Up to 2021, the conflict in Ukraine had been considered the only forgotten crisis in Europe. The humanitarian situation in the Donetsk and Luhansk regions, which had been ongoing since the war in 2014, was severe and had led to a large number of displacements, mostly internal. At the same time, the country was seeking to consolidate its independence and make progress in the political organisation of the state, carrying out significant reforms in areas such as decentralisation and healthcare. At the international level, the conflict was considered of little importance and received virtually no coverage in the press.
However, this changed dramatically with the tension surrounding the conflict in the final quarter of 2021. The outbreak of war in February 2022 and its large-scale humanitarian impact drew the attention of governments in Europe and around the world, and media coverage became almost constant. Humanitarian needs increased dramatically, and ambitious donor appeals were launched, with a proportionally more active international response than in any other global crisis. As this report goes to press, an estimated 17.7 million people are in need of humanitarian assistance. More than nine months on, the war has spread to at least fifteen regions in Ukraine. The northern, eastern and southern areas of the country have been severely affected by military activities.
Humanitarian organisations working in Ukraine have consistently called for respect for international humanitarian and human rights law obligations, and for the protection of civilians and civilian targets from hostilities. We have called on the parties to the conflict and the international community, including the appropriate UN organisations, to ensure immediate, safe and unimpeded humanitarian access, including across conflict lines, so that humanitarian assistance can reach all people in need, especially those in vulnerable situations and regardless of their origin; and to respect the independence of humanitarian organisations and the protection of humanitarian personnel. Humanitarian aid for civilians in need must be allowed and facilitated even in the context of war, and it must be impartial and carried out without distinction and in accordance with international humanitarian law. The Fourth Geneva Convention requires states to "permit the free passage of all consignments of medical and hospital supplies" destined for the civilian population and "the free passage of all consignments of essential foodstuffs, clothing and other goods destined for children under fifteen years of age, pregnant women and other post-natal situations".
However, humanitarian organisations see with frustration that attacks on civilian populations and infrastructure, including essential services such as healthcare, continue unabated. At the time of writing, the WHO has confirmed 623 attacks on healthcare in Ukraine, approximately two-thirds of the global total of 901 attacks. As a result of these attacks, 525 healthcare facilities have been damaged or destroyed, 202 health workers have been killed and 303 injured. All parties to the conflict must respect the lives and well-being of health workers and provide the necessary protection so that they can attend to the civilian population.
The number of internally displaced persons has exceeded 6.2 million and more than 7.7 million have crossed the borders of Ukraine into Poland, Hungary, Romania, Moldova, Slovakia and other European countries as refugees. In turn, an estimated 6.9 million people have arrived or returned to Ukraine in this period.
Europe’s response to refugees from Ukraine has been immediate, albeit insufficient. In March this year, the adoption of the Temporary Protection Directive aimed at granting protection to people fleeing the conflict in Ukraine for a period of between one and three years represented a historic milestone: it was the first time the European Union had activated it since its adoption in 2001. This demonstrated that the EU has mechanisms in place to protect the rights of refugees and to manage their reception. However, as has been pointed out by the migrants' movement and by NGOs, this measure was not adopted in similar circumstances for people coming from other contexts of conflict in the Global South. This includes the conflicts in countries such as Syria, the Sahel and other regions, who have arrived in Europe in recent years seeking protection and have seen their human rights violated and in many cases their lives put on hold in detention centres, or who have even died. We have joined with other organisations in the demand that all people who are forcibly displaced should have access to a fair asylum procedure, with guarantees and zero discrimination.
In several regions of Ukraine, much of the basic infrastructure and housing has been destroyed or severely damaged. Providing basic public services and healthcare involves enormous challenges. Despite the resilience of the health system, the war-affected population has limited access to emergency services, specialised medicines and Sexual and Reproductive Health assistance due to the disruption of supplies of medicines and equipment, the destruction of pharmacies, lack of access to financial resources and community isolation. According to the Ministry of Health, one of the most urgent issues is the provision of healthcare to chronically ill people who have had no access to health services for months.
With large population movements, there is an increased risk of outbreaks of vaccine-preventable diseases. Cases of gastrointestinal infections and bacterial diseases have been increasingly reported. Added to this is the approaching, particularly harsh winter in Ukraine and the challenges it poses in terms of preserving health and responding to health needs. For humanitarian organisations working in Ukraine, the prevention of security incidents and violence against humanitarian staff is of paramount importance. Uncertainty regarding security conditions sometimes delays our operations, as does unwillingness to adequately facilitate humanitarian corridors and other measures to ease the passage of aid. Furthermore, bureaucratic procedures sometimes increase the time needed to gain access to affected communities, including in relation to the issuance of visas for non-EU international staff. All of these factors hamper the ability of people affected by the war to access urgently needed services.