HEALTH CLUSTER BULLETIN # 12 April-May 2021 Ukraine Emergency type: Protracted Emergency Reporting period: April-May, 2021

2021 HRP Overview Health Cluster 2021 1.3 million people targeted by the Health Number of partners: 69 2018 Cluster in 2021 National authorities IGO 6% 473,260 people benefited from healthcare 4% INGO Others/Observers 28% services in the first quarter of 2021 7% (January-March, 2021)1 20 projects approved for 2021 HRP United Nations 13% USD 28,7 million funds requested USD 4,4 million funds received (15,2% of NNGO Donor requested) 19% 23%

CO Health Cluster – Summary

Health Cluster and WHO continued to coordinate health partners throughout Ukraine and particularly in the eastern conflict area (ECA). In April and May, the Cluster conducted four coordination meetings, including questions and answers (Q&A) sessions on relevant health topics such as quality assurance process for personal protective equipment, laboratory diagnostics of COVID-19 in Donetska and Luhansk oblasts, GCA and WHO Emergency Care System Framework.

Health Cluster developed the Incident Management COVID-19 5W Dashboard to visualize COVID-19 related activities and supplies. The dashboard reflects COVID-19 activities from all Health Cluster partners and includs inputs from WASH and Protection Clusters. With support of partners, the Cluster also completed data collection and analysis of HRP activities for Q1 2021.

1 This number represents reports from partners received as part of Q1 HRP reporting, collected during January-March, 2021.

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Health Cluster in partnership with REACH Initiative initiated an assessment to analyze and Luhansk GCA residents’ perceptions about health status, access to healthcare and healthcare services. The assessment will contribute to a wider-scale Health Assessment coordinated by the Health Cluster and aims to fill information gaps defined in the Public Health Situation Analysis (PHSA).

From 19 to 30 April Health Cluster conducted a two-weeks mission to Donetska and Luhanska oblasts, GCA. Objectives of the mission included meeting Health Cluster partners, assessing COVID-19 and humanitarian health response, visits to primary and secondary health facilities and assessment of Emergency Medical Services. Results of the mission are currently being applied for informing preparedness and response operations.

From 3 to 15 May Health Cluster in partnership with WHO conducted Rapid Assessment of ten health facilities in Donetska and Luhanska oblasts, GCA. The assessment was conducted using a specific tool designed for on sites visits. Assessment findings will be considered for the 2022 Humanitarian Need Overview (HNO).

Health Cluster conducted consultations related to potential escalation of the conflict in eastern Ukraine. As a result, the cluster developed a sectoral contingency plan, to become part of the inter-agency plan of the Inter-Cluster Coordination Group (ICCG).

COVID-19 situation overview

Epidemiological situation in ECA

In Government-Controlled area (GCA) situation has started to stabilize. In Donetska oblast number of confirmed cases has increased (89,342 cases as of 31.05.2021 comparing to 57,998 cases on 30.03.2021). According to the UPHC, in Donetska oblast, cumulative test positivity rate is 26.1%. Number of recovered cases is 83,694, number of death - 2,250 as of May 31. As for health care workers, there are 3,011 confirmed cases, of which 2,904 recovered and 42 died. In Luhanska oblast, 26,147 confirmed cases have been reported (11.4% - test positivity rate), 23,906 patients recovered and 893 died. As for health care workers, there are 1,500 confirmed cases, of which 1,460 recovered and 17 died.

Suspected Confirmed 2000 1600 1400 1500 1200 1000 1000 800 600 500 400 200 0 0

Donetska oblast, GCA

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Number 14-day Case Active cases Bed of Confirmed Recovered Deaths Active incidence fatality per 100,000 occupancy available rate rate population rate beds

89342 83694 2250 3398 132.7 2.5% 180.9 3139 30.1%

Luhanska oblast, GCA

Number 14-day Case Active cases Bed of Confirmed Recovered Deaths Active incidence fatality per 100,000 occupancy available rate rate population rate beds

26147 23906 893 1348 111.7 3.4% 200.5 1312 25.7%

Limited case-based data is being provided regarding Non-Government Controlled Area (NGCA), impacting the possibility of further analysis. In Donetsk, 38,851 cases have been reported as of 30 May, including 31,401 recovered and 2,927 died. In Luhansk, 4,767 cases have been reported on 30 May, including 4,136 recovered and 439 died. High infection rate among healthcare workers remain one of the of the major concerns reported in NGCA. For health care workers in Donetsk NGCA, 126 cases have been reported.*2

Donetska oblast, NGCA

New cases New cases Case Cases among including including Confirmed Recovered Deaths Active fatality health care arrived from arrived from rate workers GCA Russia

38851 31401 2927 4523 -* -* 7.5% -*

Luhanska oblast, NGCA New cases, New cases, Case including including Confirmed Recovered Deaths Active fatality arrived from arrived from rate GCA* Russia*

4767 4136 439 192 - - 9.2% -

Public health situation

The COVID-19 situation in eastern conflict area is gradually stabilizing: new infection, hospitalization and death continue to decline in both Donetska and Luganska oblasts, GCA. Starting first week of May, more patients are discharged than

2 * signifies that the number may not be representative of the real situation due to lack of information available.

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newly admitted. The situation is expected to continue on the same trajectory at least till mid-summer. Significant proportion of cases are reported from major urban towns and cities although reporting at rural level is quite poor.

Vaccine acceptance among the population of Luhanska and Donetska oblasts, GCA hasn’t significantly changed since August 2020. According to WHO’s Behavioural Insights (BI) study on COVID-19 in Eastern oblasts of Ukraine, 59% of respondents in Luhanska oblast and 42% in Donetska oblast stated to be prone to get a COVID-19 vaccine if it becomes available. These findings are coherent with the 48% average acceptance rate across all Ukraine. Majority of respondents stated to not planning to receive a COVID-19 vaccine due to fears over adverse effects followed by concerns about the country of production of the vaccine.

On May 4 the Mariinsky Central District Hospital in Krasnogorivka, eastern Ukraine, came under shelling

In the night between 4 to 5 May 2021, an attack on the Mariinsky Central District Hospital took place in (Donetksa Oblast). The city is located in close proximity to the “contact line” (0-5 km, government-controlled areas). Luckily, all 45 patients who were in the facility did not sustain injuries. The hospital is COVID-19 designated and there were 45 patients, out of which 38 COVID-19 patients in need of oxygen therapy. From the start of the conflict in 2014 health facility periodically suffered from artillery shelling. The incident was reported in the WHO global system for attacks on healthcare (SSA). On 7 May, following the accident, Humanitarian Coordinator in Ukraine, Ms. Osnat Lubrani, issued a statement calling for the protection of critical civilian infrastructure in eastern Ukraine.

Government response

On 16 May Ukraine received the first vaccines from COVID-19 under the COVAX mechanism. The supply of vaccines from various manufacturers under COVAX will continue, and it is expected that by the end of 2021 these supplies will allow to cover up to 20% of the population of Ukraine.3 In total, as reported by the Ministry of Health on 11 May, Ukraine has made deals for 42 million doses of vaccines by the end of 2021, under direct contracts between the Ukrainian Government and vaccine manufacturers. More specifically, there will be 20 million doses of Pfizer vaccines, 2 million doses of AstraZeneca, 10 million doses of NovaVax and 1.9 million doses of Sinovac/CoronaVac vaccines. And also 8 million doses of vaccines from the global initiative COVAX.4

Government of Ukraine is set to improve provision of emergency medical care across Ukraine. As reported by the Prime Minister Denys Shmyhal on May 21, funding for emergency medicine in 2021 has increased by almost 2,5 times: from 6 billion UAH in 2019 to 14 billion UAH in 2021. Among other things, the additional budget will cover increase in payments to doctors, purchase of new cars, repairs of emergency departments and installment of high-quality equipment.5

3 Ukraine received the first vaccines from COVID-19 under the COVAX mechanism. (2021, April 16). Ministry of Health in Ukraine. https://moz.gov.ua/article/news/ukraina-otrimala-pershi-vakcini-vid-covid-19-v-ramkah-mehanizmu-covax 4 Ministry of Health of Ukraine. (2021, May 11). Cabinet of ministers of Ukraine - Ukraine has made deals on 42 mn doses of COVID- 19 vaccines. Gov.ua. https://www.kmu.gov.ua/en/news/moz-ukrayina-zakontraktuvala-42-mln-doz-vakcin-proti-covid-19 5 Communications Department of the Secretariat of the CMU. (2021, May 21). Prime minister: Funding for emergency medical care has increased significantly. Cabinet of ministers of Ukraine. https://www.kmu.gov.ua/en/news/premyer-ministr-finansuvannya- ekstrenoyi-medichnoyi-dopomogi-suttyevo-zbilshilosya

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On May 29, 2021 Government launched three mass vaccination centers against COVID-19: in Kyiv on the basis of International Exhibition Center, in L’viv on the basis of Arena L’viv Stadium and in Odessa on the basis of Odessa Law Academy Stadium. These centers will be open on weekends. They will vaccinate citizens who have signed up for the COVID- 19 vaccination waiting list in the app or through the Ministry of Health's contact center. Pilot vaccination centers are being opened to test the algorithm of mass vaccination in large premises. When Ukraine receives more vaccines, such centers are to be established in other large cities.6

Key Cluster Updates and Initiatives

Health Cluster missions to the eastern Ukraine

1) Data collection mission to the eastern Ukraine, GCA (5-9 April, 2021)

From 5 to 9 April, Ms. Iryna Koval, Partnerships Coordination, Planning and M&E Consultant and Ms. Oleksandra Abrosimova, National Consultant Information Manager, supported by the WHO field officers Mr. Oleh Mikhalov and Dr. Igor Novikov, conducted a one-week data collection mission to Donetska and Lukanska oblasts, GCA. The mission was organized as part of a broader Health Assessment and aimed to obtain regional level data on key public health topics, including mortality, vaccination, HIV/TB, mental health, sexual and reproductive health. The data obtained from the mission will be inputted into Health Cluster Monitoring and Evaluation (M&E) Framework and will inform various sectoral analysis produced by the Health Cluster.

2) Coordination mission to the eastern Ukraine, GCA (5-9 April, 2021)

6 Ministry of Health of Ukraine. (2021, May 28). Pilot centers for mass vaccination against COVID-19 open in Kyiv, Lviv and Odessa. moz.gov.ua. https://moz.gov.ua/article/news/pilotni-centri-masovoi-vakcinacii-proti-covid-19-vidkrivajutsja-v-kievi-lvovi-j-odesi

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From 19 to 30 April, Health Cluster Coordinator Dr. Emanuele Bruni conducted a two-weeks mission to Donetska and Luhanska oblasts, GCA. As part of his visit, Dr. Bruni met main Health Cluster partners operating in the area (UNHCR, MDM, MSF, PUI, etc..), monitored COVID-19 and humanitarian health response, visited primary and secondary health facilities and assessed Emergency Medical Services across the two oblasts. Detailed presentation from the visits is available here. Results of the mission are currently being applied for informing health and response operations.

Health Cluster contribution to the Inter-Agency Contingency Plan (IACP)

In March 2021, the geopolitical context of the armed conflict in eastern Ukraine deteriorated including an increased bellicose political rhetoric, scaled up military presence along the eastern and southern border with the Russian Federation coupled with intensification of military clashes and use of heavy weapons. Following the decision of the Ukraine Humanitarian Country Team (HCT) to strengthen emergency response preparedness, Health Cluster as part of the Inter- Cluster Coordination Group (ICCG) undergone a review of the Inter-Agency Contingency Plan (IACP), requesting additional USD 3.5 million for new and existing health activities which need to be scaled up in case of potential escalation of the conflict. The IACP is currently being finalized and will be shared with all Health Cluster partners once ready.

The Incident Management COVID-19 5W Dashboard

Health Cluster developed the Incident Management COVID-19 5W Dashboard to visualize distribution of COVID-19 related activities and supplies. The online dashboard was developed using Power BI technology (presented below) and incorporates inputs from Health, WASH and Protection Clusters. As of May 2021, the dashboard reflects information from 20+ partners, covering up to 500 health facilities, 200 settlements and almost 1 million medical supplies. The platform is being updated regularly, with a frequency of eight weeks.

The Incident Management COVID-19 5W Dashboard is available here.

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Rapid assessment in selected health facilities of Donetska and Luhanska oblasts, GCA

From 3 to 15 May, Health Cluster in partnership with WHO conducted rapid assessment in selected health facilities across Luhanska and Donetska oblasts, GCA. The aim of the mission was to conduct in-depth assessment of the situation and conditions in selected health facilities and identify potential areas of intervention by WHO/Health Cluster partners.

In total, the mission targeted 10 health facilities within 0-20 km from the ‘contact line’, particularly:

Donetska oblast: • Centre of Primary Medico-sanitary Aid (CPMSA) • Toretsk City Hospital • Nikolske Central Raion Hospital • Manush Centre of Primary Medico-sanitary Aid (CPMSA) • Zoria Outpatient Clinic of General Practice – Family Medicine

• Luhanska oblast: • Markivsky Centre of Primary Medical and Sanitary Care • Troitsky Centre of Primary Medical and Sanitary Care

• Troitsky hospital • Milovsky Central District Hospital

• Milovsky Centre of Primary Medical and Sanitary Care

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Questions and Answers (Q&A) Session on quality assurance process for personal protective equipment

On 14 April, Health Cluster in partnership with WHO conducted a Q&A session dedicated to quality assurance process for personal protective equipment (PPE). As part of the session Dr. Svitlana Pakhnutova, Medicines Policy Officer at WHO CO in Ukraine, briefed partners about WHO project on assessment of quality of PPE, Ukrainian PPE manufacturers who have passed testing in the EU laboratory, WHO quality assurance procedure for PPE and specifications on masks and respirators, as well as conclusions and recommendations for partners and MOH in Ukraine. Detailed presentation and minutes from the meeting are available here.

Questions and Answers (Q&A) Session on laboratory diagnostics of COVID-19 in Donetska and Luhanska oblasts, GCA

On 28 April, Dr. Artem Skrypnyk, Technical Officer on Laboratory, National Professional Officer at WHO CO in Ukraine, briefly discussed COVID-19 diagnostics in Ukraine, specifying points of care, situation with capacities of laboratories and existing needs. The presentation attracted a lot of interest among partners and raised additional questions such as availability of data on performance of laboratories, availability of PCR tests at points of care and nessecity to scale up testing and contact-tracing. More information can be found in the presentation and meeting minutes available here.

WHO presentation on SARS CoV 2 Transmission in Ukraine: Estimation and Projections

On 28 April, Mr. Aron Aregay, WHE Information Management & Risk Assessment Officer, presented the outcomes of the latest modelling on SARS- COV-2 transmission in Ukraine, covering projections for April – June 2021. In summary, all models present evidence for decline in transmissions, but many regions remain vulnerable (including Donetska and Luganska oblasts). The projections were further reviewed in May and will be presented at the upcoming cluster meetings. Detailed presentation and minutes from the meeting are available here.

Questions and Answers (Q&A) Session on WHO Emergency Care System Framework and Assessment Tool

On 26 of May, WHO Representative Dr. Israel Gestoso presented WHO’s Emergency Care System Framework - a systematic approach to emergency care, centered on acuity-based triage, early recognition and resuscitation, and simple initial management and referral. In his presentation, Dr. Gestoso adressed key benefits and challenges of the EMS framework, as well as current situation of the Emergency Care System in Ukraine. Detailed presentation and minutes from the meeting are available here.

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Presentation of Protection against sexual exploitation and abuse (PSEA) initiative

On 26 of May, WHO Specialist in Emergency Medical Services and Clinical Management Dr. Israel Gestoso presented WHO’s initiative to combat sexual exploitation and abuse. As part of his presentation, Dr. Gestoso spoke about WHO’s ethical principles and code of conduct (including personal conduct principles), role of managers in situations of harassment and sexual exploitation and abuse, principles of whistleblowing and protection against retaliation, as well as process, roles and responsibilities in reporting concerns of unethical behavior. Detailed presentation and minutes from the meeting are available here.

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Humanitarian Programme Cycle 2022: preparations started!

Health Cluster together with Inter-Cluster Coordination Group (ICCG) began working on Humanitarian Programme Cycle 2022. The tentative calendar of the HPC process is presented below.

Update from the MHPSS TWG

Mental Health and Psychosocial support working group continues to regularly conduct its monthly coordination meetings at national level and once two months on a regional level (covering partners operating in Donetska and Luhanska oblasts).

In April MHPSS TWG together with Child Protection (CP) sub-cluster within the piloting project of “Save the children” held a meeting on strengthening referral pathways for the partners working in the field in psychosocial support (PSS) response with various target groups. Partners expressed the challenges in the referral mechanisms between non-governmental and governmental organizations and the importance of having unified at all levels referral form. Taking into account the demand, MHPSS TWG will continued working on the service map to support the strengthening the referral mechanisms for partners operating in the field.

The updated MHPSS service map that was developed with the data support of Health and Protection cluster, as well contains the additional and updated layer of the GBV services all over the country from the respective sub-cluster. The user guides were also developed and disseminated among the partners. The group is aiming to improve the tool for referral purposes and planning the workshops for the partners operating in the fields to increase the practical features of the map. The tool is available following the link.

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Useful Links and Resources

• Updated Health Cluster Page on Humanitarian • Community needs, perceptions and demand: Response Info website community assessment tool for COVID-19 • Monitoring COVID-19 vaccination: Considerations • COVID-19: Occupational health and safety for for the collection and use of vaccination data health workers • COVID-19 vaccine checklist: for frontline health • Interim Guidance on Public Health and Social workers planning a COVID-19 vaccination session. Measures for COVID-19 Preparedness and • Roadmap to improve and ensure good indoor Response Operations in Low Capacity and ventilation in the context of COVID-19 Humanitarian Settings • COVID-19 vaccination: supply and logistics guidance • IASC Key Messages to Fast-Track Health and Aid • Definition and categorization of the timing of Workers and Supplies at Borders and in Countries mother-to-child transmission of SARS-CoV-2

Contacts

Health Cluster MHPSS Working Group TB/HIV Working Group

Emanuele Bruni Alisa Ladyk-Bryzgalova Martin Donoghue Health Cluster Coordinator MHPSS Working Group TB/HIV Working Group [email protected] [email protected] [email protected]

Iryna Koval Oksana Dmytriak Partnerships Coordination, Planning and M&E MHPSS Working Group Consultant [email protected] [email protected]

Oleksandra Abrosimova National Consultant Information Manager [email protected]

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