Disease burden among Ukrainians forcibly displaced by the 2022 Russian invasion

Abstract

The Russian invasion of Ukraine on February 24, 2022, has displaced more than a quarter of the population. Assessing disease burdens among displaced people is instrumental in informing global public health and humanitarian aid efforts. We estimated the disease burden in Ukrainians displaced both within Ukraine and to other countries by combining a spatiotemporal model of forcible displacement with age- and gender-specific estimates of cardiovascular disease (CVD), diabetes, cancer, HIV, and tuberculosis (TB) in each of Ukraine's 629 raions (i.e., districts). Among displaced Ukrainians as of May 13, we estimated that more than 2.63 million have CVDs, at least 615,000 have diabetes, and over 98,500 have cancer. In addition, more than 86,000 forcibly displaced individuals are living with HIV, and approximately 13,500 have TB. We estimated that the disease prevalence among refugees was lower than the national disease prevalence before the invasion. Accounting for internal displacement and healthcare facilities impacted by the conflict, we estimated that the number of people per hospital has increased by more than two-fold in some areas. As regional healthcare systems come under increasing strain, these estimates can inform the allocation of critical resources under shifting disease burdens.

Keywords: conflict; health; refugee.

Fig. 1.

The effects of disease burden and intensity of conflict within Ukraine on refugees. (A) The estimated average intensity of conflict under a log₁₀ transformation from February 24, 2022, to May 13, 2022 (dark red = greatest intensity) based on reported conflict events (12) and reported border crossings (13) (black x). (B–F) The estimated prevalence per capita (light = low prevalence and dark = high prevalence) among Ukraine raions for (B) CVD, (C) diabetes, (D) cancer, (E) HIV, and (F) TB before the Russian invasion. (G) The daily number of conflict events reported by the ACLED inside and outside the six macroregions (black = East, dark red = North, red = South, orange = Kyiv, dark yellow = West, light yellow = Center, and gray = Other) between February 24 and May 13. (H) The geographical location of the six macroregions (black = East, dark red = North, red = South, orange = Kyiv, dark yellow = West, and light yellow = Center).

Fig. 2.

Disease among individuals in Ukraine. Among the West (dark yellow square), South (red star), North (dark red circle), Other (Crimea; gray triangle), Kyiv (orange diamond), East (black triangle), and Center (light yellow hexagram) macroregions in Ukraine, the temporal change in the number of people (Left) and age distribution (Right) up to May 13 for the (A) total population and those with (B) CVD, (C) diabetes, (D) cancer, (E) HIV, or (F) TB. The comparison of the age distribution among the different macroregions is preinvasion (lines) to that estimated for May 13, 2022 (histogram bars). Ages are stratified as 0 to 9, 10 to 19, 20 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and 70+ years.

Fig. 3.

Public health implications of the Russian invasion. Based on reports from March 16, April 1, April 17, and May 3 for IDPs among the macroregions of Ukraine, (A) the estimated destination distribution of IDPs among the 629 raions as of May 13. (B) The proportion of hospitals affected by conflict in each raion (white = low proportion and dark red = high proportion) over the course of the invasion. (C) The relative change in the number of people per hospital compared to that determined preinvasion for raions containing a hospital (brown = reduction, white = no, dark green = increase, and gray= no hospital). (D) The percent increase in people per hospital for each macroregion relative to the number of people per hospital prior to the Russian invasion for the total population (black), as well as those with CVD (red), diabetes (purple), cancer (yellow), HIV (blue), and TB (brown).