Paul Spiegel, a disaster response expert, reflects on the health of Ukraine’s refugees

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Paul Spiegel, director of the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health, spent more than six weeks in Poland and other countries neighboring Ukraine as part of a World Health Organization surge team, acting as emergency coordinator for refugee health.

Upon his return from Europe, Spiegel, an expert on responding to complex humanitarian disasters, spoke with The Washington Post to discuss the unique aspects of this disaster as well as the challenges that lie ahead. The interview has been edited and condensed for length and clarity.

Q: In terms of demographics, who is crossing the border from Ukraine?

A: Largely women and children, who are usually the majority in situations like this. What is unusual is how many are in good physical health. It’s not as if they have been traveling on foot for weeks without access to food and water.

The refugees are also moving directly into strong, functioning health systems. Those countries have been very generous: people can work, go to school, and have the same access to health care as nationals. It’s quite extraordinary.

So far, the basic health systems have not been overstretched. Governments have sufficient medications and vaccinations, and are not asking for a lot from the United Nations and nongovernmental organizations.

One of the challenges is that many people are transiting through Poland and surrounding countries. Because of the Schengen agreement[, a 1985 treaty that allows free movement between 26 European countries]we don’t know where they are moving to.

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Q: How has new technology helped you track the flow of refugees?

A: Facebook has been helpful to try to understand where people are locating. The World Health Organization has an agreement with Facebook’s Data for Good, which did allow us to be able to see where people have moved to other countries with the equivalent of heat maps. They are only following people who are 16 or older, but they use algorithms to get an idea of ​​the overall population.

Another company is collecting data from some basic health questions from people who agree to participate. That will be very useful.

Q: Are you concerned about covid-19?

A: Yes, covid is a concern, a public health concern. The Ukrainian population was already very vaccine hesitant, with only about 35 percent of people having had the first dose. People are not worrying about infection, given what they have been going through, fleeing and leaving men behind.

The magnitude of the disaster is also unique. Coronavirus tests and vaccines are free and available, but there is not an effort to do systematic testing because the refugees are moving. You do not want to keep them at the border. And it’s not as if you would quarantine these people. But so far, we are not seeing refugees taking up hospital beds because of covid.

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Q: Are there concerns about other outbreaks and vaccine-preventable diseases?

A: Yes, other diseases such as measles, diphtheria and potentially polio are concerning. Ukraine has had an outbreak of vaccine-derived polio recently.

Q: What about mental health?

A: Even in a relatively healthy population, mental health challenges came up wherever we went and can vary from stress to more florid conditions that need continuing care.

There are not enough doctors and nurses dealing with mental health. On top of that are cultural and linguistic issues. Not everyone needs to see a psychiatrist or a psychologist. Providing psychological first aid involves allowing children to play and giving women time on their own to take care of themselves or to go shopping. That is really important, and it is happening, which is good.

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Q: What about the toll on providers?

A: What is unique about this response is the number of volunteers. People are coming, they are not getting paid. They have left their jobs, and they were not prepared for the stress and trauma. We saw it everywhere. Providing support to refugees, providers and volunteers is easier said than done.

Q: Looking ahead, how do you see the situation evolving?

A: There are enormous challenges ahead, particularly as it is becoming clear this will be a protracted situation. Refugees are being supported primarily by residents, hotels and dormitories hosting them. The question is how to address the response in the longer term, what it will mean for refugees and where they will stay, what will happen to regional health systems. Local people are not going to keep this up. We’ll see increasing tiredness and eventually resentment and have to remember local people are vulnerable as well.

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