Natasha Meunier-McVey | Editorial Assistant
Citation: EMJ Respir. 2022;10:18-20. DOI/10.33590/emjrespir/10073451. https://doi.org/10.33590/emjrespir/10073451.
IN THIS pertinent session, which took place on the second day of the European Respiratory Society (ERS) International Congress 2022, in Barcelona, Spain, experts discussed the impact of crisis on both healthcare providers and patients. Chaired by Anita Simonds, Emeritus Professor of Respiratory and Sleep Medicine, Imperial College London, UK, and Arzu Yorgancıoğlu, Professor and Head of the Department of Pulmonology at Celal Bayar University, Turkey, the session saw experts and patient representatives share their experiences following the crisis of the Ukraine war.
PERSPECTIVES FROM THE WORLD HEALTH ORGANIZATION
Hans Henri P Kluge, the World Health Organization (WHO) Regional Director for Europe, opened the session by explaining how the Russia–Ukraine war has seen the world’s fastest displacement of people in recent history, with over 7 million people displaced with limited access to healthcare, and 7 million refugees having to rely on the healthcare systems of other countries. This growing humanitarian crisis may lead to the spread of contagious diseases including COVID-19 and polio, with people having limited means of self-protection or isolation.
Prior to the outbreak of the Ukraine war, the country was reforming its healthcare system, a challenge already impacted by the strain of the COVID-19 pandemic. Ukraine’s leading cause of mortality is non-communicable diseases, with the five major non-communicable diseases, including chronic respiratory disease, responsible for 84% of all deaths. Kluge explained how the country already experiences severe and long-lasting impacts of disease outbreaks. With only one in three people in the Ukrainian population having their full course of severe acute respiratory syndrome coronavirus 2 vaccinations, there is both continued circulation and increased susceptibility to both COVID-19 and seasonal influenza, which place strain on healthcare systems.
Kluge went on to highlight Ukraine’s fantastic work in the control and management of tuberculosis (TB), leading the country to be recognised as a pioneer in response to TB and its resistant forms. These efforts included the implementation of a drug force, and a patient-centred approach to improve services for the screening, diagnosis, and management of the disease. These actions saw a 20% decrease in TB cases; however, due to the ongoing active hostilities, Ukraine is faced with challenges for successful drug delivery and the overall safety of its citizens.
Kluge explained how the WHO has ensured that all medical responders are properly equipped for crisis response in Ukraine, also providing sufficient resources for ongoing management of respiratory disease, which included training over 9,000 healthcare workers. The WHO has extended its help to countries welcoming refugees, whilst also setting up 80 emergency medical teams in Ukraine, Poland, and the Republic of Moldova, as well as urgent care hubs in western Ukraine. An effective supply chain has facilitated the distribution of over 1,300 tonnes of critical medical supplies throughout the country in co-ordination with the Ministry of Health.
Kluge concluded his eye-opening session with the reminder that this winter may be challenging for Ukraine, with ongoing displacement and overcrowding coupled with cold weather. However, with the solidarity of surrounding countries and the European Union (EU), we can carry on greatly impacting the population in the midst of this crisis. Kluge stated the guiding principle of the WHO’s European Programme of Work, “leave no one behind,” leading him to emphasise: “The more collaboration, the better […] let’s not break the dialogue and technical link with specialists in any 53 member states of the European Union.”
Olena Yurchenko, a 34-year-old female Ukrainian patient who was diagnosed with pulmonary hypertension at birth, shared a patient’s perspective on the impact of war on healthcare in the context of a chronic respiratory condition. Yurchenko began by explaining the stress factors and hostile circumstances associated with the current crisis. Patients have experienced deterioration in their health due to increased stress, respiratory triggers, and the limited knowledge as to where doctors are located, as many doctors have fled to other countries. In turn, medication has become less accessible due to scarcity and price increases, exacerbating health conditions, especially in patients who are unable to work. Yurchenko rounded off her talk by explaining how the population is staying positive despite the ongoing hostilities in Ukraine, with the thought of the end of war being at the forefront of their minds.
THE IMPACT OF RECENT CRISIS ON THE HEALTHCARE SYSTEM
Yurii Feshchenko, President of the Ukrainian Respiratory Society, Kyiv, Ukraine, discussed the impacts of the events of the last 3 years on the European healthcare system, focusing on the outbreak of the Russia–Ukraine war. Feshchenko explained how these aggressive circumstances have multiplied the risk of exacerbated respiratory disease for the population, with there currently being no safe areas in Ukraine for protection.
Echoing the issues presented in Kluge’s introduction, Feshchenko highlighted the importance of patient education and self-management for chronic respiratory conditions including asthma, to reduce disease exacerbation given the lack of medical personnel since the breakout of war. The mobilisation of healthcare workers would also allow those in need to receive appropriate care and assistance, explained Feshchenko, whilst the education of all doctors on respiratory disease management would facilitate optimal patient care in the current conditions.
PERSPECTIVES FROM THE EUROPEAN RESPIRATORY SOCIETY
Joanna Chorostowska, ERS Secretary General from the National Institute of Tuberculosis and Lung Diseases, Poland, led the final presentation of the session. Chorostowska shared perspectives from the ERS in their immediate support of frontline respiratory teams during the Ukraine crisis.
Only 5 days after the outbreak of war, the ERS published a statement of solidarity and support to those affected by the invasion of Ukraine, and weeks later urged members of the society to support humanitarian aid and initiatives subsidising frontline doctors, also taking steps to halt collaborations with Russian and Belarusian societies. For the ongoing education of Ukrainian healthcare providers, the ERS provided free registration to the congress and extended memberships with no charge, a similar initiative that was offered to Syrian and Afghan members during their respective times of crisis.
With the lack of resources and accessible healthcare in Ukraine, the ERS published disaster medicine resources, which were translated into Ukrainian. Chorostowska highlighted the actions taken to offer support on a patient-level, which involved a collaboration with the European Lung Foundation (ELF). The ERS published a combined support statement with the ELF, and an article in the ELF newsletter offering direct advice to patients with lung conditions, and uniting European initiatives by patient organisations. The ERS also maintained close communication with Oksana Kulish Skaara, a Ukrainian patient with pulmonary hypertension on the ELF council, also promoting their fundraising campaign, which offers support to people with the condition forced to flee the country. A special session statement was submitted by the ERS to the WHO Regional Committee, along with a financial donation of 90,000 EUR to support the WHO’s ongoing work in respiratory and emergency medicine in Ukraine.
Highlighting both patient experience and the actions taken by European organisations, this session provided an impactful overview of the effect of crisis on a population. The overwhelming support given by the ERS, EFL, WHO, and other organisations, as well as individual contributions, reflects the solidarity offered in times of need, and reflects similar COVID-19 initiatives just a few years earlier. The importance of accessible education and information was emphasised throughout this session, demonstrating the range of support that can help a population during a time of crisis.