Christine:   Welcome to today’s Ukraine crisis update.  We’re focused on the humanitarian need. I’m Christine Squires and with me we have Dr. Julie Varughese who is the Chief Medical Officer and Adam Keehn is the Director of Complex Emergencies. He is in Poland working on the response. It is hard to believe that it was just two weeks ago and more than 2 million have fled. It’s expected more than 4 million will leave. There are 12 million right now in need of assistance. This is a complex crisis of epic proportions and deserves a global response.  Americares is responding and we have a shipment of medical supplies and emergency medical teams ready to deploy so we can meet the needs of the crisis.  We’ve been doing this 40 years. We are responding and ready to respond. Adam is our Director of Complex Emergencies in Poland now. You’ve been assessing the situation, what are you seeing and hearing? 

Adam:   Hello Christine and thanks for having me on. We are seeing what people are seeing everywhere.  Refugees, the flow has been non-stop and increased over the past week or so. These people are families mostly, many women and children. Not so many men because they’re told to stay and fight. They’re carrying all their belongings with them. It’s a desperate situation and you can see it in their eyes.

Christine:   Adam, thank you.  You told me a story of a multigenerational family that you encountered.  Can you share that? 

Adam:     We were at the train station in an a town where refugees were waiting to embark to Europe and there were six or seven people in this multigenerational family. They had contacts in Germany and they were hoping to reach them but they had everything they owned and they had come from the east of Ukraine, the region that has been under Russian control since 2014 and they did not intend to return to Ukraine. They were leaving for good.

Christine:   What are the health needs you’re seeing right now in Poland on the border and what you know about inside Ukraine? 

Adam:   We’re getting requests from the hospitals and health clinics from the closest large city in western Ukraine and they’re requesting all sorts of things, everything from regular prescription medications to bandages, gauze, wound treatment medications, antibiotics and so on.  Here in Poland, you see elderly people that had to leave without medications. A team was in Krakow where I am. And our physician on the team was interviewing an elderly man showing the medications he had for his heart condition and it was among the last dosage he had. She noticed his ankles were swollen and was concerned about what that would mean for him. On the plus side she told me many private citizens and organizations are providing hygiene kits and basic supplies to refugees to help them get to their final destinations.

Christine:   Julie as you hear Adam talk about this, what are you most concerned about? 

Julie:   Thanks, I would echo everything he said in terms of the concerns around chronic disease. That story highlights what a lot of people are going through. They left their homes and grabbed whatever they could and many do not have a significant supply of medications for diseases like diabetes and asthma and we’re going to see the exacerbations of those situations. I think about the mass movement of people and where they’re ending up. The conditions may be tight quarters, a lot of people, so there may be outbreaks of diseases like COVID-19 and a number of other gastrointestinal conditions, so expect that. And Adam mentioned the significant amount of women and children and there’s so many things to think about with that. Protection issues for women and young girls. Gender based violence.  And the other backdrop is mental health. These are groups of people that have been through acute trauma with everything going on in the last few weeks so the mental health will be immense in the days, months, and years to come.

Christine:   I want to come back to that and as of 2021, there are 26 million people classified as refugees.  And about 16 thousand of them have been settled. So this is going to be a long-term situation we need to address. What are you learning about getting the supplies to the people? 

Adam:   The logistics are improving. On the Polish side in both directions, authorities have been trying to facilitate movement as much as they can. It’s a question of traffic and there are also issues related to customs depending on the things there. There’s a shortage of trucks here in the Krakow area but we were lucky enough to make a connection through a friend of Americares who has been doing business with us and helped us gain access to trucks he’s been using and using his own personal funds to ship to Ukraine. And there’s a potential vehicle by using trains to take supplies into the country.

Christine:   Thank you for mentioning the partnerships. We have to be nimble and quick to get the supplies where they need to be. Adam, we’re talking about two million people who have fled the country and are dealing with unimaginable trauma, something most of us will never experience, so talk about some of the short-term needs for trauma and mental health and maybe Julie pick up on that and talk about what we can do in the longer term.

Adam:   Julie raised the issue of trauma. You can imagine and if you’re watching the news, you can see the desperation and anguish and fear. It’s exacerbated by the separation that the families are going through, leaving behind loved ones and friends and that kind of trauma, we know from experience sadly that it exacerbates the physical conditions. So we’re rolling out psychological first aid. And these are intended to address the immediate psychological things that people are experiencing. Not a therapy but more of an active listening where a sympathetic person can provide a pair of ears to listen to the issues and provide support and refer people to resources for longer term treatment where that is possible.  We’re lucky enough to have established a relationship with the Jewish community center which itself has been connected to a number of smaller NGO’s. The Jewish community was established to help Holocaust survivors to make sure they have everything they need to survive and thrive. But their doors are open to anybody in difficulty and they have a Ukrainian flag flying out front and have been receiving donations and providing support to smaller Polish NGO’s that are providing a variety of services.

Christine:   Thank you for talking about that.  Especially the psychological first aid and mental health and stress and trauma is something overlooked but it’s all connected. Julie, thinking about mental health, what are your concerns? 

Julie:   Adam highlighted the importance of immediate responses around comfort and support and reassurance and compassion. In the longer term, I think of anxiety and depression and I think of people already dealing with this are now going to be dealing with new symptoms and what it means for individuals and families. In the context of mental health and refugees, we think about how to support the communities who have fled their home countries and I think that is an important component. When you think about the health system at large that are receiving refugees, even the most sophisticated system doesn’t have the capacity to absorb the volume of individuals entering the communities whether it’s flow surge support and staffing. In Colombia we helped with technical assistance. So we worked with incorporating stress awareness and stress management, and we saw improvement  when they had more awareness and coping tools to manage the stress. So keep in mind ways to support the refugees as well as the support staff. So mental health, our work in Colombia highlights that. We’re providing mental health services and I think about refugees navigating a new system, having everything in one place will be important. So bringing the primary care on service as well as mental health. 

Adam:   If I could pick up on that. Julie’s point is important and maybe less understood in the general population. You know, wherever refugees are moving across borders, they have to go somewhere and our communities are often in similar circumstances. That is not entirely the situation here. When you have 2 million, possibly a million people come through, it’s going to put pressure on the healthcare system and we have seen that in parts of Africa where there’s pressure on the communities receiving refugees and it breeds ill feeling. That hasn’t happened here yet and as I described earlier, the Polish are nothing but warm and welcoming but over time that is going to continue to build and this is an issue that is going to go on for months and years, not days and weeks.

Christine:   Speaking of Colombia, I got back from there a couple days ago and we’re meeting the long-term needs of migrants and I saw it’s a stress on the health system in Colombia, so it’s an important point and we’ve seen the situations over and over in different contexts.

Julie:   If I could add one other thing, we have to think about dealing with healthcare systems who have been dealing with COVID-19. So healthcare that has depleted over the last couple years and now dealing with the crisis.

Christine:   Very important point. Thank you, Julie. Julie mentioned before a concern that we see over and over when we have situations about safety for women and girls, for gender-based violence.  Adam, can you tell me about the security and what’s being done to provide protection?

Adam:   As people come across the border, they’re leaving a country so their immediate reaction is to be in a place where the authorities are being as helpful as they can to provide support but when we’re seeing families with young children, there’s a huge risk to them of bad actors taking advantage of their vulnerability. So organizations like ourselves, we’re trying to make sure we know where these unaccompanied minors are and making information available to them about where to get support and services to include phone numbers. The authorities here in Poland have said they’re going to ensure the safety of the refugees.

Christine:   For example, how is this going to affect the supply chains in other countries especially the Middle East, Syria, and the horn of Africa? So Adam can you share your thoughts on that? 

Adam:   It’s a huge concern, Yemen has been in crisis mode for many years and Syria even longer. Not to mention other places elsewhere. Conditions there are still dire. The only hope is the attention will have a ripple effect of sympathy to the refugees that are all over the world. Yemen is another war provoked by the powers that are fighting among themselves with the populations that are powerless. And it’s an extreme challenge to take enough support to address what’s going on there. So as I said, I hope this raises everybody’s awareness that there are other crises around the world that need attention.

Christine:   So you have seen these around the world. How does it differ from Ukraine and Europe and anything else you want to from your perspective?

Adam:   It’s quite robust, although my internet was out yesterday for most of the day, generally things are working quite well; whereas in other places, the infrastructure of the receiving country is problematic. So that is a saving grace that people are able to arrive in a country where there are supports. But as we talk about that, that infrastructure is stressed seriously and as time goes on, it’s going to be more serious. So yeah, it’s — refugees anywhere are going to be placing pressure on the countries and communities receiving them. That’s no less the case here. When Syrian refugees flowed into Europe, it created a huge crisis around country’s willingness to receive refugees. Although the situation here and in Romania and others has been a warm welcome. I think we can expect over time to see the welcome strained. So it’s all the more reason for us to continue to make our best efforts to support the communities receiving the refugees coming in.

Christine:   Very important because Americares will be there and focus on that — Julie, anything to add? 

Julie:   Lessons are applying to any country. Some of the same needs are ongoing supply of medications, primary care and mental health and really the focus on long-term and traumatic needs and support there.

Christine:   Thank you so much. Adam, thank you for joining us from Poland. We appreciate you sharing and please stay safe. Julie as always, thank you for joining us and for your perspective and your comments. I do have an ask. Again, I want to thank the supporters. It means you’re curious and you care and listen. This is unimaginable and our heart goes out to everybody in Ukraine and everybody fleeing. I know many of us have family and friends in this situation. Thank you for joining. I am going to ask — we need to raise $20 million dollars for this response in the near- and long-term. So if you can help, go to americares.org/Ukraine. Thank you for your support to learn more. Thank you, Adam and Julie, for joining us today.  Thank you. 

Adam:   Thanks. 

Julie:   Thanks, Christine.

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