International Agency Response
Introduction
The war in Ukraine has created a humanitarian need not seen in Europe since WWII. Nearly a quarter of Ukraine’s population of 43.8 million people have been displaced since Russia invaded on 24th February 2022, with nearly 8 million fleeing as refugees and 6.24 million internally displaced (1). Assessments have identified that apart from food and shelter, the most pressing needs of those affected by the war are mental health and psychosocial support (MHPSS) services, while those with disabilities and children are the most vulnerable (1-3). The destruction of health facilities and critical water, sanitation and hygiene (WASH) infrastructure in regained territories have resulted in a boom of health and mental health needs. Concerted efforts to enhance MHPSS services include increasing capacity-building of healthcare professionals, accessible health access points and the prevention of human trafficking and exploitation of vulnerable peoples (4). According to The United Nations Office for Coordinated Human Affairs (OCHA), 13.47 million of an estimated 18.8 million people in need affected by the war in Ukraine have received humanitarian assistance and protection services by the end of October 2022 (1). The United Nations (UN) and World Health Organization (WHO) are working in partnership with interagency convoys, governments, community leaders and countless organisations, to support the needs and long-term wellbeing of Ukrainians impacted by the war, both domestically and internationally (1,2,4).
Capacity-building
Ukrainian First Lady Olena Zelenska responded to the humanitarian crisis in February by creating the National Program of Mental Health and Psychosocial Support (5). Utilising the country’s available resources, Zelenska’s program seeks to provide a comprehensive mental health and psychological support system for Ukrainians. Support for the new mental healthcare model has been progressively built from collaborations with leaders from the United States (US), Israel and Belgium, and partnerships with the United Nations Children’s Fund (UNICEF) and the WHO (4,6). Focusing on structure, governance and policies, the program has drawn upon the successful implementation of mental healthcare systems internationally in order to inform a domestic approach. A particular focus of the National Program of Mental Health and Psychosocial Support has been capacity-building within Ukraine. Through collaborations with the WHO and other partners, the program has trained 60,000 professionals to provide psychological support services. Staff across various ministries, such as the Ministry of Health, Social Policy, Education, Defence and Veterans Affairs, have participated in the WHO’s Self-Help Plus (SH+) (train-the-trainer) program (5). Self-Help Plus uses certified psychologists to train other health workers on how to help patients cope with stress (7). Further plans have been made to train primary healthcare workers to help patients manage common mental disorders such as depression, anxiety, Post-Traumatic Stress Disorder (PTSD), suicidal ideation and substance misuse (5). Additionally, UNICEF partnered with the program to support 34 specialists from government, education, and health sectors to strengthen their knowledge of psychological rehabilitation of children impacted by the war (2).
Separately, UNICEF has provided support through capacity-building for mental health providers and webinars for the public to address psychological self-care during the war. Ten psychologists and 78 health workers have benefited from specialised MHPSS supervision and capacity-building in order to better support the mental health needs of women and children enduring the war (2). Furthermore, three online events have been held since the start of the war, led by cultural leaders and faith-based organisations. The sessions discussed methods of coping with the war and reached more than 14,000 individuals (2). Additionally, webinars for teachers addressing wartime MHPSS support have received 81,900 online views and a UNICEF-Ukraine-supported Mental Health Day Challenge engaged with more than 5,000 children from 166 schools (2).
Clinics, Helplines and MHPSS
In Europe and Central Asia, UNICEF and the United Nations High Commissioner for Refugees (UNHCR) have partnered to deploy Blue Dot hubs that provide safe spaces for Ukrainians to rest and receive support, protection and services while on their journey (8,9). Stations are staffed with trained psychologists, social workers, and counsellors that provide immediate psychological support to those in need, as well as protective services to vulnerable groups including people with disabilities and victims of gender-based violence (GBV) (8). The Blue Dots also provide play spaces for children and information on how unaccompanied children can reconnect with family members (8,9). Additionally, the hubs offer Wi-Fi, breastfeeding spaces for mothers, group parenting activities, safe drinking water and legal aid (8). Thirty-Five Blue Dot hubs span Bulgaria, Italy, Hungary, Moldova, Poland, Romania, and Slovakia (8). Since the start of the war, nearly 2.5 million children and caregivers have been able to access UNICEF-supported MHPSS interventions to help them cope with the mental health effects of war and displacement (2). Additionally, more than 4.6 million women and children have accessed life-saving health care via UNICEF facilities and mobile teams (2).
The International Medical Corps (IMC) has been operating in conflict-torn southeast Ukraine since 2014, but has now expanded to focus on health, MHPSS, protection, GBV prevention and treatment, nutrition, food security, non-food items (NFIs), multi-purpose cash assistance (MPCA) and WASH services, as well as providing medical equipment and supplies to restore healthcare services (10). Protection services from the OCHA have delivered psychosocial support to 2.4 million people, while Emergency Protection Units provide support in areas with increasing need where access is limited (1). So far, four Survivor Relief Centres have opened to deliver comprehensive psychological, medical and legal support to survivors of conflict (1). Similarly, 27 facilities, including shelters, crisis rooms, counselling centres, psychosocial support mobile units and a national helpline, have opened to support survivors of and those at risk of GBV (1). However, specialised GBV services remain limited due to a shortage of providers. Child Protection Sub-cluster partners have managed to reach 2 million children and individuals living with disabilities, including providing psychosocial support sessions to 630,000 children to help them cope with the effects of war and displacement (1).
In partnership with organisations in European host countries, the United Nations International Organization for Migration (IOM) has deployed mobile mental health clinics to provide primary health care and psychosocial support (11). As of October 2022, the IOM has provided MHPSS services to 12,634 people within Ukraine and 23,518 Ukrainians in neighbouring host countries (11). Separately, toll-free helplines have been established to provide information and support for Ukrainians with operators available in Ukraine, Poland, Lithuania, Romania, Slovakia, Moldova, Czech Republic, Germany and Hungary (12,13). Available helplines include General Support, MHPSS services and Counter-Trafficking and Migration Advice (14). As of January 2023, the IOM reports a total of 9,487 MHPSS consultations and 4,313 Counter-Trafficking and Migration Advice consultations (15).
Winterisation and WASH
The onset of winter has created a dire situation for millions of Ukrainians facing power and water shortages after at least one third of the country’s energy infrastructure was damaged by heavy shelling (1). Ukraine operates on a centralised heating system fuelled by the water supply, making a stable water and power supply vital to surviving the harsh winter conditions (2). As a result, much of the humanitarian aid effort has focused on winterisation and WASH. UNICEF has supported thousands of families in the east of Ukraine as part of interagency convoys delivering aid and supplies to families and children cut off from humanitarian aid for more than five months (2). UNICEF has delivered food, water, shelter, health care, mental health support, hygiene kits, and education to 2.3 million of the 3.3 million children in need within Ukraine (2). UNICEF is a contributing member of the interagency framework, which includes United Nations agencies, the Government of Ukraine and humanitarian partners, and helps lead the WASH, Child Protection, and Nutrition and Education clusters, as well as the Social Protection and Maternal Child Health Care sub-groups (1,2). UNICEF currently has WASH, Child Protection, and Nutrition and Education services in place across Ukraine (2,8).
The OCHA has been focusing its efforts on reaching people in regained territories and winterisation to prepare the most vulnerable for the harsh winter months. They have facilitated the delivery of humanitarian aid through interagency convoys including international and local partners such as the IOM, UNHCR, UNICEF, WHO, WFP, Slavic Heart, Ukrainian Red Cross, Hub Vokzal, and Myrne Nebo (1). The OCHA has supported medical facilities, communities, and individuals with the delivery of generators, winterisation kits, water tanks, water purification tablets, solar lamps and heating points in the wake of power and water shortages (1). Organisations such as Caritas, ACTED, Terres de Hommes Ukraine, World Central Kitchen and Right to Protection are focusing on providing winterisation support to 5,600 centres across the country housing displaced Ukrainians (1). Additionally, Project HOPE is expanding its mobile medical units in the east of Ukraine in preparation for winter (1). Separate efforts have also been made by the IOM to provide interventions to improve shelter spaces through large-scale fuel distributions meant to meet winter needs, multi-purpose cash assistance, and a WASH program for clean water and hygiene kits (11). Overall, the IOM Reports providing over 2 million humanitarian services since February of 2022 (11).
Funding
As of 27th October 2022, UNICEF has received $656.4 of the $987 million in funding requested as part of the 2022 Humanitarian Action for Children (HAC) Appeal (2). Similarly, the OCHA aims to provide emergency humanitarian assistance to 11.5 million of those affected by the war through their Ukraine Interagency Flash Appeal until the end of 2022 (1). UNICEF is in collaboration with stakeholders at all levels, including national, local and international governmental and civil organisations, and has already disbursed $714.7 from the private sector to use inside Ukraine and in refugee-hosting countries (8). The IOM seeks to raise $377 million dollars for humanitarian assistance (8) and has so far reached 87% of its goal; of which, $33 million will be allocated for Health and MHPSS, with $14 million met so far (15).
Conclusion
The humanitarian response to this crisis has been unprecedented across the private and public sectors, with governments, INGOs, NGOs, private organisations, and private citizens donating millions in relief aid. While needs and delivery of services remain complex in the acute phase, especially during the harsh winter period, collaborative efforts at the international and national level through interagency convoys continue to deliver aid and services to the 17.7 million people in need (1,2,8), including the most vulnerable and inaccessible. Without funding from the public and private sector and fundraising from efforts such as the Humanitarian Flash Appeal or the Ukraine Humanitarian Fund, delivery and implementation of services would not be possible. Further resources and funding will be critical to the continuity of support services as this conflict endures and becomes protracted.
References
1. United Nations Office for the Coordination of Humanitarian Affairs. Ukraine Situation Report. [Internet]. 2022 Oct 26 [cited 2022 Dec 20]. Available from: https://reliefweb.int/report/ukraine/ukraine-situation-report-26-oct-2022-enukru#:~:text=Over%206%2C370%20civilians%20were%20killed,actual%20figures%20are%20much%20higher
2. United Nations Children’s Fund, Ukraine Country Office. Ukraine Humanitarian Situation Report Number 22. [Internet]. 2022 Oct [cited 2022 Dec 20]. Available from: https://www.unicef.org/documents/ukraine-humanitarian-situation-report-no22-october-2022
3. International Organization of Migration, Slovakia. People affected by the war in Ukraine benefit from the IOM mental health and psychosocial support. [Internet]. 2022 June 30 [cited 2023 Jan 3]. Available from: https://www.iom.sk/en/news-events/1663-90-people-affected-by-the-war-in-ukraine-benefit-from-the-iom-mental-health-and-psychosocial-support-en.html
4. World Health Organization, European Region. War in Ukraine: Situation Report from WHO Ukraine Country Office, Issue No 30. [Internet]. 2022 Nov 2 [cited 2022 Dec 20]. Available from: https://www.who.int/europe/publications/i/item/WHO-EURO-2022-5319-45083-67125
5. Official Website of the President of Ukraine - Volodymyr Zelenskyy. Olena Zelenska told how the initiative to create the National Program of Mental Health and Psychological Support is being implemented. [Internet]. 2022 Dec 28. [cited 2023 Jan 3]. Available from: https://www.president.gov.ua/en/news/olena-zelenska-rozpovila-yak-vtilyuyetsya-iniciativa-zi-stvo-80109
6. World Health Organization. WHO supports Ukraine by organizing a knowledge-exchange with mental health policy-makers in Belgium. [Internet]. 2022 Oct 24. [cited 2022 Dec 20]. Available from: https://www.who.int/ukraine/news/item/24-10-2022-who-supports-ukraine-by-organizing-a-knowledge-exchange-with-mental-health-policy-makers-in-belgium?fbclid=IwAR0-cqFukaISC8TRYegMmBrZ5okrVvd_mCRY05RhODpOMRukxiGQzmdkoaM
7. World Health Organization. Self Help Plus (SH+): a group-based stress management course for adults. Generic field-trial version 1.0, 2021. [Internet]. Geneva, 2021 [cited 2022 Dec 20]. Available from: https://www.who.int/publications/i/item/9789240035119
8. United Nations Children’s Fund, Europe and Central Asia Region. Ukraine Refugee Response in Neighboring Countries, Humanitarian Situation Report No. 18 - 2022. [Internet]. 2022 Nov 4 [cited 2022 Dec 20]. Available from: https://www.unicef.org/documents/ecaro-refugee-response-humanitarian-situation-report-no-18-4-november-2022
9. United Nations Children’s Fund, Europe and Central Asia. What are the blue dot hubs? [Internet]. 2022 [cited 2022 Dec 20]. Available from: https://www.unicef.org/eca/what-are-blue-dots-hubs
10. International Medical Corps. Ukraine Crisis Situation Report #23. [Internet]. 2022 Nov 9 [cited 2022 Dec 20]. Available from: https://cdn1.internationalmedicalcorps.org/wp-content/uploads/2022/11/IntlMedCorps-UkraineCrisis_SitRep23.pdf
11. International Organization of Migration. Regional Ukraine Crisis Response, Situation Report 27 October 2022.[Internet]. 2022 Oct 27 [cited 2022 Dec 20]. Available from: https://reliefweb.int/report/ukraine/iom-regional-ukraine-response-situation-report-27-october-2022
12. International Organization of Migration, Ukraine. How war and displacement affect mental health of people in Ukraine and why we should address this. [Internet]. 2022 Dec 18 [cited 2022 Dec 20]. Available from: https://ukraine.iom.int/blogs/how-war-and-displacement-affect-mental-health-people-ukraine-and-why-we-should-address
13. International Organization of Migration. Ukraine: IOM Hotlines for Persons Affected by the War. [Internet]. 2022 [cited 2022 Dec 27]. Available from: https://www.iom.int/ukraine-iom-hotlines-garyachi-linii-mom-persons-affected-war
14. International Organization of Migration, Ukraine. Mental Health and Psychosocial Support Program in Ukraine. Activities Overview February – December 2022. [Internet]. 2022 Dec. [cited 2023 May 19]. Available from: https://ukraine.iom.int/sites/g/files/tmzbdl1861/files/documents/MHPSS%20Snapshot %20for%20WMHD%202022_eng_2023-01-17%20%283%29%20%281%29.pdf
15. International Organization of Migration Ukraine. Crisis Response Operational Update. [Internet]. 2023 Jan 9-15 [cited 2022 Dec 20]. Available from: https://mailchi.mp/iom/iom-ukraine-operational-weekly-sitrep-5795526?e=e771809828
