.

- How does the war in Ukraine affect the general epidemiological situation in Europe, in particular the spread of COVID-19?

- There is always a heightened risk of outbreaks of communicable diseases, including COVID-19, whenever vulnerable people are forced to move and live very close to one another due to conflict settings and humanitarian emergencies.

In mid-February 2022, Ukraine reached the plateau of the Omicron wave. And gradually the numbers got better, and the situation improved when you look at the coronavirus pandemic around the world and in Ukraine in particular. About 40% of Ukrainians received vaccination in Ukraine. Also, I recommend to vaccinate all people who left their homes and are now abroad as well as to follow the vaccination calendar for children.

- WHO records attacks on health facilities. How does the WHO assess the damage to medical infrastructure? How many health facilities are damaged? How many of them have critical damage and cannot be repaired?

- We verified more than 225 attacks on healthcare. This means that on average more than 250,000 people a month do not receive the health assistance they need.

Attacks on healthcare are robbing people of hope and MUST stop. These attacks are killing and injuring civilians, and obstructing delivery of, and access to, health care for those in need. Attacks against healthcare and other civilian infrastructure are a violation of international humanitarian and human rights laws. If these attacks are proven to be pre-meditated, they may constitute as war crimes.

Under the laws of war, all parties to the conflict have a responsibility, an obligation, to take all necessary measures to ensure that health care is protected.
WHO’s role is to verify that attacks on healthcare have occurred to highlight their extent and consequences for the people in the community and their access to health services. Other bodies within the United Nations system such as the Security Council, or mechanisms such as the International Criminal Court, have the mandate to investigate attacks on health care and WHO cooperates with them where appropriate and following established procedures. The Human Rights Council has appointed an independent international Commission of Inquiry to investigate all alleged violations of human rights during the ongoing conflict in Ukraine. The Commission will provide an update to the Council in Sept 2022.

WHO does not specify the location or identify the affected health care facilities for reasons of security. For this reason, we do not share data beyond information published on the Surveillance system for attacks on health care (SSA), which has specific measures in place to protect the confidentiality of sources and to prevent any further harm to survivors of an attack and affected population.

- Is the WHO involved in the development of the concept of post-war reconstruction of the health care system of Ukraine? According to WHO experts, what should be emphasized in the post-war reconstruction?

- The Ukrainian Ministry of Health, as well as National Security Council (RNBO), have requested support from WHO in assessing war implications for the health system and planning its recovery in Ukraine. When a government submits a formal request for recovery support, this triggers a collaborative agreement between the World Bank, the European Union, and the United Nations.

From WHOs perspective, our primary goals are to strengthen Ukraine’s health system to address the urgent health needs of 8m internally displaced people, reconstruct damaged health infrastructure and re-establish specialized (tertiary) care facilities in government-controlled areas. We will also aim to guarantee access to pharmaceuticals through cost reimbursement or other methods.

Given that the situation in Ukraine is still unpredictable, WHO and partners will take a phased approach to health system recovery. Starting with a technical consultation paper on key principles of health system recovery, followed by a rapid assessment of damage, loss and needs, and complimented by a more comprehensive assessment and costing of needs.

I have been so impressed by the resilience of health workers and civil society on my trip to Ukraine this week. They are heroes in the truest sense of the word, continuing to risk their lives to provide care and assistance to people in need, against the odds. Civil society in particular are crucial partners for WHO to gain access to occupied areas, so we can continue to support the health needs of the population.

- How does the WHO assess the prospects for the integration of Ukrainian medical migrants into the medical systems of European countries? Can we say that Ukrainian doctors will be able to find work in European countries?

- We are seeing a wide dispersal of Ukrainian refugees across Europe. A number of these refugees are health and care workers themselves who when ready, may want to apply their professional qualifications and experiences in the countries where they have had to relocate, either to serve in the immediate needs of their fellow Ukrainian refugees or where needed in their host countries. Successful and ethical but rapid, and possibly temporary certification of health and care workers who are refugees to continue to practice is beneficial to host countries and is a tangible means by which to support these refugees but also help their host countries.

COVID-19 and other humanitarian crises such as the Syrian Refugee Crisis, have taught us that it is possible to fast-track health professional qualifications. Both Turkey and Germany have extensive experience with this. As countries consider fast tracking their qualifications, however, they will need to care for these professionals and equip them with the necessary support to perform at their best and recover from any trauma that they have experienced, whilst also meeting host country requirements to continue to deliver care safely. This is a process that requires some planning and discussion with a range of stakeholders. The degree to which we get this right, can also support the attainment of long-term sustainability of the health and care workforce in the WHO European Region.

In addition, in 2020 the European Commission published guidance for Member States on the free movement of health professionals in relation to COVID-19 emergency measures. The Commission has urged Member States to refer to this same guidance in relation to Ukrainian health workers who are now refugees in EU countries.

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