The Russian invasion has displaced over 6 million Ukrainians across Europe,1 exacerbating pre-existing health system challenges in refugee-receiving countries, which now face both acute and long-term health demands from displaced and local populations. A WHO European Region report,2 drawing on a rapid systematic review and expert interviews from seven countries, highlights the significant physical and mental health needs of refugees. It also examines the acute and medium-term responses and considers transformative policy opportunities to enhance health system resilience and sustainability as the conflict continues.
In the case of prolonged conflict or escalation, health systems in the WHO European Region must go beyond short-term adaptations to ensure comprehensive health coverage while managing emergencies and ongoing displacement.
Countries hosting large numbers of refugees face significant challenges, and must find ways to effectively integrate displaced populations into their health systems. Disruptions in health care for those requiring continuous treatment both before and after leaving Ukraine complicate this process. Host countries must address barriers to accessing primary and specialised care, workforce shortages, and the need for sustainable financing. Overcoming these hurdles requires tackling governance and financial constraints, considering diversity and linguistic differences, coordinating cross-border care, mobilising financial resources, and leveraging international solidarity.
Transformative actions are needed to close service gaps and strengthen systems to manage future crises. A coordinated European response is also required to address the unequal distribution of displaced Ukrainians, as countries with weaker health and economic systems are hosting disproportionately higher numbers of refugees.2
The displaced population from Ukraine consists mainly of women, children, and elderly individuals, with complex health needs including noncommunicable diseases (e.g., cardiovascular, cancer, diabetes), infectious diseases like HIV/AIDS and (multidrug-resistant) tuberculosis, mental health issues, and sexual and reproductive health concerns. A key priority has been catching up on missed vaccinations for children, while the need for rehabilitation and long-term care grows as the conflict persists.
So far, much has been achieved. Refugee-receiving countries have quickly established health services, initially focusing on primary care and immunisations and later expanding to include more specialised services. Multisectoral collaborations have facilitated this response involving governments, NGOs, and international agencies. Facilitated by the EU's Temporary Protection Directive,3 countries have modified legislation to provide access to national health care.4 But challenges remain in accessing primary and specialised care, due to language barriers, organisational issues, lack of effective mechanisms for cross-border health information exchange, and workforce shortages.
Multisectoral approaches involving international and national agencies and NGOs have been vital for managing the crisis. International organisations have coordinated efforts across borders, creating regional hubs to support logistical and medical responses, such as the EU-funded Medevac hub in Poland.
Health financing, including resources for mobilising and sustaining the response, has been a critical challenge, especially where displaced persons are not fully integrated into national financing systems, or where they cannot contribute due to disability or care responsibilities.2 Staff shortages in the health care sector are a common issue, although some countries have made considerable efforts to integrate displaced health professionals into their workforce.
The experience so far has provided many important lessons (Fig. 1). First, primary care and specialised services, including social services, need to be better integrated to meet the diverse health needs of refugees. This includes providing more comprehensive care that addresses noncommunicable diseases and mental health needs. Adapting service delivery towards network-based, managed and integrated care that adequately overcome language barriers and are diversity-sensitive will be instrumental to achieve this.2
Fig. 1.
Key areas for action towards transformative policy responses to displacement in Europe. Policy recommendations are derived from a rapid systematic review, key-informant interviews in seven refugee-receiving countries (Czechia, Estonia, Georgia, Germany, Republic of Moldova, Poland, and Slovakia), and formal and informal consultation with experts involved in the response.
Second, as displaced Ukrainians may continue moving within Europe, and many families have been separated, there is a critical need to coordinate cross-border health care, particularly to ensure continuity of care through effective data sharing (Fig. 1). Digital tools, such as telemedicine and mobile health solutions, can help close service gaps, especially in mental health care. Third, Pan-European professional networks, which have played a pivotal role in monitoring health care capacities and facilitating cross-border service and data exchanges, will be instrumental in creating more sustainable and integrated cross-border care systems.2
Fourth, while acknowledging the economic contributions of displaced individuals,5 countries hosting many displaced persons face significant challenges. Fiscal impacts may escalate, particularly considering the persistence of complex needs and ongoing displacement. While integrating refugees into national financing systems is essential,6,7 establishing reliable international mechanisms to share financial responsibilities8 and mobilise additional funds7 is critical for sustainable responses.2,9 This is particularly important in countries with weaker health system and economic capacity (Fig. 1).
Fifth, gaps in health information systems,10 which play a key role in tracking the health needs and service usage of displaced persons, need to be closed. Strengthening these systems to collect disaggregated data (Fig. 1) will enable better monitoring of refugee health and disparities of health care needs, and inform service provision.
Contributors
Conception: KB, MM, NB. Writing–first draft: MM, KB. Review & Editing: ER, MK, AZ, NB. Figures: ER.
Declaration of interests
KB and AZ report individual funding from the WHO Regional Office for Europe related to the work. KB, AZ and ER report travel support by the World Health Organization to present findings of the report on the Sub-regional Technical Meeting on Mid-to Long-term Solutions related to Ukraine (11–12 June, 2024). The authors declare that they have no conflict of interest.
Acknowledgements
Role of the funding source: Research for the report cited in the Commentary was commissioned and funded by the World Health Organization Regional Office for Europe. No funding was received for writing the Commentary. The funder had no role in writing of the manuscript or the decision to submit it for publication. The authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication.
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