With the war in Ukraine now in its seventh week at the time of writing it is clear that there will be ongoing and severe impacts on healthcare. The effects are diverse with some directly related to the indiscriminate shelling of hospitals and civilian infrastructure. With others the impact is indirect, for example the interruption of grain supplies to other countries or radiation sickness in people exposed to high levels of radioactive fallout in the Chernobyl region.
This piece looks at the areas of concern that are currently being highlighted by organisations such as the BMA (British Medical Association), MSF (Médecins Sans Frontières) and the WHO (World Health Organisation). (1) (2) (3)
Food Supplies and Starvation
Ukraine is a major global grain producer earning it the nickname: “The bread basket of Europe.” (4)
Globally it is the fourth biggest grain producer and it exports 98% of its grains through its ports on the Black Sea. Russian warships have blockaded the ports and no grain has been exported since the invasion. Mykola Gorbachev is the chairman of the Ukrainian Grain Association and he estimates that around $6 billion of revenue will be lost by Ukraine as a result of the blocked exports.
Over 100 cargo ships are stranded in Ukraine’s ports. It is not possible to transfer the grain by rail instead. Ukraine’s railways can transport no more than 600,000 tonnes of grain per month in normal times, there are 20 million tonnes waiting to be exported in the ports. (5)
Some of the poorest countries of the world rely on Ukraine for its wheat. Afghanistan and Yemen are highly dependent on Ukrainian wheat supplied through the World Food Programme. Since the Beirut explosion of 2020, Lebanon has been heavily reliant on imported grain. The explosion destroyed their grain storage facilities and it now depends on Ukraine for 80% of its wheat. Experts predict that Lebanon will run out of wheat by mid April. (6)
The war also means Ukraine’s winter crops are not being harvested and next season’s are not being planted. Food supply chains in Ukraine are collapsing and warehouses standing empty.
Against this backdrop is the fact that Russia is the world’s third largest grain exporter. In 2020/21 Russia was the top exporter of wheat. Now, through a combination of Western sanctions and Russia’s own export curbs, that will change. (7)
Turkey, Egypt and Saudi Arabia were the biggest buyers of Russian grain but a number of African countries also rely on Russia for grain imports. Mozambique, Sudan, Nigeria, Tanzania, Algeria, Kenya and South Africa are just some of the African countries that rely on Russia for both wheat and fertilizer and will be affected by the Russian ban on exports. Many of these countries also imported grain from Ukraine. (8)
Cancer Care
The National Cancer Institute of Ukraine is one of the world's oldest cancer institutes. It was founded in 1920, later than the UK institute founded in 1909, but earlier than the USA institute which was founded in 1937. (9) (10) (11)
Cancer care has been affected both in Ukraine and Russia as a result of the war although for different reasons. In Ukraine the indiscriminate shelling of hospitals has destroyed cancer centres. In Russia, where most cancer drugs are imported, the crash of the Rouble means they are now unaffordable.
Ukrainian cancer centres in Kharkiv, Mariupol, Sumy, Chernihiv, and eastern Ukraine have been shelled and their staff evacuated where possible. In the capital Kyiv some chemotherapy is continuing but most other treatments such as radiotherapy have stopped. Cancer centres in western Ukraine are struggling to cope with the influx of patients from the east. Refugees with cancer are being offered free treatment in Europe but co-ordinating and processing large numbers of cancer patients at once leads to inevitable treatment delays. Poland’s cancer centres in particular, having seen the largest influx of refugees, are operating beyond capacity. (12)
Medical care in both Russia and Ukraine relies heavily on government funding.
In Ukraine, both public and private hospitals provide cancer services under a national health service. Before the war the cancer service was coping well financially with the growing cost of cancer treatments and was in a strong position.
In Russia the cost of cancer treatments was already exceeding the income provided by the Russian healthcare system and many cancer hospitals were running at a net loss.
Prior to the war Russian clinics bought some of their drugs from Ukraine although there were no specific contracts between the two countries. Their shared Soviet past means that many doctors and patients alike have relatives across both countries and the sharing of resources between the two happened informally rather than at state level.
The sanctions imposed against Russia have not included pharmaceutical and medical companies who continue to supply essential products. However, prices for these have raised inexorably and the Russian Ministry of Health is warning of severe shortages of around 39 cancer drugs. Without even basic cancer drugs available or affordable, there is little hope of Russia’s cancer patients benefitting from the prodigiously more expensive cutting edge treatments such as immunotherapy and cyber- knife radiotherapy that are still in their infancy in Russia. (13)
Polio
Ukraine began a mass polio vaccination campaign on 1 February 2022 in response to a polio outbreak that began in October 2021. This campaign has now been interrupted because of the war. (14)
By December 2021 there were 22 known cases, all in children, but the reality is that there were likely to be hundreds more with minimal symptoms but the ability to transmit the infection on. With the mass movement of people and crowded living conditions for those still living in places under siege, the conditions are perfect for ongoing transmission of the virus. (15)
The country wide vaccination programme was just three weeks in when it had to be abandoned because of the war. Of the initial 150,000 children the campaign hoped to vaccinate just 40,000 were reached according to figures from UNICEF and the WHO. (16)
Chernobyl and radioactive fallout
The Chernobyl nuclear power plant, site of the 1986 explosion that caused extensive radioactive fallout across northern Europe, was taken by the Russians on the first day of the invasion, 24 February 2022.
Workers at the plant report that vital cooling systems were turned off when the electricity supply was temporarily switched off by the Russian troops. This affected the structure known as the ‘sarcophagus’ which is the concrete and steel structure built to cover the destroyed fourth reactor. The reactor temperature remains high and if not kept cool it starts to degrade.
Since retreating from the area there is now overwhelming evidence that the Russian occupation of the site has disrupted the decades of work carried out to keep the area safe. The laboratories within the power plant were raided and radioactive material stolen. Retreating troops have also laid landmines at the plant increasing further the risk of radiation leaks should they explode.
Professor Claire Corkhill is an expert in nuclear material degradation at the University of Sheffield. She said, “The international community had taken steps for Chernobyl to be completely safe, the Russian invaders have now messed up the whole plan we had for Chernobyl.”
The International Atomic Energy Agency (IAEA) normally receives daily data from Chernobyl that analyses the radiation levels at the plant. Since the invasion the IAEA has not received any data. Instead the IAEA is monitoring radiation levels in Europe, a large release of radiation from Chernobyl will eventually register in other countries. At the time of writing the IAEA had not seen any increased levels in Europe. (17)
Russian forces also entered the “Red Forest”, so called because all the trees turned a vivid red colour from radiation. The Red Forest is the most contaminated area at Chernobyl and covers four square miles. Radioactive material is buried in its soil. Drone footage shows Russian vehicles creating large cloud dusts as they entered the area. They then dug trenches and remained there for some time. There is video evidence of fires being built and discarded food wrappers and containers seen in the forest.
Workers from Chernobyl report that the Russian soldiers had no protective gear either for their vehicles or themselves. With no recent verifiable radiation data available it is not yet clear how high a level of radiation the Russian troops were exposed to by their actions. However the last record the Ukraine's State Agency of Management for the Exclusion Zone has is from 27 February 2022 and at that time monitoring systems showed the radiation level for the Red Forest was seven times higher than normal.
On 31 March 2022, Energoatom, the Ukrainian state-run company operating the plant, said the Russian troops had been exposed to “significant doses of radiation” and had withdrawn from the site because troops were becoming sick. Russian troops are reported to have been taken to Belarus suffering from radiation sickness. These reports have not been verified and radiation sickness does not necessarily show itself as soon as this after exposure unless radiation levels are very high. When the explosion happened in 1986 just over 30 people were killed out right, the vast majority of deaths directly linked to cancers caused by radiation occurred over the following months and years. (18)
People contaminated by radiation will carry it with them, for example on their clothes, and can potentially expose others to it. If the withdrawing troops were exposed to high levels of radiation they may in turn effectively pass it on to others as they regroup in Belarus.
COVID-19 and the Russian Sputnik vaccine
Russia’s COVID-19 vaccine, Sputnik, is being used in 70 countries around the world, many in South America. Sanctions against Russia may impede its ongoing roll out.
It should be noted that the Sputnik vaccine has not yet been licensed by the WHO and the Gamaleya National Centre of Epidemiology and Microbiology who created it continues to face criticism for not releasing data from its clinical trials.
WHO approval is essential if Sputnik is to be used in the Covax scheme (the Covid-19 Vaccines Global Access initiative that distributes vaccines in lower income countries), something Russia wants.
The WHO had planned to carry out onsite inspections in Russia in March 2022, these are now on hold. (19)
Effects on Global Research
Many in the scientific community are severing their links with Russia although many scientists don't agree with this pointing out that some Russian scientists have spoken out against Putin and a boycott will do more harm than good.
On 4 March 2022 the European Commission suspended cooperation with Russian institutions involved in EU funded research and innovation projects.
Germany was the first country to ban all research cooperation with Russia. They were followed by Denmark and Norway and MIT (Massachusetts Institute of Technology) in Boston, USA has terminated an 11 year partnership with its counterpart Skolkovo in Moscow. (20)
On 5 March 2022 ACTO ( Association of Clinical Trials Organizations - a trade group for clinical trial organisations in Russia) announced it was stopping all new projects and trial enrolment in Russia. (21)
The UK government is reviewing its position on scientific collaboration with Russia at the time of writing.
The BMA reports that several thousand scientists in Russia signed an open letter opposing the invasion. The letter says, “Having unleashed the war, Russia doomed itself to international isolation, to the position of a pariah country. This means that we, scientists, will no longer be able to do our job normally: after all, conducting scientific research is unthinkable without full cooperation with colleagues from other countries.” (22)
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