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Considerations on health for countries that host refugees and repatriated due to the emergency in Ukraine and in the context of the COVID-19 pandemic, 12 March 2022

Situation Report
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For several weeks now, reports describe massive population displacement from Ukraine to countries and territories in Europe and other continents (1, 2). The current priority public health concerns for Ukraine highlighted by the World Health Organization (WHO) are conflict related trauma and injuries, exacerbated by lack of access to health facilities by patients and health staff due to insecurity and lack of access to lifesaving medicines, vaccines, and supplies; excess morbidity and death from illnesses due to disruption in essential services for non-communicable diseases (cardiovascular, diabetes, cancer, etc.) and acute maternal, newborn, and child illnesses. In addition, there is a risk of increase of communicable diseases such as COVID-19, influenza, measles, polio, diphtheria, neonatal and non-neonatal tetanus, tuberculosis, HIV, and diarrheal diseases, including cholera, due to widespread destruction of critical infrastructure, which has caused a lack of access to medical care and medicines, safe water, sanitation, and hygiene, as well as population displacement, crowding, and inadequate vaccination coverage. Furthermore, mental and psychosocial health, due to the significant stress caused by the conflict and two consecutive years of the COVID-19 pandemic (1, 2).

The majority of displaced population from Ukraine are women, children, and older adults. Population displacement is a risk factor for communicable diseases and vaccine-preventable diseases, among others (1, 2, 3).

There are reports that pets, such as cats or dogs, are accompanying the displaced population and some countries have eased the process for non-commercial movement of pet animals in the context of the crisis in Ukraine. Nonetheless, it should be noted that rabies remains endemic in Ukraine among wild animals, as well as in dogs and cats (3).

In Ukraine, during the last 4 years, cases of diphtheria, measles, rubella, meningococcal disease, pertussis, circulating vaccine-derived poliovirus type 2 (2 cases reported in 2021), among others have been reported. The vaccination coverage of the aforementioned diseases, for 2020, was below 90% nationally. As of 23 February 2022, vaccination coverage against COVID-19 with complete doses was 35% (3) and 1.5% of the population had received an additional booster dose. A nationwide polio vaccination campaign had begun in February 2022 but has since been suspended due to the ongoing conflict.

All of the above may lead to excess morbidity and mortality among displaced population. Therefore, the host countries should give priority to providing health services to this population, in addition to strengthening and adapting their early warning and response systems.

In the Region of the Americas, countries such as Argentina (4), Brazil (5), Canada (6), Colombia (7, 8) Ecuador (9, 10, 11), United States (12), Mexico (13), Peru (14, 15), and the Dominican Republic (16), among others, are taking actions repatriate their nationals from Ukraine.