Armed separatists in Ukraine are disrupting health-care services and threatening health professionals, forcing some medical staff to leave their jobs. Ed Holt reports.
Human rights organisations have called on both sides in the Ukrainian conflict to respect the neutrality of medical workers amid reports of medical staff being threatened as they do their work, medical equipment being stolen, and the treatment of civilian patients being compromised.
The conflict has already put health-care services in the region under extra pressure as fighting disrupts medical supplies and injured combatants require treatment. People have also been killed as hospitals have been shelled during fighting. But health-care workers—even those well away from the front lines of battle—say they fear for their safety, not because of fighting, but because of the behaviour of armed separatists.
Ole Solvang, a researcher for Human Rights Watch who spent weeks in east Ukraine talking to medical workers, told The Lancet: “Medics told us they were afraid for their lives not just because they were in a war zone but because of the way insurgents were acting towards health-care services.”
Human Rights Watch has found that separatists had commandeered ambulances to use them as troop transports, threatened medical staff, and damaged and stolen medical equipment. They also marched into hospitals and clinics and took over wards and buildings to treat their own wounded, compromising the safety of other patients and staff and the treatment of civilians in the process.
“Medics have told us that one of the greatest fears among health-care staff is the risk of fighting in hospitals. In many hospitals there are fighters just hanging around in the buildings or on the premises, potentially drawing the fighting into the buildings”, said Solvang. But even those operating outside medical facilities have been threatened.
Médecins Sans Frontières (MSF) confirmed to The Lancet that late last month armed men had broken into its offices in Donetsk and stolen three of its marked vehicles, some of which had essential medicines in them. Officials were reluctant to discuss the incident in detail and emphasised the fact that they had no clear idea who was behind it. But in a statement, Stephane Prevost, head of MSF in Ukraine, said that the theft not only prevented medicines being supplied to hospitals to treat wounded fighters but also put treatment of civilians in jeopardy. “The international humanitarian medical organisation condemns this unacceptable assault and abuse in relation to vehicles intended for humanitarian aid… Without these vehicles, the medical activities of MSF in the region—supplying essential drugs and materials, as well as a programme for the treatment of tuberculosis—are in jeopardy.”
Although it is unclear who took the MSF vehicles, some local ambulance crews have said their vehicles have been taken from them at gunpoint by separatists, later being used as transportation for troops. But even when not having their vehicles expropriated, ambulance workers say they have been subject to constant intimidation and stress while trying to do their job. “Ambulance crews have said they are being searched at gun point at every single insurgent check point. Not only does this mean it takes much longer to get a sick person to hospital, but it is a terrible stress for the crews. And this is why many of them have left their jobs. It is simply too much for them to go through that several times a day”, said Solvang.
UN officials said early in August that as many as 70% of health-care workers in Luhansk and Donetsk had fled the conflict zone. And there is obvious tension among those who have stayed behind. Doctors and health-care workers in the region contacted directly by The Lancet refused to speak about the problems they were facing. Regional health officials also declined to comment when approached. But locals in Donetsk told The Lancet that in some hospitals staff were so anxious that they were now “afraid to talk to anyone”.
However, some medical workers who have spoken to local media have warned of the growing dangers to public health in the conflict zone, specifically worsening problems with tuberculosis. The disease is an epidemic in Ukraine. The country has some of Europe's highest rates of tuberculosis as well as one of the highest rates of drug-resistant tuberculosis in the world.
International organisations working to combat the disease, such as MSF and WHO, told The Lancet they fear tuberculosis might spread in the conflict zone. Dmytro Donchuk, tuberculosis and HIV adviser for MSF, told The Lancet: “If patients are not diagnosed in time or if current tuberculosis patients cannot continue or finish their treatment, if medicines and supplies can’t get through, or if medical staff are displaced and cannot follow up treatment for their patients, then setbacks will occur in the strategy to stop tuberculosis.”
Source: The Lancet