By Andrew Schroeder
As of Tuesday morning, the UN’s High Commissioner for Refugees reports that roughly 3 million people have fled from Ukraine into neighboring countries. The top destination country remains Poland at over 1.8 million, and Moldova based on normalized population. Recently, the influx rate from Ukraine has slowed from a peak of roughly 200,000 per day to approximately 50,000 per day.
CrisisReady, a joint project of Harvard University and Direct Relief, has been analyzing mobility data from Meta, linked to an analysis of the Facebook social connectedness index. That analysis tends to indicate a pronounced westward flow of refugees towards areas of western Poland, Slovakia, and Hungary. This aligns well with social connectedness, as well as congregation occurring in major cities.
Warsaw and Krakow in Poland recently announced that reception of new refugees in those cities would be difficult, given the current numbers of arrivals. Increasingly Ukrainians are spreading throughout the European Union, particularly to the Czech Republic and Germany.
Recently the team at REACH, a humanitarian initiative providing data to aid actors, was able to conduct interviews with displaced persons at the border checkpoints for each neighboring country. According to their research, refugees were 85 percent female and 15 percent male. Seventy-three percent of interview respondents reported traveling principally in groups of one to four, with a much smaller number traveling alone (11%) or in groups of five or more (16%). Ninety percent of respondents were Ukrainian, with 4% of Russian nationality, 1% Moldovan, and 5% another nationality.
In addition, just one percent reported traveling with a pregnant or lactating woman, and 4% reported traveling with a person with a disability. Eight percent reported traveling with an elderly person over the age of 65, with 49% traveling with children under 18.
According to respondents, their principal destinations outside of the neighboring countries included Germany and the Czech Republic – and 56% intended to stay with family or friends – which aligns quite well with the social connectedness analysis above.
According to the Protection Cluster and the International Organization for Migration, the official number of internally displaced persons within Ukraine is approaching 2 million. Most of those people have fled from the north, east, and south of Ukraine, which are principally affected by Russian attacks and have moved towards areas bordering western Ukraine. Zakarpatska and Lvivska oblasts (districts) have received a disproportionate share of IDPs.
A range of humanitarian corridors continues to be opened up for Ukrainian cities under bombardment to allow civilians to flee. As of Tuesday morning, there were officially nine such corridors open across the country. However, according to repeated reports, those corridors are coming under attack or are otherwise declared unsafe for mass evacuations.
The situation in Mariupol is considered to be the most extreme, with accusations from the Ukrainian government and the Red Cross that the corridor for that city remains closed and that residents are at risk of starvation as a result.
According to the World Health Organization’s most recent situation report, issued on March 11, the principal public health issues facing Ukrainians remain physical trauma and conflict-related wounds. Following that concern, the WHO is calling attention to:
- Non-communicable diseases, particularly insofar as supplies of insulin for diabetics, cancer medications, and other supplies for cardiovascular disease are now disrupted or in extreme scarcity,
- Emergence and spread of infectious disease including polio due to the disrupted polio vaccination campaign; TB and HIV/AIDS due to disruptions of access to treatment facilities and drug supplies; Covid-19 due to low vaccination rates and the inability under current circumstances to practice most conventional infection control protocols; as well as risks of diarrheal diseases due to widespread damage to water and sanitation facilities,
- Mental health impacts related to displacement and war-related trauma,
- Protection issues including human trafficking and gender-based violence, and
- Risks posed specifically to pregnant mothers and newborn children. WHO is estimating that 80,000 infants will be born in the next three months within Ukraine.
WHO is working with Direct Relief and other humanitarian groups to solve many of the critical supply shortages for NCDs mentioned above. The organization says it has established logistical connections outside Ukraine to all major Ukrainian cities. It has also set up an emergency epidemic surveillance system, which focuses on event-based syndromic reporting, and is expanding its focus on mapping health facilities and integrating damage/status assessments into facility mapping.
Medical oxygen continues to be a high-priority need. A Ministry of Health/WHO working group on medical oxygen has been established and will be calculating needs and issuing guidance on oxygen distribution across the country.
The WHO is establishing its first field hospital in Lviv and planning several others throughout western Ukraine.
Additionally, WHO facilities are being set up in the refugee-receiving countries to reduce pressure on the health systems in those countries. Medical supply assessments for each bordering country are ongoing and should be considered a priority.
Food, Nutrition, and Logistics
The World Food Programme estimates that 12 million people within Ukraine require immediate food assistance. The most immediate concern in this regard is the situation in cities such as Mariupol, Kharkiv, Kherson, and parts of Kyiv, which are at least partially encircled and besieged, reducing sharply their ability to move food and other essential supplies into those areas. In addition to the closure of logistics corridors, an estimated 750,000 people have lost access to electricity or natural gas supplies, which has reduced their ability to cook and posed significant challenges for heating during a period of frigid temperatures.
Apart from the conditions within Ukrainian cities, the principal concern related to food remains the curtailment of international food shipments from both Ukraine and Russia. A couple of days ago, Russia announced that they would be suspending the export of most cereal crops, which affects a large share of the world population and depends on Russian and Ukrainian exports.
In a recent piece in The Guardian, representatives from the UN Food and Agriculture Organization called attention to the severe risks posed by rising food prices throughout many of the world’s poorest regions as a result of the ongoing war. Global wheat prices recently hit all-time highs, with additional concerns regarding corn and other crops. They also called attention to the central role of Russia and Ukraine as fertilizer exporters, which in turn has a ripple effect on agricultural production throughout much of the world.
While the food crisis is not a top-level issue yet, the longer the war goes on, the more serious these disruptions will become, with longer-lasting effects across the world.
Meeting Needs and Challenges
With five million people displaced in less than three weeks, the flood of Ukrainian refugees and internally displaced persons has grown faster than any crisis since World War II. For humanitarian aid organizations and multilateral agencies, the situation requires a similarly unprecedented speed and magnitude of response.
Direct Relief is doing what it does in every major disaster to which it responds, but at a much larger scale: mobilizing and delivering medicine and other medical aid to the people who urgently need it and providing support to trusted local health providers.
Because the human toll of the war will be long-lasting, Direct Relief is building channels for efficiently securing and delivering large volumes of medical aid over an extended period.
The organization is arranging direct deliveries from pharmaceutical manufacturers and warehouses across Europe to Ukraine, most often via Poland, securing space in pharmaceutical warehouses, including refrigerated facilities, and working closely with local logistics companies. The organization is also planning a series of chartered cargo flights from the US.
At least initially, securing medicine may be less of a hurdle than the logistics of getting it to the people who need it. Direct Relief has received unprecedented pledges of support from many of the world’s largest pharmaceutical manufacturers and medical supply distributors. Enough medical material has been offered in California alone to fill multiple chartered jumbo jets, which Direct Relief is now arranging.
Large aid shipments over the last two weeks have arrived safely in Ukraine. Still, with a flood of relief supplies headed to the region, there is an increasing risk of bottlenecks, including a limited supply of trucks, delays at border crossings, and security threats inside Ukraine.
To date, the largest recipient of Direct Relief aid in the crisis has been Ukraine’s Ministry of Health. Poland’s Government Agency for Strategic Reserves is expected to play an increasingly important role in upcoming shipments; it coordinates incoming aid deliveries and acts as a logistics agent to receive cargo and transfer it to Ukraine.