Do countries taking in Ukrainian refugees have the ability to address their medical needs?
That's what Paul Spiegel, the World Health Organization's emergency coordinator for the Ukrainian refugee response, wanted to find out on his nearly 7-week deployment to cities in the Czech Republic, Poland, Romania and Slovakia where many Ukrainian refugees are currently residing. More than 5.5 million people have left Ukraine since the war started, with numbers rising every day, according to UNHCR, the U.N. refugee agency.
The answer, he found, is mostly positive. Based on his observations and his many conversations with refugees, health and government officials and charities, Spiegel believes that health-care facilities in the cities he visited "are able to take care of most of the situation right now." That is, at the moment there's enough capacity to take in refugees without overburdening the host country's health-care system.
Spiegel, the director of the Center for Humanitarian Health at Johns Hopkins University, returned to the U.S. in late April. He spoke to NPR about the medical needs of refugees and how this crisis compares to others around the world. This interview has been edited for length and clarity.
Ukrainian refugees are composed mostly of women and children because most men ages 18-60 have been banned from leaving the country. How are these refugees being greeted in these border areas?
The refugee-hosting European Union countries are extraordinarily welcoming to Ukrainian refugees.
This is a model response. Instead of staying in refugee camps, most of the refugees from Ukraine are staying with host families all over Europe or in hotels and dormitories for free. Governments are allowing them to work legally and are also providing [many of the same] health services as [provided to] national populations. That is extremely generous. There is a generosity and openness that I wish could be applied to anyone fleeing conflict and needing support, wherever they are coming from.
Is the welcome that refugees from Ukraine receive in European countries different from past refugee experiences?
In Europe, the migrants and refugees from Syria and countries in Africa were treated very differently. Walls and barriers were constructed to keep them out. However, many are fleeing violence and war and they have the right to asylum.
Ethiopia has welcomed hundreds of thousands of refugees from Somalia and other countries, but they are often put in camps and not allowed to work, and they rely on the U.N. and international NGOs [nongovernmental organizations] to set up education and health care programs for refugees.
And for Syrian refugees in surrounding host countries, access to health care varied according to country.
What are the most urgent medical needs for the refugees from Ukraine?
We need to be able to provide psychosocial and medical health care for their mental health needs. When the refugees arrived, they were in shock. You could see it on their faces. Seeing them was very emotional.
You share a story about a Ukrainian refugee woman in her 30s whom you met in Slovakia. She had fled with her mother. You were asking her a question — and at one point she was suddenly overcome by stress and the conversation abruptly ended.
Her face went blank. It was difficult to speak to beyond giving food and asking: How can we help you?
What does mental health care look like?
We need to make sure there are counselors and places for those under stress [and suffering from trauma] to see someone who will listen, provide talk therapy and evaluate [the need for psychiatric] hospitalization.
This applies to children as well as adults. I was in a train station in Romania where adults and children were staying overnight. A psychosocial counselor from a local NGO who was working with the children told me that a few of the children were not interacting with others and had signs of stress and trauma. Some of the children were drawing tanks, people being killed and other things they saw in the war. They would benefit if they could find mental health support from people who spoke their language and understood their culture, but it's not easy when the children are on the move to another country.
There are horrific reports of rape in Ukraine. In one account documented by NPR, Russian troops kept 25 women in a basement outside Kyiv and repeatedly sexually assaulted them. What needs to be done to help survivors of gender-based violence?
There are more and more reports of rape committed by Russian soldiers [on Ukrainians]. Refugees who have experienced this while they were in Ukraine must receive psychosocial support as well as proper medical care and treatment. And they must be addressed with sensitivity, because people can be embarrassed or reluctant to come forward to report. Differences in language or cultural attitudes can make this more difficult.
We have to map out a pathway to make sure there are sufficient facilities and people to provide this type of medical help and counseling and also make sure the refugees know how to access that support and treatment.
Do you foresee possible problems?
The biggest concern is that as the war continues, there will be refugee fatigue among the host countries.
At the start of the war, we did not know how long it would go on. Most people were thinking about hosting the refugees for a few weeks, not months or beyond one year. After a while, generosity can begin to decline.
This occurs, sadly, in most refugee settings over time. In Lebanon and Jordan, we have seen resentment grow among the host populations due to a variety of reasons. Both of these countries, for example, provided cash [aid] for vulnerable refugees. However, equivalent government programs were not always in place for nationals.
Can host countries counter such resentments?
To guard against such resentments, [the host countries] need to think about putting into place policies that also help vulnerable nationals and not only the refugees. If nationals [in need of assistance] perceive that refugees are receiving more than they are, it can exacerbate tensions, transforming generosity into resentment. We need to diminish that possibility.
Diane Cole writes for many publications, including The Wall Street Journal and The Washington Post. She is the author of the memoir After Great Pain: A New Life Emerges. Her website is DianeJoyceCole.com.
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