Since April 2014 more than 6,500 deaths have been reported in the Donbass region, where Ukrainian forces have battled Russian-supported separatist fighters for control. This political violence has led to humanitarian crisis. Unless action is taken right now to allow a humanitarian convoy through, more than 8,000 patients being treated for HIV or drug dependence have had life-saving medicines cut off, or will soon be without them.
An early casualty of the conflict in the Donbass was health care. To ensure that national resources did not fall into the hands of armed groups, the Ukranian government cut off funding in November to all facilities in the region, including hospitals, and told patients who remained in the conflict zone that they could travel to government-controlled territory to receive medicines. This was impractical for many people who are sick, poor or simply frightened. Health experts fear possible outbreaks of polio as mechanisms to monitor and respond to disease outbreaks are no longer functional in the territory. Also immunization coverage is low and safety of blood supplies is questionable in the territory.
Ukraine has one of the highest rates of HIV Infection in Europe: majority of the patients were infected with the virus through contaminated drug injections. Ukrainian programs helped control HIV infections in the Donbass, before the conflict, by providing sterile needles and syringes and methadone, a medicine the World Health Organization (WHO) recommends to reduce use of and craving for heroin. HIV infection rates among young people who inject drugs, reduced more than fivefold between 2007 and 2013 by the Ukranian health officials. But the Donbass conflict now threatens this progress.
More than 1,000 patients in the Donbass have either had their methadone stopped or reduced to substandard doses, forcing men and women to undergo painful withdrawal or return to street drugs, according to the International HIV/AIDS Alliance in Ukraine, a nongovernmental organization based in Kiev. Requests to the Ukrainian government to replenish methadone supplies, accompanied by an offer by Doctors Without Borders to oversee distribution, were met with the response that the medicine distributed routinely to hundreds of thousands of patients across Western Europe could be transported, under Ukrainian law, only by armed convoys. A number of patients sent a video appeal to government officials, saying they feared for their lives because their treatment had been interrupted. The video reported nine deaths due to to overdose or suicides after methadone treatments were ended.
In the Donbass, people living with HIV face a similar interruption in life-saving antiretroviral treatment. According to the WHO estimates, the supplies of HIV medicine will last only till mid-August in some parts of Donbass. The Global Fund to Fight AIDS, Tuberculosis and Malaria has offered to pay for more antiretroviral treatments, and UNICEF is willing to procure them. But no medicines by any humanitarian convoy has been delivered since February. Hopes of survival disappears for many who overcame discrimination and financial barriers to secure access to HIV medicines, as they see their antiretroviral pill supplies vanish. The WHO reports that medicines for multidrug-resistant tuberculosis which is diagnosed at high levels in the region, are also running low.
People in control of the self-proclaimed Luhansk and Donetsk People's Republics in the Donbass have shown little interest in protecting the lives of people with HIV. Violence against people who use drugs and other marginalized groups has been reported. The People's Republic of Luhansk has indicated that it does not want to continue opioid-replacement therapy (consistent with Russian policy) and has announced that United Nations agencies must register with them prior to provision of any humanitarian aid. The Ukranian Government has excluded themselves from any responsibility of the Donbass, passing a resolution that the rights of those remaining there are the responsibility of the "occupier". But the authorities in Luhansk or Donetsk have not taken measures to fill the HIV treatment gap, leaving patients in a desperate situation. No one should be forced to choose between fleeing their home and stopping life-saving treatment.
This humanitarian crisis can be solved. The Ukrainian government should permit passage of United Nations convoy with medicines funded by international donors. Those controlling the Donbass could also give the green light for the convoy. The government of Ukraine should work on an interim procedure to provide assistance to the population in these territories and facilitate the passage of humanitarian aid. The Minsk Group, led by France, Russia and the United States, should urge immediate action to restore the medicine supply in the Donbass.