How war in Ukraine created new risks for viral hepatitis infections

Before Russia launched its full-scale invasion, Ukraine had one of the highest populations of people living with viral hepatitis in Europe. While the times of war increased the risks for infection, civil society is showing dedication to addressing the rising health concerns.

It was 1st June when a medical van stopped at Lozova, in Kharkiv oblast, Eastern Ukraine. Prior to Russia’s invasion, Lozova was home to 50,000 people – though the war has displaced over 30% of the country’s population, either internally or beyond Ukraine’s borders.

As the van stopped in the town, people started gathering around. The van is one of the six vans from the Alliance for Public Health in Ukraine that operate with medical teams aiming to address medical needs in the frontline territories as well as providing testing of viral infections.

During rapid testing for viral hepatitis C, two positive results were recorded – one for a 40-year-old woman, and the other for her 45-year-old husband. The following day another case was reported for a 37-year-old man in a different city – Shevchenkiv.

The unifying factor for the likelihood of infection, according to Iryna Filenko, a social worker of the Blago Foundation, was the local dentist in Kupyansk that they visited in the past six months.

“Perhaps the infection occurred there because this city is 8 km from the front. Frequent artillery fire. Frequent power outages. In the zone of active hostilities, non-compliance with the rules of instrument sterilisation is possible,” Filenko explained to EURACRIV.

The example Filenko gave encapsulates how wartimes increase the spread of viruses, such as hepatitis C. While sharing drug injection equipment is the driving risk for the virus spread, wartimes create new ways and new risk groups.

“In terms of injecting drug use, the risks remain as they were but they are higher now because people taking less care about sterility,” Tetiana Deshko, director of International Programs at Alliance for Public Health in Ukraine, told EURACTIV at the EASL liver congress in Vienna, Austria.

But frontlines create further risk groups, as there is a lot of blood contact among the military.

“I have to say military people are now so much affected by hepatitis,“ Deshko said, adding that so far there are no statistics on this available.

“We think that this is one of the gaps that the country would soon have to address more significantly,” she said.

Another risk group are sex workers, whose number increased in the frontline areas, according to Deshko, as destroyed industries have led to reduced employment opportunities.

Taking the increased risks of hepatitis spread into account, Ukraine is in a particularly difficult situation as “even before the war the situation with hepatitis was very challenging in Ukraine”. In the opening press conference of the EASL liver congress, Deshko said that an estimated 5% of the adult population lives with hepatitis C infection.

“It’s 1.3 million people, it’s a massive population,” she said.

Moreover, as viral hepatitis does not show symptoms until serious health complications occur, only one in 10 people infected with the hepatitis C virus are aware of their condition, Deshko said. Because of this, the disease is known as the “silent killer”.

Deshko’s organisation, the International Programs at Alliance for Public Health, responds to HIV, hepatitis and tuberculosis, going closer to communities with mobile units to ensure linkage to care to the risk groups. Since the war started, they also provide humanitarian help and general healthcare.

The group operates in frontline territories with a team of a doctor, a nurse, a social worker, and a driver. Among a number of medical tests available, they provide hepatitis C testing, as well as basic medications and hygiene products.

“First, you see no one,” Deshko started telling how the situation is when visiting with the mobile units.

“After 10 minutes, people start coming out from underground of their houses. And they’re often elderly people, but also young people. They say that they haven’t seen any medical worker for the last half a year or so. So they come with very basic needs,” she said.

The mobile units address a variety of medical needs, as access to healthcare is challenging in times of war – while at the same time providing a chance to diagnose people infected with hepatitis C.

“Health-seeking behaviour is very low in people. Especially men – when they offered rapid testing for hepatitis C, they would rather say no,” Deshko said.

“But if they are coming for humanitarian aid to get some things which are necessary for the home, while they are standing in the queue, there is time to persuade the person a little bit and really kind of motivate them to seek medical advice as well.”

However, diagnosis does not ensure treatment and with the majority of Ukraine’s budget dedicated to war, the situation still runs up against difficulties.

The Ukrainian government used to procure medications for treating between 16,000 and 18,000 patients with hepatitis C annually. However, currently, as 60% of the national budget is the war budget, according to Deshko, the number of treated patients was reduced to about 12,000 in 2022.

“It is largely because there are not enough medications to treat people and there are just too many structural barriers, populations are moving across the country. Some of the facilities are not available anymore as one in 10 health facilities in Ukraine has been either destroyed or damaged by Russian shelling,” she said.

When it comes to hepatitis treatment, of the 230 medical hospitals that offered treatment before the war, only around 80 are still offering the treatment.

While the Alliance for public health procured some medication, Deshko called it a “drop in the ocean”.

“War veterans are coming without hands and without legs. They have to have proper proteases but they also need to get the proper checks for hepatitis and other blood-borne infections,” Deshko urged.

“It’s so important that we think about this response now,” she said.

By Giedrė Peseckytė