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Table of Contents 1. Executive Summary…………………………………………………………………………………………………………………………………2 2. Background…………………………………………………………………………………………………………………………………………….5 3. Objectives……………………………………………………………………………………………………………………………………………….6 4. Logistics………………………………………………………………………………………………………………………………………………….6 4.1: Banking Infrastructure…………………………………………………………………………………………………………….6 4.2: Hotel Accommodations…………………………………………………………………………………………………………..7 4:3: Transportation………………………………………………………………………………………………………………………..7 5. Communications…………………………………………………………………………………………………………………………………….8 6. Security…………………………………………………………………………………………………………………………………………………..8 6.1: Threat Assessment………………………………………………………………………………………………………………….8 6.2: Hazards…………………………………………………………………………………………………………………………………..9 6.3: Security Checkpoints………………………………………………………………………………………………………………9 6.4: Travel Between Ukrainian-held Territory and the Self-proclaimed Donetsk People’s Republic.10 7. Rapid Assessment Findings……………………………………………………………………………………………………………………11 7.1.: Gender-based Violence………………………………………………………………………………………………………..11 7.2: Child Protection…………………………………………………………………………………………………………………….15 7.3: Mental Health and Psychosocial Support………………………………………………………………………………18 7.4: Health…………………………………………………………………………………………………………………………………..22 8. Conclusion……………………………………………………………………………………………………………………………………………27 9. References……………………………………………………………………………………………………………………………………………28 10. Annex A: Agenda for Assessment Mission…………………………………………………………………………………………..29 11. Annex B: Local and International Organizations Engaged in MHPSS Activities or Services……………………32 1. Executive Summary Since January 15, 2015, hostilities between Ukrainian and separatist forces have increased and the overall situation in Eastern Ukraine has drastically deteriorated. On January 23, after days of heavy fighting between the Ukrainian Government forces and separatist forces which resulted in dozens of civilian casualties, the self-proclaimed Donetsk People’s Republic (DPR) leader rejected calls for a truce and both sides publicly stated they are gearing up for further conflict. Civilians in conflict-affected areas of Donbas face immediate security threats due to an increase in hostilities since the middle of January. Assessment Mission International Medical Corps deployed a Security Manager to Ukraine in December 2014 to conduct a security assessment, followed by the deployment of a multi-sectoral assessment team in January 2015 to conduct a rapid needs assessment. The primary objectives of the security assessment were to: 1) identify the threats to International Medical Corps staff and programs, 2) recommend appropriate risk mitigation and 3) assess whether or not the level of risk is within International Medical Corps’ acceptable levels. The primary objectives of the rapid needs assessment were to: 1) identify and assess key humanitarian needs in the areas of protection (gender-based violence and child protection), mental health and psychosocial support and health and 2) identify current gaps in meeting humanitarian needs. International Medical Corps’ assessment team consisted of 8 people, including the Country Director, technical specialists (health, protection, mental health and psychosocial support), local translators and a security manager. For the rapid needs assessment, the team used qualitative methods, including key informant interviews and focus group discussions. Team members met with a variety of key stakeholders, including representatives from Ministries, UN agencies, international NGOs, local NGOs and community- based organizations; city officials; health facility staff and health workers; civilians, including IDPs and host communities; and military personnel. The team traveled by road from Kiev to Mariupol and surrounding rural areas. Two members of the assessment team traveled by road from Mariupol to Donetsk city. Generally, the team found that access to and from the DPR was possible, although humanitarian personnel should be mindful of security checkpoints and recent permit requirements for all persons crossing the frontline. Summary of Findings Protection: Gender-based Violence and Child Protection Gender-based violence (GBV) has been recognized by the humanitarian community as a human rights violation as well as a public health concern, to which women and girls are particularly vulnerable in emergency settings and conflict contexts. The risk of GBV, particularly the use of sexual violence by armed actors against women and girls in the region is a growing concern. Even before the crisis other types of GBV, such as intimate partner violence and sex trafficking, were being reported. Elderly women are also facing substantial obstacles in accessing basic services as their mobility both due to chronic illness such as arthritis and hypertension can be significantly limited. Caregivers and service providers consistently spoke of the negative impact the conflict is having on children’s wellbeing often describing increased fear, anxiety and aggressive behaviors in children. For families with mothers who relocated with children to safer areas and fathers stayed behind to look after property and assets this has created additional stressors and anxiety for IDP children. Families living in Emergency Assessment- Eastern Ukraine 2 collective centers also described frequent bullying in schools and sometimes general mistrust in accessing other government supported social services. While social services, schools, and medical care are functioning in many areas in Mariupol, all of these services are stretched to capacity and few providers have substantial training in working on GBV and Child Protection issues, and almost no one has expertise in working on these issues in humanitarian contexts. Furthermore, large networks of local volunteers are doing remarkable work in providing basic inputs and in some cases services to conflict affected populations but few if any have received training in best practices, PSEA, IASC guidelines or do no harm principles. Mental Health and Psychosocial Support The conflict in Eastern Ukraine has seriously affected the mental health and psychosocial well-being of the affected population, including people living in the conflict area, IDPs and host populations. There are many accounts of people with concerns about the future, of people feeling hopeless and insecure, and children being afraid of loud noises and wetting their beds. These problems can have immediate as well as long- term consequences for individuals, families and communities in a divided part of the country. Mental health care in Ukraine is mainly focused on specialized care, taking place in and around psychiatric clinics and institutions. Psychosocial support is a relatively new concept. People are used to coping with their problems on their own (also with negative coping mechanisms such as alcohol abuse) or within family circles. In the current situation there is a huge gap between needs and available MHPSS activities and services. There are only few community-based initiatives or services integrated into primary health care. Staff and volunteers of local NGOs and agencies are trying to fill this gap and support the affected population. Service providers such as staff working in general health care, psychologists and social workers similarly have limited experience in and skills in psychosocial support. Health Ukraine’s health system was generally limited prior to the conflict. In the DPR, the health system is now visibly collapsing. Excessive shelling has damaged several health facilities and some evidence suggests that some health facilities in the DPR have experienced looting and many facilities lack food and water for patients. Some health staff have left the area or no longer present to work due to lack of payment, and supply chains are broken. The combination of physical infrastructure damage and lack of staff has meant that government health service provision is nonexistent in many rural areas of the DPR and at a minimal level in others. Health workers in Mariupol city and surrounding rural areas indicated that facilities can currently manage providing very basic health services to host communities and IDPs but any rise in IDPs would strain the health system. Health facilities in the rural areas of Mariupol have limited lab capacity and many do not have maternal health services available. Financing for health services is limited in all areas. Health facilities in both Mariupol and Donetsk lack essential medicines, medical equipment and consumables. In the DPR, the shortage of medicines, supplies and equipment is dire, and these facilities are also in urgent need of consumables, food and water to care for patients. Access to primary, secondary and tertiary care is limited in Mariupol and critically compromised in Donetsk. Facilities that are still operational in the DPR need assistance in building capacity to triage and provide urgent care to war wounded patients. The current lack of local capacity and referral mechanisms in many areas have increased the need to bring health services directly to communities. In Donetsk and rural areas Emergency Assessment- Eastern Ukraine 3 of Mariupol there is a need for increased mobile medical units, especially to reach rural populations. There is also a need to increase the number and types of specialists in the units. Summary of International Medical Corps’ Recommendations Based on assessment findings, International Medical Corps recommends humanitarian actors support the

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