Conflict in Ukraine: the health and humanitarian cost

Oksana Pyzik joins Gavin and Jessamy to talk about the short and long-term health impacts of the conflict in Ukraine, and what happens next for those forced to flee.

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Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Gavin: Hello, and welcome to the Lancet Voice. It's March 2022, I'm Gavin Cleaver, and I'm joined as ever by my co host Jessamy Bagnall. Conflict in Ukraine has captured the world's attention over the last few weeks, and every day we're confronted with images coming out of Ukraine of suffering and horror. As I'm recording this introduction, on March 21st, 10 million people have fled their homes, with 3.

5 million crossing the border into neighbouring countries. 90 percent of those fleeing are women and children. The humanitarian and health impact of the conflict and of this vast displacement will be felt for generations, and to discuss what these impacts might be, Jessamy and I are very pleased to be joined by Oksana Pyszyk, a Ukrainian Canadian who works in UCL's School of Pharmacy here in London.

This interview was recorded several days ago, so any data discussed in the interview may be slightly out of date, given such a fast moving situation.

Oxana, thanks so much for joining us today. It's really valuable to have you and your voice on the podcast. We can just kick off, by you telling us a little bit about your kind of role at UCL and your background. And of course, you've been such a prominent voice during the COVID pandemic for the last two years as well.

But we're here today to talk about Ukraine, but perhaps, tell us the rollercoaster you've been on for the last few years. 

Oksana: Yes, of course. So I am the Global Engagement Lead at UCL School of Pharmacy. I'm also a Global Health Lecturer there. And in 2015, I launched the Global Citizenship Program with a focus on outbreaks.

And then that has over the past two years has kept me very busy with the COVID 19 response. But in general, I also lead on the Global Health Committee. curriculum development from a teaching perspective at UCL School of Pharmacy. I'm a pharmacist myself. I sit on the board of trustees for the Commonwealth Pharmacists Association and I advise them on wider global health issues.

And given the course of events over the last three years, I found myself more and more bringing these topics to wider general audience. to help them understand how our individual impacts add up to a wider global health response, particularly with other issues, including climate change.

Gavin: So obviously we're here to talk about the conflict in Ukraine. So you know how are you feeling? 

Oksana: I have I'm Ukrainian Canadian, so this really hits home for me. I have both family and friends in Ukraine they have remained in Ukraine but moved towards Lviv, which is in the western part of the country.

Mostly because they want to contribute to the response. They are also participating in running the medical facilities, theirs, etc. And all the need which is so great on the ground at the moment. It's been, it's difficult to put it into words, really. Say it's the fight or flight response.

Even though I'm here, I'm in London, I'm in safety. But also feeling helpless to about this situation, watching it unfold it's been really difficult, but I'm just so deeply proud of the heroism and bravery shown by the Ukrainian people. And I'm trying not to to pour that anger and outrage and despair into productivity and liaising with the communities here in terms of Rallying funds and getting journalists to connect with people on the ground so that it's being a report that the situation about how it's impacting the local populations and all across the country is being covered.

I think that's really important with the issue of misinformation and particularly. Where censorship has become so extreme under the Russian regime. So we really do need to try and get those voices amplified as much as possible. And just. volunteering as much as possible to give aid and ensuring that there are safe humanitarian corridors for WHO and UN staff to deliver supplies, medicines, everything.

And so I think despite having a I, as many people of Ukrainian heritage or not it's been such a. Anxious time with really a leader who is willing to include a nuclear threat. I think most are watching in horror everything that's unfolding. 

Jessamy: Do you think this is just gonna get worse?

And are you aware of the sort of? The types of health interventions that are trying to be put in place for some of these hospitals in Ukraine in terms of moving patients out, we hear stories of people, moving children and patients trying to get them out and not necessarily being able to do.

Can you provide us some information on that? 

Oksana: The ceasefire has not been respected and the humanitarian corridors have also not lived up to that promise. Some of these areas were there were mines on these paths and civilians once again were targeted but even more crucially these humanitarian corridors then led into Belarus, which has been a sort of proxy state for Russia and has also sent troops over or into Russia.

And so again, these are not necessarily safe given the the level of anti Ukrainian propaganda that has been for the last 20 plus years been fed to the population. So those are not on the terms of where the civilians will feel safe. You don't want to be running into the hands of the people who are responsible for bombing and killing your family, friends, and relatives.

So that in, in that sense. And it wasn't arranged in such a way that I think led to true humanitarian relief A, because it was dangerous and people lost their lives in, in, in making those exits so that good faith was not held. But also where those exit leds are problematic as well and could lead to women being trafficked and other problems as well.

So those are some very serious issues as well. Within Ukraine itself, there's been a huge influx of people fleeing from the most heavy shelling. where the long range missiles and cluster bombs which are not supposed to be used in conflict. So again, that's in breach of international humanitarian laws have caused 6.

7 million people to be internally displaced within Ukraine. And that is also overwhelming health facilities in the West. Now the WHO is supplying, is trying to. assist bringing in health workers, but without those safe passages to bring in health supplies, it means that there are areas where again, strategically the military have bombed electricity supplies.

So there are some areas without electricity, without access to water, without access to medicines. And it's been very difficult to help these countries that are in the most severe bombardment in the East. In addition to that, the WHO is also supporting neighboring countries to ensure that they're receiving support for a massive influx, Poland being one of the countries that has received support the highest number of immigrants.

And that's they also had no refugee centers to begin with. So we're talking about Google offices being transformed, people opening up their homes. Now there is a many people who will have family in Poland. In that respect people are opening up their own homes, but they're, but that's still, not really at the scale when there's 1. 3 million refugees that Poland has received it is really a Struggle, but they're being very creative with it and they're being a very swift in their response. So from that perspective again, it's easier for Ukrainians to relocate I think in countries that have Already pre existing relations and they're in terms of health needs because already countries like Poland don't have a excess health workforce.

They're in short supply, like in many other countries around the world. They have had to transport make makeshift hospitals in national stadiums in Warsaw. They've had to create. Mobile trains that are transporting people around the country that are also makeshift hospitals for the most sick.

And we also saw that there have been 20 children flown in from Ukraine into the UK to, because they have severe cancer. There, there has been health interventions on that response, but it's all been very quick and in some instances in countries without much experience of this at all.

Gavin: Yeah. Given the scale of it, there'll need to be some long term structures put in place, especially in Poland, you would think. 

Oksana: Of course. And so with Poland again, as I said, they don't have the same experience in terms of being able to cope with such a rapid influx. This is the largest refugee crisis since the second world war in 1945.

So there are going to be long term measures that are necessary, and that will include many interventions around mental health. People have fled their homes with maybe just a bag. Children have crossed borders by themselves. So one of the long term needs will certainly be around supporting the mental scars of conflict, and that will include support for trauma and counseling and continuation.

of care specifically for women and Children, because these are mostly the refugees that we see are crossing. So a focus on sexual and reproductive health, also ensuring that many Children who will have not had their routine immunizations delivered. So all of that following up with patients screening patients ensuring that they have access to vaccines.

All of that will be required for men from not just Poland, but all of the communities that welcome in Ukrainians. 

Jessamy: And that process is obviously ramping up now and is going to have to continue ramping to, to get to the kind of scale and level where we're able to deal with those interventions.

Do you feel that from a kind of global point of view, there's the same focus and solidarity on trying to Action, some of those strengthening of the health system surrounding Ukraine and, directly within Ukraine in terms of health, as there is say of, talking about sanctions and business assets and freezing things.

Or do you think that the focus needs to change a bit. We need to talk more about this. I feel like we need to talk more about it. 

Oksana: I think we need to be doing everything that we can. So there's going to be the short, medium and long term aspects towards providing support. Sanctions are one way of not only trying to put additional pressure for Putin to stop this war, but also to galvanize the Russian population because it will now impact their daily lives.

A vast number of corporations have closed their doors. We have the energy problem, which is going to cause a significant squeeze on European populations, including Germany, most significantly. But it is in the long term also a view towards moving for green energy, which we need to be doing anyhow.

In the short term, however, I don't think we're able to do that so quickly in terms of the, again, the sanctions, it was. It's a, I would say a snowball effect. So once some of the really major companies spoke out on the issue and took a stance to stand with Ukraine condemning the Russian invasion in the strongest possible terms, it became untenable really for any other company to, to stay neutral on it.

And that pressure. He had a domino effect. And I think that however, I don't see this being the ultimate tool to end the war because I don't think that Putin is particularly concerned. With the health and well being of his own population based on the imprisonment of protesters, of the very severe censorship laws that have come into place.

The fact that even children have been imprisoned for carrying peace signs. I don't think that I think he's prepared to let his own population suffer for him to win this war. 

Gavin: And the fact that so many people are fleeing Russia as well. 

Oksana: Yes. Yeah. And so I think that makes it much more difficult to use as an effective tool in terms of sanctions to, to prevent the war from escalating.

Again, this is there, it's historic in so many ways. The attack on the nuclear power plant and the threat of that being it is, it was contained, but had it been more severe, that health catastrophe would have been six times larger than that of Chernobyl. So we do, we are, this conflict does affect everyone because not only does it normalize leaders trying to.

Threaten use of nuclear weapons. It's also even utilizing strategies including nuclear power plants as ways to seize land and other countries. So this has un in that, as in, in that perspective, the knock on consequences of that. are not to be minimized. It is as, I would say, scary for world leaders.

But I think at this stage, despite the symbol of solidarity, I fear it will just In bold Putin to crack down further on the invasion using more similar tactics to those used in Syria. 

Gavin: What do you think about the kind of solidarity across European nations shown towards Ukrainian refugees so far?

Of course, we've seen those scenes, for example, in German train stations of people just showing up to welcome whoever from the Ukraine into their homes. In a way, it's been heartening, but there's a danger, isn't there, that these things can be quite short term? Whereas actually refugees need long term support.

Oksana: Yeah. And also it's not been equal everywhere. So there have been some countries that have been, have, taking their own initiative to show up with signs and help in any way they can. Whereas if we compare the UK response they have had. 760 visa approvals only in two weeks, which is quite frankly disgraceful.

Poland has taken over 1. 2 million refugees. Hungary has taken 190, 000. Germany has taken over 50, 000. Really, the UK is lagging far behind. Ireland has waived all visa requirements similar to Canada. I think it's also important to point out that not everyone has had the same level of security.

support, but you are 100 percent right to say that there is in the immediate crisis while we, the tension of the world is on the issue people stepping up to support, but the longterm aspect of helping people to rebuild their lives. It's almost a second crisis for the refugee themselves.

They need to be able to secure an income, find a place to live. And that's, these are huge barriers to overcome, and particularly being able to When their families that are separated from their partners and young children and their education while also dealing with not knowing when they'll be able to return to their homes because many of the people have fleed, they want to be able to return.

to their lives in Ukraine and not just not knowing when and how this will, how long this will carry on for the mental burden, emotional burden of that is incredibly challenging as well. But in the meantime, we do need to ensure that there are appropriate programs that have the appropriate funding to help refugees from all over the world.

We're talking about Ukraine now, but these types of programs are usually Not funded well enough and our require expansion to ensure that we are really helping to build the most integrated and diverse populations and that comes as a strength, the Ukrainian diaspora all over the world has also helped to galvanize and bring lobby to ensure that these sanctions come through and that is a result of people who have from previous conflicts, my parents being again they fled the USSR under communist regime and in Canada, there's a huge diaspora population and the communities really rally around each other.

But it also shows that you can have, the power of those communities to act in crisis, but it's we need everyone to be stepping up to that as well. 

Jessamy: There's obviously going to be lots of sorts of consequences of this, and maybe you've touched on it already. I'm talking about the sort of nuclear aspect, but what are some of your biggest concerns?

Oksana: I think it sets precedent that the international community will not act when there is an aggressor as you say, there's no there isn't a justification for The invasion that is valid and that has been widely condemned by the United Nations. I believe 141 votes supporting a Ukraine and dismissing the Russian claims.

So there is globally I think a strong condemnation of any country to interfere with the right of another country's self-determination. It is really only up to Ukrainians to decide whether they are, looking for a future with a free press with democracy, with free elections. I was actually in Kyiv when Poroshenko and Zelensky were up against each other.

And at that point I have to say, I thought. What will the future of our country look like in the hands of a former comedian turned president? So I was dismayed, but I have to eat my words now because President Zelensky has really emerged as a, not only brave, but a man of integrity and standing amongst his people.

And I think contrasting that leadership against. Seeing Putin and his ridiculous long table and his flight attendants flocked around him in a sham press conferences. You can just see the style of leadership being from Zelensky rallying uniting people together without this sense of a hierarchy to the most strict, strictest sense of command.

chain hierarchy based society. And I think that's why the Russian soldiers are also losing a lot of morale because, they're invading a country that doesn't want to be taken over and fall under the iron curtain again. So people from all over the world have actually come back to, to defend the right of Ukraine to exist.

As a Ukrainian myself, Putin's essay published in July 2021 about really claiming Ukraine as a Bolshevik invention was extremely dehumanizing because it diminishes my identity and heritage and I think that is why there is so So despite it being a David versus Goliath story, the resistance is so strong because it's for something much greater at stake and that is that it really, you cannot, it is up to the people of a country to decide their own future.

And I think that has rung so much with the international community in terms of what is right and what is wrong. Certainly I agree that, we should be. looking at all conflicts in similar light to ensure that we have really, it's a requirement for any type of long lasting peace is to respect these rules.

And that there, the West has not always been on the right side in terms of that. And I think that, that hypocrisy does need to be addressed, but I don't think this is just about Europe had two world wars, and those scars are still within our generation. So I think the emotive response of a war in Europe is also due to the reverberation of all of the experiences that have through generations been passed on in in continental Europe, as well as in the UK.

The impact of that. I don't think we should underestimate and I think that's also partly why we saw such a strong response and post the war, we had, there was supposed to be a new world order with NATO, the United Nations and the EU specifically designed so that, they're never again, would we see this type of conflict and destruction on European soil, but that's only lasted around 75 years.

And now we see that There is once again, a war in Europe. And so I think that has been deeply disturbing for people of non Ukrainian descent within Europe who still have the tragedies of the previous world wars, including, Holocaust survivors and everything else, like within their families.

But I also agree that we need to be this is a, perhaps a lesson to be learned if we can prevent, Ukraine to be completely destroyed, for it to be, follow the same tragedy of what has happened in Syria. I think that's why there's such a galvanization to act because there is so much suffering already and we don't, anything to stop it from being, to adding to that.

But we do need to ensure that welcoming all of those people from war torn nations and there's no place in the world for double standards. 

Gavin: Looking for the next couple of weeks, what are some of the kind of issues you're hoping to galvanize support for? What's most important for you going forward?

Oksana: I think we absolutely need to ensure that there is facilities, so the hospitals, the schools are safe. That there need to be some consequences to the fact that 34 hospitals have been attacked. And that there is Some compliance with the intern, international humanitarian laws. So we need to ensure that these humanitarian corridors are respected.

So that supplies, medicines, there is oxygen shortage. There are as well as HIV medication shortages reported by the WHO. All of these need to ensure that safe access to the areas of most need within Ukraine. I'd say that is what people need to be focused on. In the short term immediately because of just the severity of these medical shortages and ensuring that they're, that health workers are not targeted.

So we need to galvanize the community to. put an end to this. And I don't think that there is a particularly simple way, but if we allow the further assault on Ukrainians to continue without respect for civilian life I don't think we will be, it will turn into a prolonged conflict.

And if eventually Ukraine does fall within the iron curtain, what you have left is. The same problem of Putin with nuclear weapons even closer to the doorstep of Europe, pointing west. That problem doesn't disappear. There have been talks about trying to supply more military equipment, but there's been a lot of back and forth and indecision.

And every moment, every second that continues, Putin gets the upper hand in the conflict. But ultimately, kicking the can down the road doesn't solve the problem of Putin.

Gavin: That's it for this episode of The Lancet Voice. We're publishing a lot of content on the conflict in Ukraine, which you can find by going to our website, thelancet. com, where you'll see it on the homepage. If you'd like to join the conversation on Twitter, you can follow Jessamy and I on our Twitter handles, at Jessamy Baganal and at Gavin Cleaver.

Thanks for listening, and we'll see you again soon.