Older people in Ukraine during the war
The unfolding of war in Ukraine on Feb 24 2022, led to one of Europe's most significant humanitarian crises, severely impacting vulnerable groups such as older people due to their advanced age and perhaps poor physical and mental condition (1,2). Ukraine has more than 10 million persons aged 50 and over (3) who are classified as elderly, according to the World Health Organisation (4). Older people are particularly vulnerable and feature an increased risk of experiencing adverse psychosomatic events, limited access to food, water, housing, sanitation, and medical treatment, including for chronic comorbidities and may also be more vulnerable to abuse, neglect, and exploitation (5). The situation of Ukrainian elders is complicated since they have gone from one disaster (the Covid-19 pandemic epidemic) to another (the war inception) (2,6).
Furthermore, while younger counterparts were able to flee the ravages of war - nearly 8 million refugees were registered outside Ukraine at the time of writing (7) - most older people in Ukraine remained behind, facing even more perilous routes to access medication and essential goods due to active war zones, and with limited mental health support available (8). Less than 10% of older adults in Ukraine are estimated to have fled the war (9), with up to 1,200,000 million older people being internally and externally displaced (10). A recent report by Amnesty International (10) explores the experiences of 226 older people in Ukraine, highlighting multifaceted complex challenges for this vulnerable group, including relocated people living in shelters or state institutions since the war began. Key highlights of the report comprise the implications of electrical outages and running water, including at hospitals, which impeded routine and emergency health checks. One of the respondents described that due to the lack of access to emergency tests, the doctors could not detect a stroke in her brother, who subsequently died of a second stroke (11) Yet, such unfortunate cases may be more recurrent in Ukraine, especially when missiles destroy a general practice or clinic, and all paper-based records are lost. While younger individuals can seek help with their treatment, prescriptions or other health concerns, older people rely on others to access care, information, and medication, which poses greater difficulty and exacerbates untreated and uncontrolled comorbidities and psychological traumas (12,13). In addition, medication for chronic comorbidities was scarce when the war began, and 98% of older adults had indicated at least one comorbidity in previous reports (14).
With limited opportunities for income, isolation, potential intersecting of stigmas (15), and persistent trauma, the posing question is how can this vulnerable population overcome such barriers, and what can humanitarian help do to mitigate the impact of such adverse circumstances on physical and mental health?
A brief overview of current responses and recommendations:
Since the war started, international and National support has been mobilised to support the needs of older people in Ukraine. Foodbanks, clothing, medicine and hygiene supplies are being provided by various national and international organisations such as HelpAge International (16), and emergency psychosocial support (17–19). The Ukrainian Government has also provided support and guidance to frontline health workers (20). Humanitarian aid was made available throughout Ukraine (21,22) and delivery of medication to remote areas has been continued as per the methods employed in the previous crisis (Covid-19), such as mail-post-delivery or drone drop-off (23). In addition, specialised mental healthcare providers have offered their support through online platforms and building online support groups, even from outside Ukraine (24). While the lack of digital access among older people is significant, and frequent electricity disruptions obstruct the delivery of information and governmental guidance among this vulnerable group, REACH Humanitarian Situation Monitoring reports between June, and September 2022 indicate that nearly 90% of older people with disabilities or comorbidities were unable to receive humanitarian aid (25,26).
The tremendous treatment gaps posed by war underscore the need to design and implement integrated health and mental health interventions for detection, treatment and long-term care tailored to the needs of older people (1). Similarly, sustainable capacity-building pathways are needed to enable adequate care among this vulnerable group, while social support interventions may ameliorate psychosocial burden and even boost adherence to treatment and resilience (27–29). Lastly, there is imperative to expand on translational research, enabling high-quality healthcare services and shaping policy-making in Ukraine, building on Ukraine's Strategy and Action Plan on Healthy and Active Longevity (30). This includes securing the adoption of targeted, non-discriminatory policies, enabling active participation in decision-making and autonomy in later life, protection, access to high-quality palliative care and mental health care, and reconstruction efforts (30,31).
A brief overview of additional resources:
Kyiv City Council - Advice for people with disabilities in case of emergency: https://kyivcity-gov-ua.translate
Fight For Right - Resources for emergency preparedness, planning and evacuation (Ukrainian People with Disabilities in Crisis): https://eng.ffr.org.ua/
Inter-Agency Standing Committee (IASC) - Guidelines on mental health and psychosocial support in emergency settings: https://interagencystandingcommittee.org/
mhGAP Humanitarian Intervention Guide (mhGAP-HIG) - Clinical management of mental, neurological and substance use conditions in humanitarian emergencies:
- Armocida B, Ussai S, Pavlovych M, Valente M, Missoni E, Pistis M, et al. Older people: forgotten victims amid the Ukrainian humanitarian disaster. Vol. 7, The Lancet Public Health. Elsevier Ltd; 2022. p. e402–3.
- McGivern MKA. Ukraine crisis disproportionately affecting older people [Internet]. HelpAge International . 2022 [cited 2023 Jan 9]. Available from: https://www.helpage.org/newsroom/press-room/press-releases/ukraine-crisis-disproportionately-affecting-older-people/
- Gutterman AS. Older People and the Crisis in Ukraine [Internet]. 2022. Available from: https://ssrn.com/abstract=4092078
- UNAIDS. UNAIDS. The Gap Report: People Aged 50 Years and Older. Geneva; 2014.
- Yang Chan EY. Disaster public health and older people. Disaster Public Health and Older People. 2019.
- Human Rights Watch. Older People No Longer Invisible Casualties of War in Ukraine Governments, Aid Agencies Should Ensure Protection and Assistance [Internet]. 2022 [cited 2023 Jan 9]. Available from: https://www.hrw.org/news/2022/05/02/older-people-no-longer-invisible-casualties-war-ukraine
- UNHCR. Operational Data Portal: Ukraine Refugee Situation [Internet]. Operational Data Portal : Ukraine Refugee Situation. 2022 [cited 2023 Jan 6]. Available from: https://data.unhcr.org/en/situations/ukraine
- Sheppard P. Why we must not forget older people and people with disabilities in Ukraine [Internet]. London School of Hygiene and Tropical Medicine . 2022 [cited 2023 Jan 9]. Available from: https://www.lshtm.ac.uk/newsevents/expert-opinion/why-we-must-not-forget-older-people-and-people-disabilities-ukraine
- HelpAge International. Eastern Ukraine: the needs of older people [Internet]. HelpAge International. 2022 [cited 2023 Feb 8]. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/Needs%20of%20older%20people%20in%20Eastern%20Ukraine%20-%204-03-22.pdf
- Petr Stefan. Wartime winter in Ukraine: 10 things you need to know [Internet]. People in Need. 2023 [cited 2023 Feb 8]. Available from: https://www.peopleinneed.net/wartime-winter-in-ukraine-10-things-you-need-to-know-9902gp#31edb162-434e-434b-b393-1165b91c316f
- Amnesty International. “I USED TO HAVE A HOME” Older people’s experience of war, displacement, and access to housing in Ukraine. [Internet]. 2022 [cited 2023 Jan 9]. Available from: https://www.amnesty.org/en/latest/research/2022/12/older-people-ukraine-war-displacement-and-access-to-housing/
- Medicins Sans Frontieres. Absence of medical care for the elderly caught between the frontlines [Internet]. Medicins Sans Frontieres. 2022 [cited 2023 Feb 8]. Available from: https://www.msf.org/absence-medical-care-elderly-caught-between-frontlines-ukraine-war
- Alessi J, Yankiv M. War in Ukraine and barriers to diabetes care. Vol. 399, The Lancet. 2022.
- HelpAge International. Humanitarian needs of older women and men in government-controlled areas of Donetsk and Luhanska oblasts, Ukraine [Internet]. 2021 [cited 2023 Feb 8]. Available from: https://www.humanitarianresponse.info/en/operations/ukraine/document/helpage-international-snapshot-assessment-humanitarian-needs-older-2?_gl=1*1dyr6t2*_ga*MjExMjA3MDcxNC4xNjY5MjM2ODMx*_ga_E60ZNX2F68*MTY3NTg1OTM0MC4xMS4xLjE2NzU4NTk4MzAuNjAuMC4w
- Rozanova J, Zeziulin O, Zaviriukha I, Kiriazova T, Justice A, Altice F, et al. The hardest thing is to return to who I was before the diagnosis": Gendered stigma among Naïve Older Patients presenting to HIV care in Ukraine. In: 10th International AIDS Society Conference on HIV Science. Mexico City, Mexico; 2019.
- HelpAge International. Supporting older people in Ukraine [Internet]. HelpAge International. 2022 [cited 2023 Feb 8]. Available from: https://www.helpage.org/what-we-do/older-people-in-ukraine/
- HealthRight. Ukraine War Relief [Internet]. 2022 [cited 2023 Feb 8]. Available from: https://healthright.org/ukraine-war-relief/
- Humanity & Inclusion. HI provides mental health support for older people displaced by Ukraine war [Internet]. Humanity & Inclusion. 2022 [cited 2023 Feb 8]. Available from: https://www.humanity-inclusion.org.uk/en/news/hi-provides-mental-health-support-for-older-people-displaced-by-ukraine-war
- Amnesty International. Ukraine: Older people confronted with war rely on the support of volunteers [Internet]. Amnesty International. 2022 [cited 2023 Feb 8]. Available from: https://www.amnesty.org/en/latest/campaigns/2022/06/ukraine-old-people-confronted-with-war-rely-on-the-support-of-volunteers/
- Iacobucci G. Ukraine war: GPs get updated guidance on treating refugees and returning citizens. BMJ. 2022;376.
- European Civil Protection and Humanitarian Aid Operations. Ukraine: Factsheet [Internet]. European Commission. 2022 [cited 2023 Feb 8]. Available from: https://civil-protection-humanitarian-aid.ec.europa.eu/where/europe/ukraine_en#:~:text=EU%20humanitarian%20aid%20in%20Ukraine,million%20so%20far%20in%202023.
- The UN Refugee Agency. Ukraine emergency [Internet]. UNHCR. 2022 [cited 2023 Feb 8]. Available from: https://www.unhcr.org/uk/ukraine-emergency.html
- Matt Hamblen. Airborne drones to deliver medical supplies to Kiev, Kharkiv as war rages. Fierce Electronics [Internet]. 2022 [cited 2023 Feb 8]; Available from: https://www.fierceelectronics.com/electronics/airborne-drones-deliver-medical-supplies-kiev-kharkiv-war-rages
- Irene Velicer. How virtual healthcare services are coming to the aid of Ukraine. Geneva Solutions [Internet]. 2022 [cited 2023 Feb 8]; Available from: https://genevasolutions.news/peace-humanitarian/how-virtual-healthcare-services-are-coming-to-the-aid-of-ukraine
- REACH. UKRAINE: Humanitarian Situation Monitoring. 2022 Sep.
- REACH. UKRAINE: Humanitarian Situation Monitoring. 2022 Jul.
- Rozanova JSSZOZIKT. Resilience in HIV and Aging Research in Response to Crises: Lessons from Ukraine". In: Centre for Interdisciplinary Research on AIDS [Internet]. New Haven : Yale University; 2022 [cited 2023 Jan 9]. Available from: https://cira.yale.edu/news/register-cira-talk-resilience-hiv-and-aging-research-response-crises-lessons-ukraine
- Age International. We’re still there for older people in Ukraine. 2022 [cited 2023 Jan 9]; Available from: https://www.ageinternational.org.uk/news-features/news/2022/were-still-there-for-older-people-in-ukraine/
- Patwary MM, Polack S, Zharkova A, Swed S, Shoib S. People with Disabilities in Ukraine – A Call for Action. Prehosp Disaster Med. 2023 Feb;38(1):139–40.
- Ukraine Government. Government approved the State Policy Strategy for Healthy and Active Longevity of the Population till 2022 [Internet]. Kyiv; 2018 [cited 2023 Feb 8]. Available from: https://www.kmu.gov.ua/en/news/250533921
- Roagna IIOSY. Assessment of Ukraine’s policy and legal framework related to the rights of older people to social protection in the light of Article 23 of the Revised European Social Charter [Internet]. 2020 [cited 2023 Jan 9]. Available from: https://rm.coe.int/old-people-eng-soft/1680a242de