Ukraine war and refugee health

For health care providers who may be caring for Ukrainians displaced by the war, a new analysis published in CMAJ (Canadian Medical Association Journal) provides an overview of health and clinical considerations in this population. It also highlights the key gaps in the Canadian health care systems that need to be addressed to deliver equitable care to refugees and other migrants.

The war in Ukraine has driven global counts of displaced populations and refugees to an all-time high. These numbers are expected to increase as a result of global instability and the impacts of climate change. The Canadian government has acted rapidly to engage the Ukrainian diaspora and other Canadians to provide shelter for Ukrainians as part of a novel 3-year temporary visa program, the Canada–Ukraine Authorization for Emergency Travel (CUAET). The country may accept more than 112 000 people. This visa program, unlike a traditional refugee program, may allow more rapid sheltering and job/school integration, but could leave some Ukrainian migrants vulnerable owing to limited settlement services and medical supports. Ukrainians fleeing the war will be entitled to provincial health coverage during the 3-year period, but coverage varies across Canada and practitioners will need to verify if all services, including medications, are covered.

"Refugees fleeing traumatic situations face socioeconomic stressors and barriers to services after arrival and are more likely to transition to poor health than other immigrants, but this can be mitigated by supportive resettlement services," writes Dr. Christina Greenaway, an infectious disease physician researcher at the Centre for Clinical Epidemiology of the Lady Davis Institute and expert in migrant health at the Jewish General Hospital and McGill University, Montreal, Quebec, with coauthors.

The article contains practical points for clinicians on how to address this population's specific health needs, highlighting that, among people from Ukraine:

• the prevalence of chronic diseases, such as cardiovascular disease and diabetes, is high;
• use of tobacco products is common;
• rates of mental illness are high, with 33% of the country's population having experienced mental illness before the current conflict, which may be amplified by displacement from Ukraine;
• risk of vaccine-preventable diseases, such as measles, polio and COVID-19 may be elevated, because of lack of vaccine access and vaccine hesitancy; and
• rates of tuberculosis, viral hepatitis and HIV may be elevated, particularly in certain risk groups.

Timely access to care, with medical interpretation services, and using a trauma-informed care approach will be important in supporting the health needs of Ukrainians.

"Although Canada has a long history of welcoming and integrating refugee groups and other humanitarian migrants, the concurrent arrival of Ukrainians displaced by the war and refugees from Afghanistan into health systems strained by COVID-19 requires an examination of current refugee health practices and programs and demands creative solutions," the authors write.

They note that the lack of universal access to interpreters and lack of supports for coordinated care across health services and sectors are key health system gaps preventing the provision of optimal care to these populations.

"Now more than ever, with an overstretched health care system in Canada, a coordinated multistakeholder approach—with partnerships between policy-makers, health administrators, practitioners and communities—is needed to protect refugees and other migrants, promote their self-reliance and health, and build responsive health systems in host communities," they conclude.