Access to Healthcare (Vulnerabilities) Households Reported Accessing Medical Hearing of Shelling (20%)

UKRAINE Capacity & Vulnerability Assessment

Popasna Raion, Government Controlled Area.

July - August 2018 Introduction Methodology Fighting between the Government of Ukraine’s mine presence, creates significant protection The assessment began with a secondary The populations of interest in this study are: (GoU) forces and armed opposition groups risks and causes significant damages to data review in order to identify the main internally displaced persons (IDPs), non- in the territory of Donbas is entering its fifth service infrastructure. In addition, facilities service providers in the raion. REACH used displaced populations and service providers in year. The conflict is concentrated around face challenges regarding insufficient supplies geospatial data from the main mapping Popasna raion. The research used a stratified the contact line separating the government and equipment, budget constraints and limited services in Ukraine to map the settlements in random sample with four strata: rural areas controlled areas (GCA) from non-government qualified staff. Using a network approach2, relation to the provision and access to basic within 5km of the contact line, rural areas controlled areas (NGCA) of Donetsk and this study maps the basic service delivery services.3 The maps were later validated by beyond 5km of the contact line, urban areas Luhansk oblasts. capacities at a facility level and the access to direct observations of REACH enumerators in within 5km of the contact, and urban areas such services at the household level in order the field. beyond 5km of the contact line (Table 1). Popasna raion is located along the contact to identify barriers in service capacity and The primary data collection was conducted The household survey included 798 face-to- line in the GCA of Luhansk oblast. The contact vulnerabilities relating to household access. from 11 July – 21 August 2018, and included face household interviews across the GCA line has isolated much of the population of The basic services assessed in this Capacities key informant interviews (KIIs), community settlements of Popasna raion, designed to be Popasna raion from important urban centres and Vulnerabilities Assessment (CVA) are: key informant interviews (CKIIs), focus statistically representative of households in located in NGCA, reducing the ability to education, healthcare, social, administrative group discussions (FGDs), and household the raion with a 95% confidence interval, and a access basic services. The ongoing fighting services, food markets, non-food item (HH) surveys. KIIs were conducted with 7% margin of error. The confidence level may has disrupted the local economy and service (NFI) market, construction markets, banks, representatives of service providers who be lower or have a wider margin of error for availability in many settlements, forcing a ATMs, post offices and pharmacy stores. were interviewed in Popasna raion to assess smaller subsets of the population. highly vulnerable population to travel longer Service capacities and household access are the impact of the conflict and challenges to Limitations distances to access basic services. As a result, compared to identify resulting vulnerabilities, the service provision. REACH conducted Some key informants (KIs) interviewed were the pressure on service provision in GCA using strata disaggregated by rural and household surveys regarding perceptions of not working for their facility in 2013, and were has increased. The Area-Based Assessment urban areas and their distance to the contact change in service access and usage since unaware of the issues faced at that time, on (ABA) of July 2017, identified that there was line, within 5km (5km) and beyond 5km of 2013. Following field visits, enumerators some occasions making comparisons of an increased pressure on service provision as the contact line (>5km). The study compares participated in FGDs in order to share their the humanitarian situation in 2013 and 2018 a result of the conflict in Popasna.1 This study perceptions of change in service provision and direct observations of the conditions of each a challenge. On questions related to the expands on the previous assessment, further access from 2013 to 2018. The findings will be facility. The data collection for CKIIs used provision of services, some responses may analysing the challenges faced by service used to inform humanitarian and development a purposive sampling method. Pensioners, be slightly under reported as respondents may providers in delivering basic services and the aid providers in their support of basic service strategic professionals and service providers have believed it would increase their likelihood barriers experienced by households when delivery. were interviewed: three in rural and five of receiving assistance, especially at a facility accessing basic services. The study found that in urban settlements. CKIs reported on level regarding the availability of equipment. incidents of shelling, as well as military and Table 1. Household (HH) survey sample the community’s access to services and To mitigate this potential bias, REACH Primary data collection methods Stratum 1 Stratum 2 Sample size the shelling occurrence. Using a network enumerators explained to respondents before Urban** 5km 206 approach, REACH also mapped changes of data collection that the research would not Household Surveys 798 Urban >5km 202 households’ access to services, comparing directly lead to humanitarian assistance. perceptions of access in 2013 and 2018 to In addition, responses regarding security Key Informant Interviews 168* Rural 5km 186 identify extra burdens on service providers. incidents and shortages might be under Community Key Informant Interviews 268 Rural >5km 204 For a more extended methodology see Annex reported due to the normalization of issues as **Note: settlements in Ukraine are officially classified as “village,” “urban- A. a result of the protracted nature of the conflict. Focus Group Discussions 38 type village,” or “city.” This assessment classifies villages as rural and *Some key informants were interviewed regarding multiple facilities urban-type villages/cities as urban.

1 Map 1. Assessed Settlements in Popasna Raion

Lyman Luhanska oblast Shypylivka

Lysychansk Sievierodonetsk Metolkine NGCA Bilohorivka Donetska Lysychanskyi oblast Russian Voronove Federation Zolotarivka Maloriazantseve Siversk Topolivka Borivske Verkhnokamianka Vovchoiarivka Bila Hora Myrna Ustynivka Loskutivka Dolyna Bobrove Rai-Oleksandrivka Toshkivka Mykolaivka Hirske Nyzhnie

Vrubivka Novoivanivka 7+14+13+8+6+9 Nyrkove Shchastia Novotoshkivske Zolote Orikhove Soledar Viktorivka Komyshuvakha Oleksandropillia Katerynivka

Popasna Marinka Urban settlements Druzhba Pervomaisk Karlivka Rural settlements Assessed settlements Bakhmut Novozvanivka No data Kadiivka Main roads 9+15+13+9+5+7 Railroad

Troitske Checkpoints Luhansk Kostiantynivka Contact Line (OCHA, as of August 2018) 5km area from the contact line Alchevsk Popasna raion Km 0 4.59 Svitlodarsk

2 W Population The Popasna raion population demographics Figure 1. Population geographic distribution Map 2. Population density (Figures 2 and 3) show a distribution with a higher proportion of people over 46 years old than under 30.4 As illustrated in Map 2, the Shypylivka population is concentrated in urban areas Bilohorivka Sievierodonetsk within 5km of the contact line, mainly in the Lysychanskyi cities of Popasna, Zolote and Hirske. Eighty Maloriazantseve Zolotarivka percent (80%) of the population lives within To polivka Lysychansk Siversk Verkhnokamianka 5km of the contact line, and 20% live beyond 78+11+9+2+A Bila Hora 75+ Urban 5km 4% 78%2% Vovchoiarivka 5km of the contact line. Myrna Loskutivka Urban >5km 11% Dolyna Ustynivka The majority of households (75%) had between Rai-Oleksandrivka Pidlisne Toshkivka Nyzhnie 61-75 Rural >5km 14% 10%8% Mykolaivka Hirske one or two members. Households with one Novoivanivka member were more commonly reported as Rural 5km 2% Nyrkove Vrubivka living within 5km of the contact line, mostly in Novotoshkivske 46-60 15% 9% Viktorivka Komyshuvakha Orikhove urban areas (44%). Overall, 33% of the heads Figure 2. Population demographics (>5km) Soledar Zolote Oleksandropillia ? of household were widowed. The majority of 7+14+13+8+6+9 2+10+11+7+6+7 Katerynivka 31-457% 75+8% 7% 2% Popasna households within 5km of the contact line were Druzhba Pervomaisk headed by females (63%), in contrast to 37% 14% 61-75 10% Bakhmut Vyskryva headed by males. This difference could be due 16-3013% 46-607% 7% 11% Novozvanivka to the higher life expectancy of women, and 75+8% 31-454% 2% 7% Kadiivka Reported population in assessed settlements (persons) that vulnerable individuals were found to be Troitske 0-156% 16-308% 8% 6% ral more likely to stay in their settlements despite urban ru less than 1000 5 9% 0-15 7% being close to the conflict. 61-75 14% 10% 1001 - 5000 Alchevsk Female Male Km more than 5001 The city of Popasna is the largest settlement, 0 4.59 Svitlodarsk followed by the cities of Hirske and Zolote. 46-60 15% 9% Both Popasna and Zolote are located within Figure 3. Population demographics (5km) Largest settlements in the assessed area Inaccessible settlements due to restrictions on

5km of the contact line, making the area within 9+15+13+9+5+7 1+11+9+6+7+8 movement 31-45 8% 7% 5km of the contact line an important hub of 9% 75+ 1% 1. Popasna 6. Vrubivka 1. Novooleksandrivka service delivery and livelihood opportunities. 15% 61-75 11% 2. Zolote 7 Vovchoiarivka 2. Zholobok (in NGCA) However, the disruption caused by the conflict, 16-3013% 46-607% 7% 9% 3. Hirske 8. Komyshuvakha 3. Katerynivka (some areas in the grey zone) puts the elderly vulnerable population at risk. 9% 31-45 6% 4. Nyzhnie 9. Nyzhnie Unpopulated settlements 0-155% 16-308% 8% 7% 7% 0-15 8% 5. Troitske 10. Myrna Dolyna 1. Hlynokarier (abandoned) Female Male 2. Topolivka (planned demolition)

3 ] Vulnerability & Displacement

The Popasna raion is located in an area Figure 8. Percentage of HH with a HoHH Figure 9. Percentage of HHs with displaced Figure 6. Proportion of HoHHs having at least of active conflict. Figure 10 illustrates that one vulnerability displaced or returnee or returnee members shelling incidents have increased since March to August 2018.6 Against the backdrop of a protracted conflict, significant security risks, Rural HoHHs Rural HHs members and barriers to accessing basic services, 73% of households had at 4% IDPs (status) protection concerns are exacerbated due to an least one vulnerability 3% IDPs (status) 1% IDPs (no status) already vulnerable elderly population. Seventy- 73+27A 1% Returnees (no status) three percent (73%) of HoHHs reported having 3+97A 4+1+94A a vulnerability, which were mostly pensioners (Figure 6 and 7). Overall, 82% of households Figure 7. Most reported types of HoHH Urban HoHHs Urban HHs members vulnerability7

61+37+5+2+2 8% IDPs (status) Figure 4. HoHH gender distribution Pensioner 61% 3% IDPs (status) 3% IDPs (no status) 1% Returnees (no status) Chronic illness 37% 2% Returnees (no status) Disability (unofficial) 5% 3+1+96A 8+3+287A \ 38% Disability (official) 2% members with a disability were mainly due to higher percentage of IDPs with status in urban ^ 62% Single parent 2% the difficult procedure, not being able to get to settlements than in rural ones. However, the facility to register, lack of documents and many had no official status of being displaced 62+38A reported having at least one member with a the benefits being less than the effort required or returned, representing a challenge for vulnerability. Seventy-eight percent (78%) Figure 5. Proportion of heads of household for registering. humanitarian aid provision. The relatively of female heads of household had at least (HoHH) with a vulnerability small number of displaced populations in one vulnerability, in contrast to 64% of male Despite the high proportion of the population comparison to other areas could mean that heads of household. This difference is due to having a vulnerability, many of the assessed Female-headed households those who have been displaced due to the the higher life expectancy of women and that facilities did not have disabled access. Two conflict moved either outside the raion, the average age of the head of household was thirds of the healthcare facilities assessed or abroad to work in Russia, as the FGD pensioner age (60 years and older) as reported (63%) lacked disabled access, as well as 79% 78% have a vulnerability participants suggested. by 61% of households. Other vulnerabilities of administration facilities, 82% of educational 78+22+A household members reported having were facilities, and 50% of social service facilities. chronic illnesses (37%). The proportion of Male-headed households Household members with displacement household members with an official disability status in the raion represented a relatively was reportedly 7%, those with an inofficial low percentage. Overall, 5% of households disability reportedly 3%. The main reported 64% have a vulnerability reported at least one member being displaced 64+36+A reasons for not officially registering household or returned. Figures 8 and 9 illustrate a slightly

4 & Protection Risks The main security concerns reported by Figure 11. Most reported security concerns Map 3. Households reporting shelling when accessing services households vary according to the differing when accessing services by HH7 conflict dynamics across Popasna and 5km Rural 5km Urban Shypylivka household vicinity to the contact line. 30+22+19+13+ 1+0+22+4+ Mined fields 30% 1% Throughout the raion, especially in urban Bilohorivka Sievierodonetsk areas (5km), the most common concerns Land mines 22% 0% Lysychanskyi reported were the hearing (22%) and seeing of Heard shelling 19% 22% Maloriazantseve Zolotarivka Lysychansk shelling (4%) (Figure 11). Households in rural Saw shelling 13% 4% Siversk To polivka 57 77 Verkhnokamianka settlements within 5km of the contact line were None 57% 77% Bila Hora Vovchoiarivka Ustynivka more likely to report perceiving mined fields Pidlisne Myrna (30%) and land mines (22%), followed by the transport in settlements and military presence Loskutivka Dolyna that all significantly affect the access to and Rai-Oleksandrivka Toshkivka hearing (19%) and seeing of shelling (13%). Mykolaivka delivery of services. During FGDs enumerators Novoivanivka Nyzhnie Since the population is highly concentrated Nyrkove Vrubivka Hirske reported that residents were often reluctant to Novotoshkivske within 5km, shelling poses a significant Orikhove Viktorivka security risk for households particularly in answer all the questions, and reported security Zolote Soledar Komyshuvakha relation to traveling to accessing services. KIs concerns such as the hearing of shelling Oleksandropillia and gunfire in half of the settlements. Wild Katerynivka reported more exposure to military presence Popasna Druzhba and shelling in the settlements within 5km of the animals and stray dogs were also a concern in Pervomaisk Shelling occurrence Troitske, Hirske, and Nyzhnie since they were (as reported by community contact line. Lysychansky and Myrna Dolyna, Bakhmut Vyskryva key informants) reported to be attacking people. Enumerators Novozvanivka were affected by shelling and the perceived Never happened also reported military presence in almost half Kadiivka presence of mines. Additionally, during FGDs Infrequently of the settlements visited. Troitske enumerators reported observing very poor Monthly quality of roads, the disruption or absence of Weekly Alchevsk 6 Figure 10. Security incidents over time Km 0 4.59 Daily Svitlodarsk 1,400 Regarding bomb shelters, one third of the Settlements with the most protection concerns 1,200 households (31%) reported not knowing the reported in accessing services* 1,000 location of the nearest bomb shelter, and most 1. Troitske 800 KIs in the city of Popasna reported not having 2. Popasna 600 enough bomb shelters. 400 3. Zolote 200 4. Katerynivka 0 5. Pidlisne *All protection concerns related to the conflict: seeing and hearing of shelling, mined fields and landmines.

5 ! Capacity of Social Service Providers

The following section reports on social service Figure 12. Proportion of social service Map 4. Key informant reported damage to social service facilities capacities,8 initially from the perspective facilities with FTE positions unfilled of KIs, followed by outlining challenges to accessibility from a household perspective. A total of 12 KIs from social services facilities 42% have unfilled FTEs were interviewed. The social services facilities were located in urban settlements within 5km of the contact line: 11 in Popasna, and 1 in supplies42 such as+58+A stationary (three facilities), Nyzhnie (Map 4). office equipment (three facilities), paper (three Table 2 outlines the services provided by the facilities), and computers (two facilities). facilities where KIIs were conducted, of which Nyzhnie In terms of Full Time Equivalent (FTE) mostly provided in-home services, and the positions, KIs from seven facilities in the registration of vulnerability status, such as city of Popasna reported not having all FTE displacement status, disability, chronic illness, positions filled due to the absence of qualified pensioner or single parent. KIs were asked candidates, attributed to them either leaving about their needs relating to supplies, where the community, or because it was a common four of the facilities reported lacking necessary Popasna situation for the settlement where the facility Reported social facility 7 3 damage level Table 2. Social services offered by number of was located. When asked if their caseload Indicated damage level: facilities offering such service had changed since 2013, KIs from 10 facilities Damaged and partially renovated reported that there had been a significant Damage and fully Service # of facilities increase. One facility in the city of Popasna renovated reported that they were unable to cope with Not damaged In-home support 5 2 Number of facilities in their current caseload. a settlement with Km an indicated damage level Legalisation of vulnerable status 4 0 4.59 The majority of the social service facilities Payments of social benefits 3 were not found to have been damaged as perceiving the presence of landmines, mined a result of the conflict (eight facilities), three Figure 13. Proportion of facilities perceiving an fields and mined roads. The onset of the increase in caseload since 2013 Issuing supporting documents 3 were damaged but repaired and one had conflict has exacerbated an already strained 73+27 been fully destroyed and moved to another Significantly increased 73% Restoring documents 2 system9 due to the caseload increase, and the facility. Almost all KIs (10 out of 12) reported reduced social services in the raion, affecting The same 27% Job search support 1 having to cross a checkpoint on their way the quality of the service. The findings show to provide in-home services, and all of them Training for unemployment 1 a decrease in the different types of social reported security concerns while doing their services available and an increasing caseload Other 8 job such as the hearing and seeing of shelling, across Popasna raion.

6 ! Access to Social Services (Vulnerabilities) More than half of households (60%) reported Figure 15. HH dissatisfaction with social Table 4. HHs reported traveling distance to Figure 16. Most reported reasons for needing to access social services to receive services their social services facility dissatisfaction with social services7 their pensions, government subsidies, social 83+ benefits, and allowance schemes. This Distance 83% 61 proportion was perceived as slightly higher of HHs are dissatisfied with 5km 5km >5km >5km 61% +0+19 37% Distance than in 2013 (53%). More households living in social services. Rural Urban Rural Urban Procedure 19% +34+ rural settlements (within 5km) reported using 34% 0+24 37+63+A <1km 6% 20% 3% 4% no social services (53%) than households

24% +32+ living in urban areas (38%) (within 5km). Table 3. Dissatisfaction with social services by Staff attitude 1-5km 5% 15% 7% 3% 32% 0+17 Enumerators reported that poor quality of vulnerability type

17% +57 roads in rural settlements, and the longer 5-20km 38% 17% 12% 14% Lines distance to social services provided in urban Vulnerability 2013 2018 57% +0+30 settlements, negatively affect rural settlements >20km 43% 43% 69% 72%

30% +21 HH with more than 3 children 18% 90% Lack of transport access to social services. 21% +0+30 HH with foster children 63% 63% Don't know 8% 5% 10% 7% Overall, 22% of households reported security 30% +28 Cost of transport concerns. Households more likely to report Disability (unofficial) 9% 58% in 2013 but reported having to go to Popasna 28% security concerns were those living in rural or Nyzhnie in 2018. That could be due to the Disability (official) 7% 54% settlements within 5km of the contact line (43% reduction of operative social services in the Rural Urban of households living in 5km rural) of which Single parent (official) 7% 47% urban settlements of Zolote, Komyshuvakha, 10 10 most concerning issues included perceiving Torshkivka and Hirske, since these cities are Pensioner 15% 39% queues (57%) and distance (61%). This finding mined fields (31%) and land mines (19%). highly exposed to shelling and smaller than confirms the reported increase in caseload The hearing of shelling was more likely to be Chronic illness 9% 22% Popasna city. found in some social service provider hubs in reported in more densely populated urban A higher proportion of households reported urban settlements (Map 6), in addition to the areas, as apposed to slightly less populated None 11% 42% being dissatisfied with their social service shift in where households are accessing social rural areas. Distance to social services was living beyond 5km and 43% living within 5km in 2018 compared to 2013, where 37% services since 2013. In rural areas 30% of an important reason for dissatisfaction with of the contact line reported traveling more of households reported being dissatisfied households were dissatisfied while accessing social services, whereby 72% of households than 20km to access their social service in 2018 and 14% reported that they were social services, reporting issues relating to Figure 14. Proportion of HHs reporting security facility. Overall, 48% of households reported dissatisfied in 2013. A significant change in distance (83%) lack of transport (30%) and the 7 concerns when accessing services needing to travel more than 20km to access level of satisfaction was observed in urban cost of transport (30%) (Figure 16). Nineteen

42+6+6 social services, using the (paid) bus (60%). areas, in which 12% of households in 2013 percent (19%) of all HHs reported the public Heard shelling 21% Households living in settlements beyond 5km and 37% of households in 2018 reported transport as unreliable. Of those HHs, the main Saw shelling 3% also reported using the train (33%). As shown being dissatisfied. In urban areas households reasons for this were due to frequency (57%), Mined fields 3% in Maps 5 and 6, households previously dissatisfied reported that the main reasons the roads’ conditions (89%), the weather (51%) accessed social services in different localities for dissatisfaction in 2018 (38%) were long and bus conditions (47%).

7 Map 5. Access to social services network 2013. Map 6. Access to social services network 2018.

2013 2018

Shypylivka Shypylivka Sievierodonetsk Sievierodonetsk Lysychansk Lysychansk Bilohorivka Metolkine Bilohorivka Metolkine

Voronove Voronove Zolotarivka Maloriazantseve Zolotarivka Maloriazantseve Borivske Borivske Topolivka Topolivka Verkhnokamianka Verkhnokamianka Vovchoiarivka Bila Hora Vovchoiarivka Bila Hora Pidlisne Bobrove Pidlisne Bobrove Ustynivka Ustynivka Loskutivka Loskutivka Myrna Dolyna Myrna Dolyna Toshkivka Toshkivka Rai-Oleksandrivka Rai-Oleksandrivka Mykolaivka Nyzhnie Mykolaivka Nyzhnie Hirske Hirske Novoivanivka Novoivanivka Nyrkove Vrubivka Nyrkove Vrubivka Novotoshkivske Novotoshkivske Viktorivka Komyshuvakha Viktorivka Orikhove Komyshuvakha Orikhove Zolote Zolote Oleksandropillia Oleksandropillia Katerynivka Katerynivka

Holubivka Druzhba Popasna Druzhba Popasna

Pervomaisk Vyskryva Vyskryva Novozvanivka Novozvanivka Role of settlement in service access and provision network

Troitske Troitske only in another location

only within the settlement Brianka within the settlement and providng to other settlements

primary service provider

connection to the service Km 0369

8 % Capacity of Education Facilities The following section outlines the findings Figure 17. Proportion of education facilities Map 7. Key Informant reported damage to education facilities regarding education services, firstly on service with FTE positions unfilled capacities from the KIs perspective, and secondly on the service accessibility from Shypylivka !% a household perspective. The assessment 31% have unfilled FTEs Bilohorivka Lysychanskyi !%? !%? conducted 62 KIIs representing the facilities, !% of which 40 were within 5km of the contact Maloriazantseve Zolotarivka !% line. While all facilities offered services to 31+69+A !%? 3 reported security concerns with stray dogs and 4 GCA areas, two facilities in Hirske offered Vovchoiarivka perceiving mined roads (Zolote). According to !% educational services to households from the KIs, of the schools offering lunch for students 2 Myrna Dolyna Luhansk NGCA. !% (an estimated 77%), 19% provided it for free Toshkivka !% !%? Nyzhnie for all pupils, and 58% for some children, !%!%? !%? The availability of services provided at the NovoivanivkaHirske 2 !% !%? !%? 2 schools assessed, was greater in the urban subject to age and vulnerability criteria. Two Vrubivka !%? !%? !% 2 2 4 settlements of Popasna, Zolote, and Hirske thirds of the facilities (61%) provided all school !%? Novotoshkivske Komyshuvakha !%? !%? !%? Zolote 2 !%!%? !%? than in rural areas and small urban centers. books for free to their students, whereas 4 7 3 2 KIs reported that 68% offered free education 58% did in 2013. Other basic services were for all students, and 50% reported providing not provided by all facilities, only 61% had a Popasna !%? !%? education for disabled children, of which functioning library, and 39% fully provided 7 Reported education facility 18% offered in-home education for disabled sports equipment. Furthermore, KIs reported damage level Indicated damage level: children. According to KIs, teaching staff that 13% of schools could not provide a safe !% Not damaged while traveling to provide in-home education, outdoor space to play, and 40% did not have Troitske !%? Damaged and fully renovated ? !% !%? Damaged and partially renovated basic hygiene supplies (soap, toilet paper) for 2 Table 5. Proportion of education facilities !%? Damaged and not renovated 7 their students. Number of facilities in a settlement offering services by settlement type 2 with an indicated damage level In terms of expenditures, according to KIs Km Service 2013 2018 04.5 9 98% of the facilities reported not being able experienced an increase in workload and 26% totally renovated. Enumerators Medical support 66% 74% to cover them all. Facilities mostly struggled to cover operational expenditures, capital since 2013. Thirty-one percent (31%) of KIs observed that 82% of the facilities did not have reported having FTE positions unfilled of disabled access. In terms of education service Education for children expenditures, services except utilities and 42% 50% provision, both rural and urban facilities faced with disabilities salaries. Between 2013 and 2018, KIs which 24% reported it being due to a lack of reported no changes in their caseload (50%), candidates. Even with all FTEs filled, 23% challenges in offering basic services to their Psychological support 26% 34% or a decrease (32%). According to KIs only KIs reported that facilities would be unable pupils, constrained by their budget, insufficient one facility in Novotoshkivske reported a to manage their workload. Overall, 74% of staff and the changes in their workload (either Social-pedagogical significant increase, and two of the facilities in the facilities were reportedly damaged due increased or decreased) as a consequence of 21% 26% support Zolote, one in Vrubivka and one in Bilohorivka, to the conflict, with 44% partially renovated, the conflict.

9 % Access to Education (Vulnerabilities) Of the households that reported accessing children, who are more likely to play in mined (67%) in rural settlements within 5km of the Figure 18. Most reported reasons for educational facilities (16%), 14% reported fields and with ERWs.10 contact line and the feeling of schools being dissatisfaction with education service by accessing schools, and 3% reported accessing unsafe (50%) in urban settlements within 5km dissatisfied HHs7 The reported level of dissatisfaction with 82+35+23+19+ 7 of the contact line. The reported feeling of lack kindergartens. education services was 4% in 2013 and 14% Quality of teaching staff 82% of safety could be due to the hearing or seeing In terms of the means of transport used to in 2018. The main reason for this reported by School is unsafe 35% of shelling in urban areas. access educational facilities, households in households was the low quality of teaching Distance to school 23% urban settlements (>5km) were more likely staff (82%). This correlates with the findings In terms of affordability, 37% of all households No psycho-social support 9% 21 to report traveling by foot (77%), followed by relating to education capacities whereby, accessing education reported not being able Other 21% using a free bus (18%) or paid bus (13%). Rural according to KIs there are unfilled FTEs and to cover all education expenses. they are unable to cover costs to function households (5km) were more likely to report As illustrated in Maps 8 and 9, there are no Figure 19. Most reported security concerns by contributing to the overall challenges in the 7 using a free bus (39%) followed by traveling by major changes in the education networks HH when accessing education services provision of education services. Other reported foot (28%) and using private (17%) or shared of access, the most important education 0+0+34+9+ reasons for dissatisfaction were: distance to 5km Rural33+28+17+6+ 5km Urban cars (17%). For the majority of households the services being accessed remain in Popasna school (23%), and the lack of psychosocial Mined fields 33% 0% traveling time to access their education service city, Zolote and Komyshuvakha within 5km, services (9%). In specific areas other reasons Land mines 28% 0% was less than 30 minutes (90%). Households and Lysychansk, Severodonetsk and Myrna were given such as the quality of the venue living in rural settlements were most likely to Dolyna beyond 5km. Heard shelling 17% 34% report traveling for a longer time, with 33% of Saw shelling 6% 9% 63 households reporting traveling for between 30 50 None 50% 63% minutes and 1 hour. Table 6. Reported services available in schools Figure 20. HHs of those with school aged children reported traveling time to their education Overall, 32% of households accessing between 2013 and 20187 facilities education services reported having security Rural Urban concerns when traveling to access their Service 2013 2018 63% <30 min 94% <30 min education service. Overall, households Medical support 92% 88% 30 min to 1h 30 min to 1h reported the hearing (29%) and seeing of 36% 4% shelling (7%) as their main security concerns. Psychological support 63% 75% 1% 1h-3h 3% >3h These were mostly reported within 5km of the Afterschool care 76% 68% contact line, presenting a high humanitarian Figure63 21. Reported+361A dissatisfaction with education services93 levels between+4+3A 2013 and 2018 by Extracurricular activities 61% 58% risk for children’s protection in these areas HoHH vulnerability of those with school aged children closest to the active conflict. As Figure 19 Socio-pedagogical support 40% 40% illustrates, households from rural settlements within 5km reported security concerns such as Education for disabled 11% 15% the perceived presence of mined fields (33%) Mine risk awareness 13% 65% and land mines (28%). This situation presents 00%+9+0+0+9% 55% +15+0+0+15% 3434% +62+0+62% 431% +1764% an significant security risk especially for Single parent Pensioner Disability (official) No vulnerability 10 2013 10 2018 10 Map 8. Access to education network 2013. Map 9. Access to education network 2018.

Kreminna 2013 Pryvillia 2018 Pryvillia 82+35+23+19+

Shypylivka Shypylivka Sievierodonetsk Sievierodonetsk Lysychansk Lysychansk Metolkine Bilohorivka Metolkine Bilohorivka

21 Voronove Voronove

Zolotarivka Maloriazantseve Zolotarivka Maloriazantseve Borivske Borivske

Verkhnokamianka Verkhnokamianka

Vovchoiarivka Bila Hora Vovchoiarivka Bila Hora Pidlisne Bobrove Pidlisne Bobrove Ustynivka Ustynivka Loskutivka Loskutivka 0+0+34+9+ Myrna Dolyna Myrna Dolyna Toshkivka Toshkivka Rai-Oleksandrivka Rai-Oleksandrivka Nyzhnie Mykolaivka Nyzhnie Mykolaivka

Hirske Hirske Novoivanivka Novoivanivka Nyrkove Vrubivka Nyrkove Vrubivka Lypove Novotoshkivske Novotoshkivske 63 Viktorivka Viktorivka Komyshuvakha Komyshuvakha Orikhove Orikhove Zolote Zolote Oleksandropillia Oleksandropillia

Katerynivka Katerynivka

Druzhba Popasna Molodizhne Druzhba Popasna

Pervomaisk Pervomaisk

Vyskryva Vyskryva Novozvanivka Novozvanivka Kadiivka RoleRole of settlementofof settsettlementlemen t in servicein service access access and and provision provision networnetworknetworkk

Troitske Troitske only in another location

only within the settlement

Myronivka Myronivka within the settlement and providng to other settlements

Myronivskyi Myronivskyi primary service provider connection to the service Km 0369

11 + Health Facility Capacities The contact line disrupted the connection Table 7. Proportion of health facilities offering Map 10. Key Informant reported damage to health facilities between settlements in GCA and the city services by settlement type7 of Luhansk in NGCA, where previously, Service 2013 2018 Shypylivka households received specialised healthcare. !C Referral 91% 67% This section contains the findings from the Bilohorivka Patients visits 78% 100% !C Meto!Clkine perspective of KIs, followed by the perspective Lysychanskyi!C Primary injury 65% 83% of households’. The assessment for Popasna Zolotarivka !C raion assessed a total of 35 healthcare !C Maloriazantseve Outpatient 60% 50% !CBorivske facilities. Vovchoiarivka Inpatient 43% 25% !C !C Bila Hora Across the raion, only the city of Popasna Myrna Dolyna Pharmacy 48% 50% Loskutivka !C !C !C 11 contained secondary hospitals (three) Mykolaivka Pidlisne Toshkivka Nyzhnie Dental 22% 8% !C !C !C and one clinic. When compared to 2013, Hirske X-ray and Novoivanivka!C !C 2 KIs reported fewer available services in 22% 0% !C 2 fluorography Vrubivka Orikhove !CNovotoshkivske 2018 (Table 7). According to KIs, none of Zolote !C!C !C Surgery 22% 0% !C!C 2 the facilities had ambulance or blood bank Komyshuvakha services available. Lab 22% 0% !C Popasna Katerynivka Compared to 2013, more KIs reported that Druzhb!Ca !C 5 facilities in 2018 did not have the availability senior medical staff. KIs working in urban Reported health facility damage level of basic medicines, or medical supplies. The facilities reported that it was both a common Indicated damage level: most commonly unavailable medications situation for the settlement, and that medical !C Not damaged Troitske staff have been leaving the community due to !C !C Damaged and fully renovated reported were painkillers and sedatives. In !C the conflict. According to KIs, 33% of facilities Damaged and partially renovated terms of medical supplies, 20% of KIs reported !C Damaged and not renovated missing medical supplies (beds, intravenous would not be able to cope with the workload if !C Not sufficient data Km 2 Number of facilities in a settlement equipment, syringes, pumps, needles), and they had all FTE positions filled. Regarding the 04.5 9 with an indicated damage level 32% reported missing medical equipment. facilities' expenses, 54% KIs responded that However, it should be taken into account their facilities were not able to cover them all. The majority of facilities damaged as a availability of equipment, medical supplies, and that 19% of the KIs were not able to provide As Maps 11 and 12 indicate, the settlements of consequence of the conflict were located within medicines. However, since some KIs could not information about the situation in 2013. Popasna and Zolote (5km) and Lysychanskyi 5km of the contact line. In addition, facilities give information relating to 2013, assessing Related to staff capacity and workload, the (>5km) reported a significant increase of their required repairs for lack of maintenance in the perception of change in satisfaction healthcare services were struggling the most caseload since 2013. On the contrary, Tritske heating (31%), windows and doors (29%), and with healthcare services due to the conflict compared to social and education services, and Novotoshivske reported a decrease in the structural and infrastructural repairs (29%). is difficult, since the role of humanitarian where 71% of the FTEs positions were unfilled caseload which might be attributed to their assistance and the previous constraints on the due to expected cuts to budgets (71%) and closeness to the contact line, and greater The study found that overall, healthcare service should be considered. low salaries (23%), predominantly affecting security concerns. services are struggling mostly with workload,

12 + Access to Healthcare (Vulnerabilities) Households reported accessing medical hearing of shelling (20%). Figure 22 illustrates services and overloaded services in Popasna. Figure 24. Most reported reasons for HH not services more often in 2013 (60%) than in that rural households within 5km to the contact On the other hand, the importance of Hirske for accessing health care services in the 3 months prior data collection7

2018 during the three months prior to data line reported higher security concerns than providing healthcare services has decreased 52+47+18+9+6+4 collection (52%). However, more households urban households within 5km to the contact since 2013. Did not need 52% reported needing medical care and not line. Self-treatment 47% receiving any in 2018 (48%) than in 2013 As for transportation, households reported Had no money 18% (35%). Among those that reported needing but Figure 23. Most reported reasons for HH walking (61%) or using a paid bus (36%) to dissatisfaction with health care service7 Do not trust doctors 9%

not accessing healthcare in 2018, the main 49+44+39+30+26+25 access healthcare. Overall, 67% of households reasons were not having the money to afford Traditional medicine 6% reported traveling less than 30 minutes to the Medical staff quality 49% it (18%) or using self-treatment (47%) (Figure Could not reach 4% nearest healthcare facility. However, in rural Quantity of doctors 44% 24). The following findings only apply to those settlements 40% of households reported Cost of services 39% households accessing healthcare services in traveling times between 30 minutes to 1 hour, 2018 (52%). The reported level of satisfaction Staff attitude 30% and 11% between 1 hour and 1 ½ hours, related to healthcare has deteriorated since Distance to facility 26% traveling by paid bus (46%), a private car 2013 according to households; 20% reported Lack of equipment 25% (26%) or a shared car (23%). As seen in Figure dissatisfaction in 2013 compared to 34% in 25, households in rural areas reported more 2018. The sources of dissatisfaction were Figure 25. Proportion of households reporting to pass a checkpoint to access their healthcare frequently crossing a GCA checkpoint (23%) distance (69%), lack of doctors and staff facility in 5km of the contact line, disaggregated by settlement type or a NGCA checkpoint (5%). As Maps 11 and (54%), quality of medical staff (49%), the price 12 illustrate, more households in 2018 had to Rural 5km Urban 5km of services (39%), the staff’s attitude (30%), access healthcare in other settlements, such and lack of equipment (25%). 72% None 94% None as larger cities like Lysychansk, Hirske, Zolote 23% GCA checkpoint 5% GCA checkpoint Since access to healthcare has become more and Popasna. On the one hand, the disrupted difficult after the start of the conflict due to the connection with Pervomaisk in NGCA has 5% NGCA checkpoint 1% NGCA checkpoint main reported reasons of dissatisfaction, lack isolated areas within 5km from healthcare 5+2372A 1+594A of money, and the increasing vulnerabilities, the population could be exposed to greater Figure 26. Household dissatisfaction with health care services by HoHH vulnerability type health risk if engaging in dangerous coping Figure 22. Most reported security concerns by strategies such as opting for not receiving the HH when accessing services7 healthcare they need. Most households had

Urban20+3+2 5km access to medical services, and 32% reported Rural23+16+29+ 5km having to pay for all or some medicines or Heard shelling 23% 20% health supplies. Saw shelling 16% 3% Mined fields 29% 2%

+78 0% 97% 22% 31% 18% 44% Overall, the most reported security concern 53 97+0+0+22+31+0+0+77% +22+0+0+22% 18+44 while accessing healthcare continued to be the None 53% 78% Single HoHH Pensioner Disability (official) No vulnerability 10 2013 10 2018 13 Map 11. Access to healthcare network 2013. Map 12. Access to healthcare network 2018.

Kreminna Rubizhne Kreminna Rubizhne 2013 Pryvillia 2018 Pryvillia

Shypylivka Shypylivka Sievierodonetsk Novodruzhesk Sievierodonetsk Lysychansk Lysychansk Bilohorivka Metolkine Bilohorivka Metolkine

Voronove Voronove

Zolotarivka Maloriazantseve Zolotarivka Maloriazantseve Borivske Borivske Topolivka Topolivka Verkhnokamianka Verkhnokamianka

Vovchoiarivka Bila Hora Vovchoiarivka Bila Hora Pidlisne Bobrove Pidlisne Bobrove Ustynivka Ustynivka Loskutivka Loskutivka Myrna Dolyna Myrna Dolyna Toshkivka Toshkivka Rai-Oleksandrivka Rai-Oleksandrivka Nyzhnie Mykolaivka Nyzhnie Mykolaivka

Hirske Hirske Novoivanivka Novoivanivka Nyrkove Vrubivka Nyrkove Vrubivka Novotoshkivske Novotoshkivske Viktorivka Viktorivka Komyshuvakha Orikhove Komyshuvakha Orikhove Zolote Zolote Oleksandropillia Oleksandropillia

Katerynivka Katerynivka

Holubivka Luhansk Druzhba Popasna Druzhba Popasna

Pervomaisk

Vyskryva Vyskryva Novozvanivka Novozvanivka Kadiivka Role of settlement in service access and provision network

Troitske Troitske only in another location

only within the settlement

Myronivka Myronivka within the settlement and providng to other settlements Alchevsk primary service provider Myronivskyi Myronivskyi connection to the service Svitlodarsk Km Svitlodarsk 0369

14 O Employment

Most of the population in Popasna raion is Of household members of working age (Table reported the highest rates of unemployment Table 9. Reported levels of employment status of elderly age and, as households reported, 10), 11% were unemployed, more than in 2013 among vulnerable categories (Figure 27). of HoHH in 2013 and 2018 their main sources of income were found to (7%). However, there were reportedly fewer Most of the population who were employed be pensions, social benefits and government household members receiving education, and worked in larger settlements or sought job subsidies. Twenty-seven percent (27%) reportedly an increase of household members opportunities abroad (Map 14). The main Employment status HoHH 2013 2018 of heads of household were in full-time acting as housekeepers or family carers within sectors of employment were mining, followed employment, a slight decrease since 2013 their household. This finding correlates with by the industrial, trade and education sectors. Retired 54% 63% (Table 9). This difference could be due to the different unemployment rates by gender In 2013, proportionally more members of Full-time employed 31% 27% the increased number of retired heads of (Figure 28), and with the fact that the conflict households were reported to be working in 13 household from 54% (2013) to 63% (2018). has reinforced traditional gender roles. mines, industry and trade and less in services Unemployed 8% 7% The overall percentage of unemployed heads Household members who were reportedly and education. The increase in trade could be of household was 7% (8% in 2013).The full-time employed in 2018 had decreased due to the finding during FGDs that a great Family carer 3% 3% highest rate of households’ unemployment since 2013 (Table 10). The main reported part of the population depended on vegetable Freelance 2% 2% was in rural settlements (10%)12. reasons for unemployment were the lack of gardens or farming as an alternative source of relevant vacancies in the settlement, followed income, and would then sell their own produce. Self-employed 1% 1% by family and personal reasons. Of head of The changes in the employment sector could Figure 27. HoHH unemployment rate by HoHH vulnerability households reporting to be unemployed (7%), result in a mismatch of skills, increasing the Table 10. Reported levels of employment

25+17+10 66% had at least one vulnerability (Figure 27). difficulties of the service provision. status of adult HH members in 2013 and 2018 Single parent (official status) 25% Heads of household who were single parents Family with foster children 17% Family with more than 3 10% Employment status HH Figure 28. Gender of HoHH who reported being Figure 29. Reported HoHH unemployment 2013 2018 children member unemployed rates by area Retired 36% 39% Table 8. Top 5 employment sectors Full-time employed 31% 25% Receiving education 14% 9% Sector Unemployed 7% 11% 1. Mines 27% 50+35+30+2010% 7% 6% 4% 459% +15+3% Family carer 6% 9% 2. Education 17% Rural Urban Rural Urban 5km >5km >5km 3. Service 15% ^ \ 5km Physically unable to work 2% 4% 4. Industry 9% N T N T Freelance 2% 2% 5. Trade 7%

15 Map 13. Access to employment network 2013. Map 14. Access to employment network 2018.

Rubizhne Rubizhne

2013 Pryvillia 2018 Pryvillia

Shypylivka Shypylivka Sievierodonetsk Sievierodonetsk Lysychansk Lysychansk Metolkine Metolkine Bilohorivka Bilohorivka Pavlohrad RussianRussian Federation Federation Russian Federation

Voronove Voronove

Zolotarivka Maloriazantseve Zolotarivka Maloriazantseve Borivske Borivske Verkhnokamianske Topolivka Topolivka Verkhnokamianka Verkhnokamianka

Hirske Hirske Novoivanivka Novoivanivka Nyrkove Vrubivka Nyrkove Vrubivka Novotoshkivske Novotoshkivske Viktorivka Viktorivka Komyshuvakha Komyshuvakha Orikhove Orikhove Zolote Zolote Oleksandropillia Oleksandropillia

Katerynivka Katerynivka

Holubivka Druzhba Popasna Druzhba Popasna

Pervomaisk

Novozvanivka Kadiivka Role of settlement in service access and provision network

Troitske Troitske only in another location

only within the settlement

Myronivka Myronivka within the settlement and providng to other settlements Alchevsk Myronivskyi Myronivskyi primary service provider connection to the service Svitlodarsk Luhanske Km Svitlodarsk 0369

16 s Financial Services This section outlines findings on households’ Overall, 27% of households reported hearing Levels of dissatisfaction with financial services Figure 33. Most reported security concerns by access to financial services, including ATMs shelling when accessing ATM services (Figure varied across the raion. Overall, 10% of HH when accessing financial services7 and bank services. 33). Security concerns continued to be higher households accessing financial services

in rural settlements within 5km of the contact were dissatisfied. Rural households reported ATMs 18+5+2+ Overall, 10% of households reported not line, where the perceived presence of mined higher levels of dissatisfaction (21%). Overall, Heard shelling 18% having any financial services available in their fields (41%), landmines (22%), and the the main reasons for dissatisfaction were Saw shelling 5% settlement. Households in rural settlements Mined fields 2% hearing (18%) and seeing of shelling (12%) the distance, the lack of cash and long lines 80 were less likely to have financial services were reported. None 80% available, especially households living within the 5km area (Figure 30). Some rural Overall, over half of households (57%) used Figure 32. Most reported reasons for HH 7 settlements reported that they could pay utility bank services. Those households living in dissatisfaction with financial services 56+47+37+32+27 Bank 27+7+1+ bills and other payments in their settlements rural settlements had to travel farther to their Distance to ATM 56% Heard shelling 27% using post services. nearest bank facility (Figure 35). Households No cash 47% Saw shelling 7% in urban settlements beyond 5km reported Overall, 63% of households used ATMs. As Lines 37% Mined fields 1% higher traveling times since they are further 72 Figure 34 illustrates, 60% of the households Distance to bank 32% None 72% away from the main hubs of financial services. using ATMs living in rural settlements within Commission withdrawal 27% For the households in rural settlements, 5km and urban settlements beyond 5km of the the main means of transport to their bank contact line (55%) reported traveling between services were the bus, private or shared cars Figure 34. Proportion of HHs reporting traveling times less than 30 min, 30 minutes to 1 hour, more 30 minutes and 1 hour, and 14% of households and the train. Overall, 28% of households than 1 hour to their nearest ATM facility in rural settlements beyond 5km reported reported security concerns while accessing <30 min 30 min - 1h >1h 60+16+47+55 36+83+39+41 traveling more than 1 hour. This is due to the 1+0+14+3 bank services (Figure 33). Security concerns concentration of financial services in the cities Rural 5km 36% 60% 1% were concentrated in rural settlements within of Popasna, Hirske, Zolote, Lychanskyi and Urban 5km 83% 16% 0% 5km of the contact line, 55% hearing helling, Sieverodonestk. Rural >5km 39% 47% 14% 35% seeing shelling, and 60% perceiving Urban >5km landmines. 41% 55% 3%

Figure 30. Proportion of settlements reporting Figure 31. Proportion of households reporting Figure 35. Proportion of HHs reporting traveling times less than 30 min, 30 minutes to 1 hour, more no access to financial services dissatisfaction with financial services than 1 hour to their nearest bank facility 82+45+16+3 27+19+10+9 Rural 5km 82% Rural 5km 27% <30 min 30 min - 1h >1h 0+1+6+4 25+89+48+63 75+9+44+33 Rural >5km 45% Urban >5km 19% Rural 5km 25% 75% 0% Urban 5km 16% Rural >5km 10% Urban 5km 89% 9% 1% Urban >5km 3% Urban 5km 9% Rural >5km 48% 44% 6% Urban >5km 63% 33% 4%

17 Map 15. Financial service access network 2013. Map 16. Financial service access network 2018.

2013 Pryvillia 2018 Pryvillia

Shypylivka Shypylivka Sievierodonetsk Sievierodonetsk Lysychansk Lysychansk Metolkine Bilohorivka Bilohorivka Metolkine

Voronove Voronove Siversk Zolotarivka Maloriazantseve Siversk Zolotarivka Maloriazantseve Borivske Borivske Topolivka Topolivka Verkhnokamianka Verkhnokamianka Vovchoiarivka Bila Hora Vovchoiarivka Bila Hora Pidlisne Bobrove Pidlisne Bobrove Ustynivka Ustynivka Loskutivka Loskutivka Myrna Dolyna Myrna Dolyna Toshkivka Toshkivka Rai-Oleksandrivka Rai-Oleksandrivka Nyzhnie Mykolaivka Mykolaivka Nyzhnie

Katerynivka Katerynivka

Holubivka Luhansk Druzhba Popasna Druzhba Popasna

Pervomaisk Pervomaisk

Bakhmut Vyskryva Bakhmut Vyskryva Novozvanivka Novozvanivka Kadiivka Role of settlement in service access and provision network

Troitske Troitske only in another location

only within the settlement Myronivka Myronivka within the settlement and providng to other settlements Alchevsk Myronivskyi Myronivskyi primary service provider connection to the service Km 0369

18 : Electricity & Heating * WASH This section outlines findings on utility services three months’ prior to data collection, of which This section outlines the issues that facilities In education faclities, 34% KIs reported facing the assessed facilities from a KI 40% reported having shortages for more than face from the KIs perspective related to WASH, experiencing water shortages, mainly in perspective, including electricity and heating. three hours. Most of these shortages were such as water shortages and access to toilets. urban settlements within 5km (62%). One irregular, and were more commonly reported facility in Zolote, one in Popasna and one in Education Water shortages in facilities located within 5km of the contact Maloriazansteve were reported to have an More than a third of the facilities where KIs line, especially those in rural settlements. In health facilities, KIs reported that 46% of increase in water shortages since 2013. One were interviewed (35%) reported experiencing facilities did not have a central water supply facility in Popasna reported to experience On the gas and heating provision of health electricity shortages in the three months before and 17% reported not having water shortages daily shortages, and one in Maloriazansteve facilities, 5 facilities within 5km (Troitske, the data collection. Rural facilities within 5km in the 3 months prior the assessment. KIs reported 2-3 times a week. Komyshuvakha, Orikhove, Katerynivka, of the contact line were reported to experience reported water shortages in 35% of the and Zolote) and 1 facility beyond 5km of the Toilets the longest electricity shortages, occasionally facilities. Only one facility in Hirske reported contact line (Pidlisne) reported increased gas for more than three days. KIs reported that two an increase in water shortages since 2013, According to KIs, the availability of toilets was shortages since 2013. facilities in Zolote and two in Novotoshkivske which can be explained by the reported not an issue for 76% of the education facilities, reported an increase since 2013 (Figure 38). Social services incidence of shelling in the area (Map 3). One but 23% were reported needing more and 2% The majority of education facilities (82%) was facility in each of the settlements of Popasna, reportedly had none. Compared to 2013, the KIs reported that one social service facility not connected to the gas network at the time Hirske, Lysychanskyi, and Novotoshkivske availability of toilets had actually improved. in the city of Popasna and one facility in of data collection according to KIs (Figure were reported to experience the longest water Nine percent (9%) of KIs from health facilities Nyzhnie experienced electricity shortages in 36). The conflict seems to have exacerbated shortages in the three months’ prior the survey, reported not having a toilet, and 23% did not the three months prior data collection, which the problem with gas provision, since 44% of between 1-3 days. Three other facilities in have enough. This is most likely due to the fact had increased since 2013. In terms of heating, the facilities were reportedly not connected the city of Popasna were reported by KIs to that many of the healthcare facilities were small there was no information available. in 2013. This raises questions regarding the experience water shortages from 6-12 hours in facilities such as primary posts (a total of 17) state of gas provision in Popasna. the three months before data collection. These and primary healthcare clinics (14 facilities). facilities were located in settlements with high Social services facilities were reported to have Health incidence of shelling. Only one KI in Popasna enough toilets for both staff and visitors. KIs reported that 66% of health facilities (out saw an increase in shortages since 2013. of 35 facilities) have electricity shortages in the

Figure 36. Proportion of education facilities Figure 37. Proportion of facilities experiencing Figure 38. Proportion of facilities reporting water shortages changes since 2013 not connected to the gas network electricity shortages in the 3 months prior to 2013 2018 assessment Education Health 82% Education Health 66% 81% The same 34% The same 44% 37% 11% N/A 63% N/A 5% Increased 3% Significantly increased 44+82 37+66 3+5+11+81+A 3% Decreased 3+54+43+A

19 ) Access to Markets This section outlines findings on access (90%). Urban households beyond 5km 41). Eight percent (8%) of households reported settlements beyond 5km of the contact line to markets, representative of households reported the hearing of shelling (25%) the occasional use of Internet to purchase NFI (26%). Rural households within 5km of the reporting accessing markets: food (100%), items, more frequently in urban settlements contact line reported more security concerns Access to NFI Markets non-food items (NFI) (100%), and construction (10%). such as the perceived presence of mined fields materials market (91%). Overall, 87% of households reported traveling (33%), landmines (22%), and the hearing or less than 30 minutes to their NFI market. Access to construction materials Food Markets seeing of shelling. Households more likely to report traveling Households in rural settlements within 5km of Overall, 91% of households traveled less times between 30 minutes to 1 hour were the contact line were those reporting longer Forty-three percent (43%) of households than 30 minutes to their food market and households living in urban settlements (23%), travelling times to their nearest market for were dissatisfied with their markets, the main most traveled by foot (92%). Some rural and in rural settlements within 5km (18%). construction materials, of between 30min-1h reassons being, the price of goods (92%), households reported longer distances to Households mostly walk to their NFI markets (65%). Households in rural areas in the rest of the distance to markets (higher in rural areas their food markets, 12% traveling between 30 (81%) but need to rely more on bus and private Popasna raion had to travel longer compared to for NFI and construction materials markets), minutes to 1 hour and 6% traveling more than car compared to the access to food markets. those households living in urban settlements. and the quality of goods (20%) (Figure 42%). 1 hour. In rural settlements households relied The low frequency, bad weather and the poor As for their means of transport, households Households in rural areas report higher levels more often on private car (6%) and paid bus road conditions were the main reported issues reported walking (68%) or using the bus (paid) of dissatisfaction related to transport, either the (6%), compared to urban households, from for transport. (27%). In rural areas, households travel more cost of transport (51%) or the lack of it (37%) which 4% used the bus and 1% private car. compared to households in urban areas, who Households reporting crossing a checkpoint often by bus (44%) or private and shared car Rural settlements within 5km of the contact reported the cost of transport (18%) and the to their NFI market were 11%: 9% for GCA (22%). line reported more transport problems, being lack of transport (8%) as main reasons for and 2% for NGCA checkpoints. Households Overall, 7% of households reported crossing the most commonly reported issues: low discontent. in urban settlements beyond 5km and a checkpoint. Fifty-three percent (53%)of frequency of buses and bad roads. Overall, households in rural settlements reported households living in rural settlements within the main security concern was the hearing of crossing checkpoints more often. Twenty 5km of the contact line reported having to shelling (17%) for all settlements. In addition, percent (20%) of rural households within 5km cross a checkpoint, 42% GCA and 11% NGCA Figure 43. Proportion of HHs reporting to pass a rural households within 5km reported the crossed GCA checkpoints. Six percent (6%) of checkpoints. Overall, 18% of the households checkpoint to access their construction market seeing of shelling (11%) and perceived households in urban settlements beyond 5km in Popasna raion reported the hearing of Rural 5km presence of mined fields (10%). Households crossed NGCA checkpoints. The main security shelling, which was a higher concern in urban 47% None in rural settlements beyond 5km of the contact concerns were similar for food markets (Figure 42% GCA checkpoint line more often reported no security concerns Figure 42. Reported reasons for dissatisfaction 11% NGCA checkpoint 7

Figure 40. Most reported security concerns by Figure 41. Most reported security concerns by with all markets 92+20+20+17+14 HH when in accessing food markets7 HH when accessing NFI markets7 Price 92% 11+4346A Urban 5km Rural 5km Urban 5km Rural 5km Urban 5km Distance to travel 20% 17+4+0 18+3+ 15+11+10 16+11+14 95% None Heard shelling 15% 17% Heard shelling 16% 18% Quality of goods 20% 5% GCA checkpoint Saw shelling 11% 4% Saw shelling 11% 3% Cost of transport 17% 0% NGCA checkpoint Mined fields 10% 0% Mined fields 14% 0% Range of goods 14% 5+95A

20 Map 17. Food markets access network 2013 Map 18. Food markets access network 2018 2013 2018

Shypylivka Shypylivka Sievierodonetsk Lysychansk Lysychansk

Bilohorivka Metolkine Bilohorivka Metolkine

Voronove Voronove

Zolotarivka Maloriazantseve Zolotarivka Maloriazantseve Borivske Borivske Topolivka Topolivka Verkhnokamianka Verkhnokamianka Vovchoiarivka Vovchoiarivka Bila Hora Bila Hora Pidlisne Bobrove Pidlisne Bobrove Ustynivka Ustynivka Loskutivka Loskutivka Myrna Dolyna Myrna Dolyna Toshkivka Toshkivka Rai-Oleksandrivka Rai-Oleksandrivka Mykolaivka Nyzhnie Mykolaivka Nyzhnie Hirske Hirske Novoivanivka Novoivanivka Nyrkove Vrubivka Nyrkove Vrubivka Novotoshkivske Novotoshkivske Viktorivka Komyshuvakha Viktorivka Orikhove Komyshuvakha Orikhove Zolote Zolote Oleksandropillia Oleksandropillia Katerynivka Katerynivka

Holubivka Druzhba Popasna Druzhba Popasna

Pervomaisk Bakhmut Vyskryva Vyskryva Novozvanivka Novozvanivka Role of settlement Kadiivka in service access and provision network

Troitske only in another location Troitske only within the settlement

Brianka within the settlement and providng Myronivka to other settlements

Myronivskyi primary service provider Alchevsk connectionconnection toto thethe servicservice Myronivskyi connection to the service

Luhanske Km 0369

21 / Administrative Service Capacities Conclusion This final section outlines the capacities of Figure 45. KIs reported change in caseload The findings in this Capacity and Vulnerability Employment was most likely to be disrupted in the administrative services as reported from since 2013 Assessment of Popasna raion further the industrial sector in rural settlements within the perspective of KIs. KIs reported on 59 elaborates on the findings on Popasna in 5km of the contact line. Households reported administration facilities within the Popasna The same 43% the ABA in 2017. The study highlights the that they were more dependent on pensions raion, both in urban and rural areas. The most Do not know 21% impact of the conflict on the service provision, and were more likely to be unable to work due recent administrative records were from 2017. Significantly increased 21% and how the contact line between GCA and to chronic illness in 2018 compared to 2013. In addition, a higher proportion of female The Popasna raion recorded that the Increased 14% NGCA has shifted the networks of access household members were reported as not largest number of requests received for 43+21+22+14A to basic services. The conflict has created highest number of requests, and none of the working in order to take care of other family administrative services in 2017 were related new challenges and exacerbated preexisting KIs reported receiving requests related to members in 2018. This could potentially be to social protection (Figure 44). In 2017, the issues that both households and service healthcare. However, 21% of the KIs from the reinforcing traditional gender roles. administrative facility in Vrubivka received providers faced in 2013. It has created facilities interviewed could not answer as they the highest number of total requests to the constraints on the availability, proximity and The population is exposed to protection risks, were not in their positions in 2013, or due to administration service. One administration in quality of the aforementioned services due to not only due to active conflict but also due to the lack of records from that period. the city of Popasna (5km) reportedly received increased vulnerabilities among the population barriers related to long distances to services, the highest number of requests for social KIs reported that 36% of facilities had been and overburdened facilities. the lack of quality services and the lack of protection and public utilities. Requests for damaged due to conflict, all of which had The separation of the Popasna raion from the affordability. Households face long distances, public utilities services were reported to been partially renovated. The administrative important urban centre of Luhansk city, now in long lines, overworked staff and limited have had the greatest increase since 2013 facilities which were more damaged as a result NGCA, and the incidence of the conflict near services, in markets, education, healthcare according to 29% of KIs. For transport and of the conflict were located within 5km. Most of the line of contact, has negatively affected and financial facilities. The main reasons for communication, Komyshuvakha reported the the urban facilities beyond 5km of the contact the availability of employment, and increased dissatisfaction were the quality of staff, the Table 11. Number of administrative facilities line had not been affected at all. Enumerators the vulnerabilities of the population with distance to services and their affordability. covered during FGDs noted that the majority of more economic instability and subsequent Utility shortages were already common in facilities (79%), did not have disabled access. protection risks. 2013, however, the number of education # of facilities covered Overall, 29% of facilities reportedly had FTEs From the perspective of service providers, facilities without access to gas had reportedly Rural 5km 5 unoccupied. This percentage was higher for since 2013 the situation has deteriorated in increased in 2018, especially in facilities within Urban 5km 12 facilities in urban areas (46%), predominantly terms of staff quantity and quality. The loss of 5km of the contact line. However, the situation Rural >5km 31 attributed to the absence of qualified connection with urban centres now in NGCA regarding water shortages and availability Urban >5km 11 candidates. Since 2013, 35% of facilities had has created additional pressures on service experienced few changes. reported experiencing an increase in workload providers in GCA. The conflict dynamics For the reasons highlighted above, it is Figure 44. Total administrative requests in with 14% reporting they were unable to cope have created restricted access to services important for humanitarian and development 2017 by type even with all FTE positions filled. In terms of particularly within 5km of the contact line,

76+23+1 organisations to plan their response in costs, 43% of the KIs reported that the facilities Social protection 837 forcing more accessible facilities to serve reference to the strained capacity providers were not able to cover all their expenditures, a greater population. This has negatively Public utilities 248 and the increased vulnerability of the including salaries, operational expenditures affected their ability to cover expenses and population as a consequence of the decreased Transport and communication 10 and capital expenditures. provide quality services. access to services.

22 Endnotes

1 REACH. Area-Based Assessment: Popasna Basic Service Unit Overview, July 2017. Available Online. REACH. Situation Overview Area-Based Assessment in Government Controlled Areas within 5km of the Line of Contact. July 2017. Available Online. REACH. Capacity and Vulnerability Assessment, Yasynuvata raion, January 2018. Available Online.

2 A network approach was used as a tool to describe the processes of accessing different types of services by the local population as a networked structure. See Annex A.

3 Partly Google maps, and Open Street Map. Mostly information from local authorities.

4 Pre-pensioner (46-60) and pensioner (over 60) age are the most vulnerable group in the region due to their higher rates of unemployment rate and the low amount of pensions and benefits received.

5 HelpAge. Missing millions: How older people with disabilities are excluded from humanitarian response, 2018. Available Online.

6 UN OCHA. Humanitarian Snapshot, 3 October 2018. Available Online.

7 Questions permitted multiple responses.

8 Governmental public services providing social support to vulnerable populations.

9 World Food Programme. Social protection and safety nets in Ukraine, 2017. Available Online.

10 UNICEF. The Children of the Contact Line in East Ukraine, 2017. Available Online. UNICEF. 220,000 children threatened by mines and other explosive weapons in eastern Ukraine, 2017. Available Online

11 Secondary hospitals are the main hospitals of the raion.

12 Since 2013 there has been a drop in employment in almost all sectors and industry has dramatically declined, especially in rural areas. REACH. Thematic assessment of local enterprise and labour markets in eastern Ukraine, 2017. Available Online.

13 UNFPA. Analytical report: Gender-Based Violence In The Conflict-Affected Regions Of Ukraine, 2018. Available online.

23 Annex A. Methodology of Network Maps A network approach was used as a tool to describe the processes of accessing different Ex. 2: Reportedly, Village E does not have any employment within the settlement. There are no links types of services by the local population as a networked structure. The network maps show visualized from this settlement to another settlement, which means that employment locations are the service access patterns (who is accessing which provider where) in 2013, and 2018, to diverse (each location was reported by HHs or CKIs less than 2 times). identify changes in those connections in relation to the conflict. This approach enables aid Self-sustaining settlement. Households and community KIs reported accessing services agencies to identify key service provision hubs to target their response. only within their settlement. REACH created the network maps using two different data: community key informant Ex. 1: People from Village C, as reported by HHs and CKIs, are employed only within Village C. There interviews (CKIIs) and household surveys. The network maps mainly rely on household are no links visualized which means that no HHs or CKIs reported accessing services in Village C. As there is a service located within Village C, it can potentially become a provider to other settlements in data; however, when household data was not generalizable, REACH used CKIs data. CKIs the future. were purposively sampled and assessed in every settlement, as opposed to HHs that were randomly sampled and assessed not in every settlement of the sampling frame. Households Settlements were connected by directed links when a connection between were asked for the specific locations of their service providers. CKIs provided answers on settlements was reported at least twice by households or community KIs. The behalf of the community and were asked where their community members were employed number of links determine the importance of these connections. The links and where they were accessing services. After the settlements were identified, both findings therefore do not represent the exact route people take to access settlements. were combined in order to establish patterns of service access and triangulate data. Directed Ex. 1: HHs and CKIs in City A and Village B mentioned twice or more accessing to Distant Location links between settlements represent frequently mentioned connections, mentioned at least and Town C. twice by households or CKIs. After visualizing the data, each settlement was assigned a role in the service provision Example of network map: network according to their location and connection with other settlements in the access and provision of services. The roles were (examples are given for employment networks): Primary service provider. A star is displayed on settlements that due to its importance in service provision, represents a service provision hub. Ex. 1: City A is a primary employment location within the network. Directed links display that this city is reported as a services provider in 2 (or more) HH surveys or CKI interviews in City B, Village D, and Town B. Ex. 2: A Distant Location is an employment location for City A and Town B, as well as for smaller Village A and Village B. A white box around the name of Distant Location indicated that it is a location outside of the map extent. Secondary service provider. Households and community KIs reported accessing services within the settlement as well as being a service provider to households from other settlements. Ex. 1: Town C is an employment location for people from Village B, which is located on the border of the assessed area, as well as for people from City A. Ex. 2: Town A has employment opportunities within, and some people from other settlements are employed there. There are no strong trends of HHs accessing services there from certain settlements, therefore no links were visualized. Primary service recipient. Households and community KIs reported accessing services (health, education, financial services, markets, employment) only in another location different from their settlement. Ex. 1: As reported among respondents during the assessment, people from Village D are not employed within the village. They have employment in City B and City A.