‘One of the Greatest Tragedies We Can Witness as Human Beings’.

‘One of the Greatest Tragedies We Can Witness as Humans’
Russia’s invasion of Ukraine has created a humanitarian crisis that will affect the public’s health for months and years to come. SPH faculty members Donald Thea, Monica Onyango, C. Robert Horsburgh, Kimberly Sullivan, Jaimie Gradus, George Annas, and Sondra Crosby weigh in on the current and future health challenges resulting from the catastrophic events of this unprovoked war

Russia’s Targeted Anti-Vax Disinformation Has Led to an Overall Distrust in the Ukrainian Public Health System.
The searing scenes of Putin’s violence and firepower catastrophe directed at the most vulnerable Ukrainians horrify and shock us. But this is the culmination of a two-decade assault by Putin to weaken the foundations of civil order in its neighbor. Less noted has been the highly successful campaign of Russia’s targeted anti-vax disinformation directed at Ukrainians (and others) that has led to an overall distrust in the Ukrainian public health system, and among the lowest vaccination rates in Europe. From one of the worst outbreaks of measles in recent European history (2019), to the lowest routine polio vaccination rates (50 percent), to one of the lowest COVID-19 vaccination rates in Europe (35 percent), to the destruction of 500,000 doses of COVID-19 vaccine due to lack of demand (November 2021), Putin’s battlefield failures were preceded by substantial disinformation successes. As 3.3 million refugees—with low vaccination coverage—stream into Eastern and then Western Europe and beyond, Putin’s stealth weapon is silently striking well beyond his original theatre of battle.

60 percent of maternal deaths worldwide occur in fragile settings such as Ukraine.
Past evidence has shown that women and children suffer the worst consequences in any conflict. They are killed, wounded and profoundly traumatized by the violence around them. Women, girls, and children are at risk of sexual and gender-based violence, physical violence, trafficking and mental health challenges. The bombing of hospitals, maternity units and children’s hospitals, has disrupted emergency medical services, health care, social services and the public health infrastructure.
The World Health Organization has estimated that 60 percent of maternal deaths worldwide occur in fragile settings such as Ukraine. An estimated 80,000 women in Ukraine are expected to give birth in the next three months, and many of them are without access to adequate maternal healthcare. Additionally, 12,000 of those 80,000 women will require life-saving emergency obstetric and newborn care for complications in pregnancy and will not have access to critical maternal healthcare. Child birth will be a life-threatening event for the mother and the unborn child.
For the women and children fleeing to neighboring countries, family separation will make it hard to begin life afresh, despite the warm welcome received from the host populations. On their way to refuge, women and children who are not adequately protected are at risk of being targeted by predators and traffickers.
Women are not only victims of the crisis, they also have to shoulder the responsibilities of their families and communities in a fragile environment, further putting their physical and mental health in jeopardy. During response to this crisis, the health and rights of women, girls and children must be safeguarded, including conditions to give birth safely and to live free from violence and abuse.

Spread of TB is of particular concern among refugees.
The current humanitarian disaster unfolding in the Ukraine has major implications for the global tuberculosis (TB) epidemic. The greatest risk factors for TB are malnutrition, crowding and lack of access to healthcare. During war, food is scarce, forced migration is common and of those fleeing the war zone spend prolonged periods residing in crowded refugee camps. Such camps can be the source of spread of TB. Moreover, because of the insidious nature of TB—it takes several years for the disease to become manifest—this spread is often unrecognized. Spread of TB is of particular concern among refugees from the Ukraine, because Ukraine has the 4th highest TB incidence rate among the 53 countries of the WHO European Region, with over 17,000 persons being diagnosed with TB in 2020. Fortunately, the countries into which Ukrainian refugees are migrating are aware of the risk of TB and are capable of prompt diagnosis and treatment, but the magnitude of the migration could overwhelm this capacity.

The toxic wounds of war in Ukraine.
The invasion of Ukraine will leave lasting emotional wounds for soldiers and civilians alike. It will also leave physical and chemical wounds from the many chemical exposures that are also happening. The air is filled with pollutants from bombings, the ground is full of lead bullets and casings and the water systems will undoubtedly be contaminated by the debris and chemicals in the environment. There is also a real threat of nuclear contamination if the power plants are not properly protected. This is a resilient nation who have previously endured the Chernobyl nuclear disaster and came back to create a peaceful, democratic nation. However, these ‘toxic wounds’ of war will last for years to come for the Ukrainian people and will unevenly affect the most vulnerable including children, the immunocompromised and the elderly. Although we will hail the end of this unjust invasion of a democratic nation when it is over, we must not forget that these toxic and emotional wounds will last for years to come. The public health community has an opportunity to mobilize to help with these toxic and emotional wounds by putting our public health skills into action to help Ukraine and its people.

The tragedy of war also extends far beyond loss of life.
As a person who has studied trauma epidemiology for almost 20 years, there are not enough words to describe the devastation I feel as I witness the war in Ukraine or other acts of aggression and violence of any kind across the globe. The large-scale preventable loss of life that results from these acts is one of the greatest tragedies we can witness as humans. The tragedy of war also extends far beyond loss of life. Survivors of conflict—both military and civilian—can experience a wide array of interwoven posttraumatic mental and physical health effects, and social and economic consequences, that have an impact for years, if not generations, to come. Stressors and traumatic experiences that occur as part of war, and in the aftermath of war, have well-documented negative consequences across all domains of health and functioning. My every thought is with the people of Ukraine. My thoughts are also with the people of Russia who are subject to the decisions of a powerful few but will experience their own individual suffering nonetheless; with the people in Europe and elsewhere who are living in fear of escalation; and with all of us, who are struggling to cope with bearing witness to yet another unthinkable tragedy in a brief couple of years.

The US must support the International Criminal Court.
President Biden has called Putin a “war criminal” for indiscriminate murders of civilians, including intentionally bombing schools and hospitals. Petitions are circulating to set up a war crimes tribunal for the Ukraine, similar to those established for the former Yugoslavia and Rwanda. But a respected tribunal already exists and it is inexcusable that the US has not vigorously supported the International Criminal Court as the tribunal constructed to be what has been described as a “permanent Nuremberg,” following the precedent established by the International Military Tribunal that tried the major Nazi war leaders for war crimes and crimes against humanity after World War II.
After decades of multinational work, the new ICC came into formal existence in 2002. Almost immediately thereafter the US withdrew its agreement (signed by President Clinton) to join the ICC when President George W. Bush “unsigned” the ICC treaty, an unprecedented action. It remains a devastating embarrassment that the US continues to argue that US officials should not be subject to international war crimes law (as does Russia and China), including trial at the ICC. It is past time for the US to not only re-endorse the Nuremberg principles, but to rejoin the International Criminal Court and end our unjustifiable double-standard on bringing war criminals to justice.
The chief prosecutor at the multinational tribunal at Nuremberg, Mr. Justice Robert Jackson of the US, explained why we must apply the same war crimes laws we applied to the Nazis to ourselves: “If we pass these defendants a poisoned chalice, we put it to our own lips.”

All human beings have the right to request asylum.
Images of death and destruction are horrific and we should be doing all we can to end this senseless war. But images from our southern border are horrific in a different way: Ukrainian and Russian refugees are greeted warmly and welcomed to the US, while asylum seekers from Central America, Haiti, and Africa are barred from entry using a bogus public health rationale, known as Title 42. We should welcome Ukrainian asylum seekers. But international human rights law, which we have endorsed, requires that we not discriminate against asylum seeker on the basis of race. It doesn’t take a study to demonstrate that this is exactly what we are doing.
The Ukrainian crisis has highlighted the discriminatory and racist nature of our asylum policy. Ukrainians who can reach U.S. soil are virtually guaranteed protection—only four of the 1,553 who entered from September-February were barred. These war refugees should be granted entry. However, Title 42 continues to be used to expel the majority of Central Americans, Haitians, and Africans also fleeing violence and conflict—over a million times in fiscal year 2021 alone.
All refugees deserve the same justice and compassion as the Ukrainian refugees. Every life matters and every person deserves to be treated with dignity, no matter their country of origin or skin color. All human beings have the right to request asylum and seek protections from persecution.
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