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KIEV, Aug 17 2014 (IPS) - Doctors are warning of a worsening tuberculosis epidemic in Eastern Ukraine as the continuing conflict there begins to take a heavy toll on public health.
With thousands of people fleeing the region every day, medical supplies severely disrupted and those left behind under growing physical stress and increasingly unable to access medical services, conditions are ripe for a rise in new TB cases.
Dr Masoud Dara, Tuberculosis Programme Manager at the World Health Organisation (WHO) Europe, told IPS: “The situation with TB was not good before the conflict, but we can say that the conflict has certainly made it worse.”
Since the outbreak of hostilities and the Ukrainian military’s push to reclaim control of areas in Eastern Ukraine from pro-Russian separatists, health care providers in the region have come under increasing pressure.
Not only have hospitals been forced to deal with treating of casualties of the fighting, they have also had to cope with patients being moved in and out of hospitals and abandoning or interrupting treatment as the security status of individual towns and cities changes.
It has also become increasingly difficult to obtain supplies of vital medicines, and terrified staff – up to 70 percent of medical staff are estimated to have fled Donetsk and Luhansk, according to U.N. officials – have left hospitals and clinics.
The problems have been particularly acute with regard to TB. Ukraine has one of the worst TB problems in Europe, second only to Russia in terms of infection numbers.
According to official data, there are 48,000 people registered with the disease and it claimed the lives of just over 6,000 people in 2013. However, one in four people with TB are not officially registered, according to WHO.
The country also has a particular problem with multidrug-resistant tuberculosis (MDR-TB) which is much harder to successfully treat than normal TB.
WHO reports that Ukraine is one of “27 high multidrug-resistant tuberculosis (MDR-TB) burden countries in the world,” adding that “despite the adoption of the Stop TB Strategy by the National TB Programme (NTP), its components have not been sufficiently implemented.”
Organisations working in the region say they fear the disease will claim lives as the fighting is making it impossible to identify cases, monitor or guarantee timely treatment for those who need it.
Dr Dara told IPS: “There are indications that incidence of TB may increase. TB sufferers need to have medicines provided to them in a timely fashion and if that cannot be done and TB sufferers’ treatment is interrupted and they cannot access treatment elsewhere, there is a risk that the disease could then be spread and that people may die.
“We do not have detailed information at the moment on how exactly the conflict has affected the TB situation in Eastern Ukraine, but we do know that it has, at least, affected TB control efforts. It is hard to thoroughly implement checks on all people with TB in the conflict zone.”
Doctors in Donetsk, a city of one million and regional stronghold for pro-Russian separatists, have told humanitarian organisations working in the region of their fears over the fate of patients needing treatment.
Ole Solvang of Human Rights Watch, who carried out detailed research in Eastern Ukraine on the effects of the current conflict on the region’s health care, told IPS: “One hospital administrator in the main hospital in Donetsk told us that his hospital had a capacity for 1,200 patients but that because of the war they had only 450 at the moment.”
Solvang said that “the explanations put forward for this are that because people were afraid of travelling they were not coming to the hospital, that they were saving money and did not want to pay to get to hospital or that so many people have left the region because of the conflict.”
But his fear was that people with medical problems not connected to the conflict, such as serious diseases, are now not getting the treatment that they need.
Other doctors have warned that problems with medicine supplies because of the conflict could turn out to be an even bigger problem than the interruption of TB treatment.
One who spoke to IPS said that if a TB patient was given only a few drugs instead of the full range of medicines needed as part of treatment, it could lead to developing the much more dangerous drug-resistant TB.
The true scale of the problem with TB in the region is impossible to ascertain clearly because of the rapidly changing conditions in the conflict zone, while many under-pressure medical staff working directly in the conflict zone have been reluctant to speak in detail to anyone other than colleagues.
Regional officials also declined to comment when approached by IPS.
One doctor from Donetsk who spoke to IPS said that TB patients in regional hospitals, as well as hundreds being treated on an out-patient basis, were receiving the treatment they needed.
According to Dr Yuriy Semionovich, “there are 550 tuberculosis patients in Donetsk and Slavyansk hospitals at the moment. They are getting all the medicines and treatment they need. There are 200 patients treated on an out-patient basis and they too are receiving what medicines they need. We have the situation under control.”
However, some others are far more pessimistic in their assessment of the TB threat to the region.
Natalia Chursina, deputy head of the Donetsk Regional Tuberculosis Hospital, told local media earlier this month that “we will definitely have an outbreak in prevalence of all forms of TB after all this ends”.
Despite claims from some Ukrainian officials that the separatists will soon be dealt with and that fighting could be over in a matter of weeks, many experts say a quick end to the conflict is unlikely. And even if that were to happen, it is unclear how quickly medical service provision would return to normal, nor how many TB patients may have abandoned or interrupted treatment.
What is clear though is that without a change in current conditions, the situation with TB in the region is unlikely to improve any time soon.
“If conditions improve with regard to the supply of treatment, medicines and provision of health care services then we can foresee some improvement with the TB situation,” Dr Dara told IPS. “But without a change in those, then there is little hope that TB treatment can improve.”
(Edited by Phil Harris)
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