International Development Committee
Tuesday 3rd November 2026
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14:00
Sarah Champion
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Sarah Champion
Thank you for joining us at the International Development Select Committee. To our witnesses on panel one, we're looking specifically at the humanitarian situation in Ukraine. It's with great sadness that we're having this session and the war is continuing. Thank you for making the time to be with us. If I could ask the witnesses to introduce themselves. Elena, could you introduce yourself and who you work for?
14:00
Speaker 1
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Speaker 1
Sure. Thank you very much for invitation. And I'm Elena Elena. I'm a leading research fellow at the Institute of Molecular Biology and Genetics of the National Academy of Sciences of Ukraine, where I lead the biofilm study group. I'm a microbiologist myself, and I'm specializing in antimicrobial resistance, bacterial biofilms, and multidrug resistant infections. I also coordinate the Horizon Europe project aimed at strengthening Ukraine's IMR research capacity through international cooperation in a one health approach. And my current work is particularly focused on the challenges of treating highly resistant bacterial infections in wartime Ukraine, including combat related infections.
14:01
14:01
Speaker 2
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Speaker 2
Good afternoon sir. My name is Luke Moore. I'm a consultant medic here in London at Chelsea and Westminster Hospital. But then in my spare time, I'm an academic at Imperial College London, where I focus on antibiotic resistance and how we as a global community can address that. I'm a member of various learned societies, including editor at the Journal of Hospital Infection, where we focus on how, as a globe, we can combat antibiotic resistance.
14:01
Sarah Champion
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Sarah Champion
You're both very busy and very valuable people, so thank you for making the time today. Elena, I wonder, could you give us an overview of the current healthcare situation in Ukraine ? And then maybe if you could sort of, you know, I'll ask Doctor Luke to go into the antimicrobial, but just the general health situation, please.
14:02
Speaker 1
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Speaker 1
Sure. Thank you. I'll let me try to guide you through the problem which we have now with medical system care in Ukraine. And I should start here from Ukraine. The the fact that Ukraine's healthcare system now in reformation stage of reformation. We have this reform lodged from 2022. And the aim of this reform is to bring health care financing and service delivery closer to Western standards. However, it began in the same year as Russian full scale invasion and continued despite the unprecedented challenges imposed by the war. This is actually without adequate adaptation to the new realities or sufficient consideration of the rapidly deteriorating health care infrastructures, financing constraints and changes, changing medical needs in medical needs.
So as a result, the healthcare system has been expected to implement extensive structural and regulatory changes under wartime conditions without sufficient financial financing resources, institutional preparation or workflow development in particular. In particular, Ukraine lacks a comprehensive system of national clinical guidelines as guidelines for antimicrobial treatment, sufficient number of trained specialists in antimicrobial resistance and infection prevention and control, and dedicated hospital fundings to implement the new requirements. So I would say that infection prevention and control is a particularly difficult to implement. In those circumstances, low salaries should staff shortage and extensive workloads severely influence the resulted in the problems which we have now with infection prevention and control requirements.
In some hospitals, one nurse is responsible for 4060 beds, making consistent implementation of basic infection prevention measures extremely difficult. I should also say that the farthest, the furthest stage of healthcare reform has resulted in a consolidation of healthcare facilities, hospital mergers and the closure of additional institutions and hospitals. Unable to provide the extended, expanded range of services required under the new system. And . Regional hospitals are particularly in trouble because they they are smaller, and that's why they cannot provide the full range of services, and that's why they are just considered to be closed. This approach arises serious concerns in the context of healthcare associated infections and IMR, specifically because the concentrating of large numbers of patients and fewer hospitals increases pressure on infrastructure, healthcare personnel and infection control system, potentially facilitating the transmission of healthcare associated infections.
And at a time when Ukraine faced a substantial burden of infection caused by multidrug resistant bacteria, healthcare planning should prioritize. In my opinion, healthcare should really make the priority on improving the hospital capacity, so reducing overcrowding and appropriate patient to staff ratios rather than further concentrating patients population in a smaller number of hospitals. So another problem, which we also have now is access to publicly funded medical care. This this access is deteriorating and particularly outside major urban cities. Hospitals face shortage of antibiotics and other essential medicines, while regional and local authorities, whose budgets have been severely depleted by the war, are increasingly unable to compensate those gaps in national healthcare financing.
So consequently, regional healthcare provision is deteriorating faster than in major cities, creating the growing inequalities in access to medical services and effective treatment. So this problem is really specifically important for the regions where the war activities now happens. And it also includes the infections community acquired infections such as osteoporosis, Lyme disease. Pyelonephritis and pneumonia, and the further damage of energy infrastructures and other problems related to war. Religious makes the situation even worse because people really cannot get access to specialized medical treatment. Another problem, and I also would like to mention, is treating infections caused by highly resistant bacteria is becoming increasingly difficult due to the limited availability of last resort antibiotics.
Some essential antimicrobial agents are either not registered or unavailable on the Ukrainian pharmaceutical market, while other candidates others cannot be procured by hospitals because of the insufficient fundings. Consequently, even when microbiological diagnosis diagnostics identify the appropriate treatment, clinicians may have no practical means to provide it, and this creates a dangerous gap between identifying and effective antibiotics and actual delivery these antibiotics to the patient. So this is like very, very general overview. And I'm I think I just mentioned the most important on my side, but maybe you can also add some comments from.
So as a result, the healthcare system has been expected to implement extensive structural and regulatory changes under wartime conditions without sufficient financial financing resources, institutional preparation or workflow development in particular. In particular, Ukraine lacks a comprehensive system of national clinical guidelines as guidelines for antimicrobial treatment, sufficient number of trained specialists in antimicrobial resistance and infection prevention and control, and dedicated hospital fundings to implement the new requirements. So I would say that infection prevention and control is a particularly difficult to implement. In those circumstances, low salaries should staff shortage and extensive workloads severely influence the resulted in the problems which we have now with infection prevention and control requirements.
In some hospitals, one nurse is responsible for 4060 beds, making consistent implementation of basic infection prevention measures extremely difficult. I should also say that the farthest, the furthest stage of healthcare reform has resulted in a consolidation of healthcare facilities, hospital mergers and the closure of additional institutions and hospitals. Unable to provide the extended, expanded range of services required under the new system. And . Regional hospitals are particularly in trouble because they they are smaller, and that's why they cannot provide the full range of services, and that's why they are just considered to be closed. This approach arises serious concerns in the context of healthcare associated infections and IMR, specifically because the concentrating of large numbers of patients and fewer hospitals increases pressure on infrastructure, healthcare personnel and infection control system, potentially facilitating the transmission of healthcare associated infections.
And at a time when Ukraine faced a substantial burden of infection caused by multidrug resistant bacteria, healthcare planning should prioritize. In my opinion, healthcare should really make the priority on improving the hospital capacity, so reducing overcrowding and appropriate patient to staff ratios rather than further concentrating patients population in a smaller number of hospitals. So another problem, which we also have now is access to publicly funded medical care. This this access is deteriorating and particularly outside major urban cities. Hospitals face shortage of antibiotics and other essential medicines, while regional and local authorities, whose budgets have been severely depleted by the war, are increasingly unable to compensate those gaps in national healthcare financing.
So consequently, regional healthcare provision is deteriorating faster than in major cities, creating the growing inequalities in access to medical services and effective treatment. So this problem is really specifically important for the regions where the war activities now happens. And it also includes the infections community acquired infections such as osteoporosis, Lyme disease. Pyelonephritis and pneumonia, and the further damage of energy infrastructures and other problems related to war. Religious makes the situation even worse because people really cannot get access to specialized medical treatment. Another problem, and I also would like to mention, is treating infections caused by highly resistant bacteria is becoming increasingly difficult due to the limited availability of last resort antibiotics.
Some essential antimicrobial agents are either not registered or unavailable on the Ukrainian pharmaceutical market, while other candidates others cannot be procured by hospitals because of the insufficient fundings. Consequently, even when microbiological diagnosis diagnostics identify the appropriate treatment, clinicians may have no practical means to provide it, and this creates a dangerous gap between identifying and effective antibiotics and actual delivery these antibiotics to the patient. So this is like very, very general overview. And I'm I think I just mentioned the most important on my side, but maybe you can also add some comments from.
14:07
14:07
Speaker 2
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Speaker 2
Thank you very much, Miss Gilbert. So in you right now there are more bacteria than there have ever been humans on the face of the planet earth. We reproduce what every 20 years we teach our young, our young are better than us. Bacteria do the same. But rather than having a generation every 20 years, they have a generation every 20 minutes. So that means they have the ability to learn and adapt to everything that we, as human in our human civilization are doing, including developing new antibiotics, developing new surgery, giving people chemotherapy for their cancer.
And people often think about antibiotic resistance as being an issue for just an infection. You have a urinary tract infection. Whoops. I cannot now give you a tablet antibiotic. I need to now bring you into hospital to treat. Sure, that's part of it. But actually if you need a metal hip, you need surgery, you need chemotherapy, you have diabetes and get a manky foot. I can't now manage that as effectively as I could have 20 or 30 years ago. And just coming back to that time issue, the amount of money and time it takes to develop a new antibiotic, I think is replete in the media 20 years to 1 billion USD.
And yet these bacteria, as I alluded to, are reproducing every 20 minutes. And there are so many of them on each of us. So if we as human healthcare are trying to enable longevity, enable health rather than ill health, then we need to address the way in which we enable the rest of healthcare to be undertaken. We need to support that with antibiotics. That's status quo in a reasonably resource replete healthcare organization, which is national and is not in the midst of conflict and catastrophe. Add into that conflict, catastrophe, huge internal or external displacement of hundreds of thousands of citizens.
Add into that dissolution of the infrastructure where we actually provide healthcare, the organizations, the buildings in which we do it. Add into that removal of healthcare providers, either through casualties or through displacement to other countries, and suddenly you take a severe issue for the whole of healthcare and just compound it. So what we're facing now in areas of conflict and catastrophe, such as Ukraine, is an inability to treat infections with any antibiotic. We have increased spread of those resistant bacteria from citizens who have an injury because of the conflict, to citizens in beds next to them who may have come in for a pacemaker or a hip replacement, and that that exponential increase in the problem of antibiotic resistance really undermines all of healthcare provision in Ukraine.
And then what have we seen here in the United Kingdom and in the Netherlands and in Poland and in Germany , is movement of citizens from conflict areas such as Ukraine to our healthcare organizations with, again, exponential increase in the dissemination of those resistant bugs. We kind of understand borders. Bacteria don't. Thank you.
And people often think about antibiotic resistance as being an issue for just an infection. You have a urinary tract infection. Whoops. I cannot now give you a tablet antibiotic. I need to now bring you into hospital to treat. Sure, that's part of it. But actually if you need a metal hip, you need surgery, you need chemotherapy, you have diabetes and get a manky foot. I can't now manage that as effectively as I could have 20 or 30 years ago. And just coming back to that time issue, the amount of money and time it takes to develop a new antibiotic, I think is replete in the media 20 years to 1 billion USD.
And yet these bacteria, as I alluded to, are reproducing every 20 minutes. And there are so many of them on each of us. So if we as human healthcare are trying to enable longevity, enable health rather than ill health, then we need to address the way in which we enable the rest of healthcare to be undertaken. We need to support that with antibiotics. That's status quo in a reasonably resource replete healthcare organization, which is national and is not in the midst of conflict and catastrophe. Add into that conflict, catastrophe, huge internal or external displacement of hundreds of thousands of citizens.
Add into that dissolution of the infrastructure where we actually provide healthcare, the organizations, the buildings in which we do it. Add into that removal of healthcare providers, either through casualties or through displacement to other countries, and suddenly you take a severe issue for the whole of healthcare and just compound it. So what we're facing now in areas of conflict and catastrophe, such as Ukraine, is an inability to treat infections with any antibiotic. We have increased spread of those resistant bacteria from citizens who have an injury because of the conflict, to citizens in beds next to them who may have come in for a pacemaker or a hip replacement, and that that exponential increase in the problem of antibiotic resistance really undermines all of healthcare provision in Ukraine.
And then what have we seen here in the United Kingdom and in the Netherlands and in Poland and in Germany , is movement of citizens from conflict areas such as Ukraine to our healthcare organizations with, again, exponential increase in the dissemination of those resistant bugs. We kind of understand borders. Bacteria don't. Thank you.
14:11
14:11
14:11
14:11
Speaker 2
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Speaker 2
Thank you very much, Mr. Mundell. So Elena and her team and our team here in the UK have been collaborating for several years, most recently with financial support from the UK Defense Innovation, which has given us a an ability to form a formal network looking at conflict wound infections, including universities in the UK such as Birmingham, Imperial College, Strathclyde and Great Ormond Street Hospital, and then Elena and the National Academic Academic Academy of Sciences in Ukraine, where we have been building a network of excellence as much as we can all be excellent together, but actually much more functionally than that, to look at the types of bugs, the types of drugs that are still effective, how we can deploy diagnostics to improve insight.
You diagnosis of resistant infections as close to the front line as we can. And that is, I hope , Elena of of use on the shop floor, but also provides us here in the UK with resilience should we need it further down the line.
You diagnosis of resistant infections as close to the front line as we can. And that is, I hope , Elena of of use on the shop floor, but also provides us here in the UK with resilience should we need it further down the line.
14:12
14:12
14:12
Speaker 2
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Speaker 2
Yeah. So I wish Mr. Mundell. So our collaboration initially started off of some very small grants. So we have a learned society called the Healthcare Infection Society. They gave us a small stand up grant at my own hospital, Chelsea and Westminster. We have a charitable fund. They gave us a small start up grant and with that we were then able to roll forward to this UK grant. There are other pockets of UK money.
I do not know whether Fcdo have any pockets of money to help us with Ukraine antibiotic resistance issues.
I do not know whether Fcdo have any pockets of money to help us with Ukraine antibiotic resistance issues.
14:13
14:13
14:13
14:13
14:14
Sarah Champion
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Sarah Champion
14:14
Speaker 1
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Speaker 1
Thank you for this question. This is really a very complicated story, and it has a new. If you. If you problems related to that, I should say like, really? Yeah. Well, I would start from the from the problem that the major problem now in Ukraine is a growing gap between the increasingly complex regulatory framework established by Ministry of Health and the actual capacity of hospitals to comply with those standards. And really, the healthcare facilities are expected to meet extensive clinical administrative requirements, but often lack the financial and material resources to do them. And in practice, responsibility for providing the appropriate treatment is increasingly transferred from the governmental institutions to hospitals and individual clinicians, even when the necessary medicines are simply unavailable.
And this I should say, that it's really creates an extremely difficult ethical and I would say, practical clinical dilemma for clinicians. They may have to prescribe antibiotics that they are valuable in their hospitals. Even when those are not the most appropriate options for the treatment of this disease, or ask patients to purchase the required medicines themselves. And the latter is particularly problematic because patients are officially promised to provide the medical care for him for free. And that means that doctors may even be, you know, be blamed in corruption when asking them, when asking the patient to buy essential medicine.
So it's really a problem, psychological problem even. And this consequences from antimicrobial treatment. I mean it's rather serious because antibiotics may be selected accordingly according to what the hospital can afford or has in stock, rather than what microbiological susceptibility is suggested to be to be used. And in some cases, clinicians may even hesitate to request bacterial culturing. So just don't don't provide the specific diagnostics simply because they already expect the infections which they may identify will not be able they will not be able to treat. In fact, sometimes they will just miss the diagnostics because they expect high resistance rate, which they really cannot cannot treat according to, I wouldn't say even recommendations, but just according to .
Let's say that antibiogram. So this creates a, I would say like a dangerous cycle . When inadequate funding and limiting access to appropriate antibiotics comprise treatment and undermine antimicrobial stewardship and may accelerate the emergence and spread of antimicrobial resistance further. And the other problem related to this issue is I would also would like to to mention is the lack of comprehensive and nationally coordinated and adequately implemented system of clinical guidelines for the treatment of both infection diseases in Ukraine, particularly those which are multidrug resistant infections. And I should also mention that simply adopting recommendations developed by leading Western medical infectious disease societies is not sufficient in Ukraine, because those guidelines should provide an essential scientific foundation, but also treatment strategies which must reflect the Ukrainians local resistance patterns, bacterial epidemiology, diagnostics capacity, and, of course, the actual availability and affordability of this antibiotic.
So this is crucially important. And Ukraine urgently needs evidence based national treatment guidelines to which are adapted to epidemiological situation and healthcare resources. This is essential. So but you know, guidelines alone will not provide the problem. So this I would believe that government must also ensure the national wide access to those antibiotics required according to those guidelines and decisions about which essential antibiotics should be available and publicly funded must be made at the national level. So not it shouldn't be hospitals or just any clinicians to develop this standard. I mean, the recommendations and protocols themselves, it should be like national expertise to offer those protocols to the clinicians in Ukraine with all the recommendations, science based, practical, based, but still rational in the Ukrainian reality.
So we really cannot have national standards for care without national responsibility for ensuring access to those medicines required to meet those standards. Thank you.
And this I should say, that it's really creates an extremely difficult ethical and I would say, practical clinical dilemma for clinicians. They may have to prescribe antibiotics that they are valuable in their hospitals. Even when those are not the most appropriate options for the treatment of this disease, or ask patients to purchase the required medicines themselves. And the latter is particularly problematic because patients are officially promised to provide the medical care for him for free. And that means that doctors may even be, you know, be blamed in corruption when asking them, when asking the patient to buy essential medicine.
So it's really a problem, psychological problem even. And this consequences from antimicrobial treatment. I mean it's rather serious because antibiotics may be selected accordingly according to what the hospital can afford or has in stock, rather than what microbiological susceptibility is suggested to be to be used. And in some cases, clinicians may even hesitate to request bacterial culturing. So just don't don't provide the specific diagnostics simply because they already expect the infections which they may identify will not be able they will not be able to treat. In fact, sometimes they will just miss the diagnostics because they expect high resistance rate, which they really cannot cannot treat according to, I wouldn't say even recommendations, but just according to .
Let's say that antibiogram. So this creates a, I would say like a dangerous cycle . When inadequate funding and limiting access to appropriate antibiotics comprise treatment and undermine antimicrobial stewardship and may accelerate the emergence and spread of antimicrobial resistance further. And the other problem related to this issue is I would also would like to to mention is the lack of comprehensive and nationally coordinated and adequately implemented system of clinical guidelines for the treatment of both infection diseases in Ukraine, particularly those which are multidrug resistant infections. And I should also mention that simply adopting recommendations developed by leading Western medical infectious disease societies is not sufficient in Ukraine, because those guidelines should provide an essential scientific foundation, but also treatment strategies which must reflect the Ukrainians local resistance patterns, bacterial epidemiology, diagnostics capacity, and, of course, the actual availability and affordability of this antibiotic.
So this is crucially important. And Ukraine urgently needs evidence based national treatment guidelines to which are adapted to epidemiological situation and healthcare resources. This is essential. So but you know, guidelines alone will not provide the problem. So this I would believe that government must also ensure the national wide access to those antibiotics required according to those guidelines and decisions about which essential antibiotics should be available and publicly funded must be made at the national level. So not it shouldn't be hospitals or just any clinicians to develop this standard. I mean, the recommendations and protocols themselves, it should be like national expertise to offer those protocols to the clinicians in Ukraine with all the recommendations, science based, practical, based, but still rational in the Ukrainian reality.
So we really cannot have national standards for care without national responsibility for ensuring access to those medicines required to meet those standards. Thank you.
14:18
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14:18
Speaker 2
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Speaker 2
Thanks very much. So I guess when I think of antibiotic availability across the globe, including in Ukraine, there are some issues with licensing and regulation. And as Elena said, many of the antimicrobials which we would use reserve line here are just not available in many countries, including in Ukraine. Then you have issues with counterfeit or substandard medications, including because of failure of supply chain, cold chain, and that is a particular issue in areas of conflict. So you have access to the antibiotic for the antibiotic compound itself is degraded. Then you have, as Elena said, issues with reimbursement strategies.
So we're very lucky here in that at the point of care, nobody pays for medicine. That's not true in many areas of the world, including in Ukraine. Then you have issues with abnormalities in the economics of a drug cost versus a diagnostic cost, meaning that if you come to me with an infection, sometimes it's cheaper for me to prescribe you best guess antibiotic one, then two, then three, then four, getting it wrong each time contributing to antibiotic resistance each time. Because that approach is cheaper than doing one diagnostic test where I give you the right drug at the first first guess.
Sorry, Elena. Sorry to butt in there.
So we're very lucky here in that at the point of care, nobody pays for medicine. That's not true in many areas of the world, including in Ukraine. Then you have issues with abnormalities in the economics of a drug cost versus a diagnostic cost, meaning that if you come to me with an infection, sometimes it's cheaper for me to prescribe you best guess antibiotic one, then two, then three, then four, getting it wrong each time contributing to antibiotic resistance each time. Because that approach is cheaper than doing one diagnostic test where I give you the right drug at the first first guess.
Sorry, Elena. Sorry to butt in there.
14:20
14:20
14:20
Sarah Champion
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Sarah Champion
I think that it's got another question. I was just going to I mean, you've sort of touched on this already, but I really wanted to ask about the implications on global health when there is a surge in this sort of disease from Ukraine. You sort of did touch on this, but if you want to just elaborate a bit on the implications for global health, please. Elena or doctor? Yeah. Sorry.
Elena, I was looking at you. Sorry. You can't see me looking at you, but Elena was looking at you.
Elena, I was looking at you. Sorry. You can't see me looking at you, but Elena was looking at you.
14:20
Speaker 1
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Speaker 1
Oh, sorry. Thank you for that question to me. Right. Okay. So I would say, like, definitely in Ukraine, we have many reserve antibiotics are not registered. That's true. But the other true is that we do have the problems with those antibiotics, which are not so expensive, not so innovative, let's say, but still unavailable because like, like already mentioned, the market, the I mean, the pharmaceutical market, market market is very small and those vendors are simply do not bring this to Ukrainian market. So I would like just specifically calculated a brief example for you just to, to let you in.
This is problem as an example. I mean, I have an example just to explain you how bad everything is in Ukraine just a few weeks ago. We have a new paper published by Public Health Center. They just describing the the wound infection. And they just stated like almost every second infection on those war related wounds are multidrug resistant infection, a gram negative multidrug resistant infection. And that means to treat those wounds they need to have. I mean, the doctors need to prescribe reserve antibiotics. It looks like I mean, according to this, like almost at least half of antibiotics, which is purchased in the medical system should be from this reserve group.
But in fact, I just specifically calculated this based on the international electronic procurement platform , Ukrainian platform, where everyone, every hospital obliged to use in 2024, the total amount of reserve antibiotics purchased by hospital was just only 1.7 37%. And this is mostly because of the price. So in fact, this is a huge discrepancy between the resistance, like criminal resistance, cumulative resistance of infection in Ukrainian hospitals, let's say hospital acquired infections and antibiotics, which is purchased and prescribed to treat those infections. And this is just like, I mean, the best illustrate this really discrepancy between the reality and the affordability from the hospital side.
This is problem as an example. I mean, I have an example just to explain you how bad everything is in Ukraine just a few weeks ago. We have a new paper published by Public Health Center. They just describing the the wound infection. And they just stated like almost every second infection on those war related wounds are multidrug resistant infection, a gram negative multidrug resistant infection. And that means to treat those wounds they need to have. I mean, the doctors need to prescribe reserve antibiotics. It looks like I mean, according to this, like almost at least half of antibiotics, which is purchased in the medical system should be from this reserve group.
But in fact, I just specifically calculated this based on the international electronic procurement platform , Ukrainian platform, where everyone, every hospital obliged to use in 2024, the total amount of reserve antibiotics purchased by hospital was just only 1.7 37%. And this is mostly because of the price. So in fact, this is a huge discrepancy between the resistance, like criminal resistance, cumulative resistance of infection in Ukrainian hospitals, let's say hospital acquired infections and antibiotics, which is purchased and prescribed to treat those infections. And this is just like, I mean, the best illustrate this really discrepancy between the reality and the affordability from the hospital side.
14:24
14:24
14:24
Speaker 2
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Speaker 2
No. I guess just zooming out a little bit to global health. We here in a reasonably resource replete society we focus a lot on non-communicable diseases, cardiovascular health, diabetes in areas of the world where there are fewer resources, the weight of health care still is in communicable diseases. So we're talking a lot here about infections and antibiotic resistance. And that might not resonate so much here, but actually in areas of the world with fewer resources, infectious diseases still trump non-communicable diseases.
And that's why it's so important.
And that's why it's so important.
14:26
14:26
14:26
Speaker 1
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Speaker 1
Oh, thank you for this question. I wish I could I would know the answer. Yeah. The decision was yeah. Well, okay, I, I'm not a fan of the previous system. That's true. There was a lot of problems with the previous system, but I still do not I do not I don't know the answer. The question why the, you know, the the the the the the the politics, the , the national medical system decide to provide this reform despite the fact of the war. So I would really postpone this. And well, it looks like that there was a strong recommendation not to stop the planned reform and to move this forward.
And this reform really changes anything. Like everything, even the structure of the hospital, availability of antibiotics, availability of the other medicines, everything was absolutely different to those we used to have before. And the other question is why this reform was not planned for the smaller region later to upscale if it is effective. I still don't know the answer. The problem is the real problem. Perhaps by being in this reform and by just recently, I mean the serving the number of resistant strains. And this is really looking at the bigger, bigger problem with the medical system.
But this reform was not adjusted to the gaps we can observe now. That's still a question. It looks like the reform was planned. And it looks like there is no corrections to those reform being suggested. And what should I say now. We do understand that the problem there are a number of problems. And it looks like now the Minister of Health is trying to find a solution for a number of gaps. I just recently visit a specific meeting dedicated to EMR in Ukraine, which been organized by Robert Koch Institute and Charité Hospital in Berlin. And it looks like there was a specific decision made to, to formulate a kind of a specific fund for the reserve antibiotics, which could be donated by the partners to Ukraine and to distribute through the hospitals.
But this was original, you know, system, which we used to have before the reforms. It looks like they've been trying to compensate the problems . And coming back to initial state, because it looks like with those resources we have in Ukraine, this reforms absolutely impossible to implement. And it's not only about funds, it's also about specialists. The core idea of this reform is to introduce another system for infection control and prevention. And that means every hospital must have specialists in infection control and IMR. And we simply do not have enough specialists in Ukraine. So this reform starts without a financial background, without, you know, number of specialists which could be employed by the hospitals.
So still so many, so many questions about this reform. So definitely now the main, I would say like, it's my personal opinion, but the main problem is availability of antibiotics and the cost of the treatment, which is like evidence based treatment.
And this reform really changes anything. Like everything, even the structure of the hospital, availability of antibiotics, availability of the other medicines, everything was absolutely different to those we used to have before. And the other question is why this reform was not planned for the smaller region later to upscale if it is effective. I still don't know the answer. The problem is the real problem. Perhaps by being in this reform and by just recently, I mean the serving the number of resistant strains. And this is really looking at the bigger, bigger problem with the medical system.
But this reform was not adjusted to the gaps we can observe now. That's still a question. It looks like the reform was planned. And it looks like there is no corrections to those reform being suggested. And what should I say now. We do understand that the problem there are a number of problems. And it looks like now the Minister of Health is trying to find a solution for a number of gaps. I just recently visit a specific meeting dedicated to EMR in Ukraine, which been organized by Robert Koch Institute and Charité Hospital in Berlin. And it looks like there was a specific decision made to, to formulate a kind of a specific fund for the reserve antibiotics, which could be donated by the partners to Ukraine and to distribute through the hospitals.
But this was original, you know, system, which we used to have before the reforms. It looks like they've been trying to compensate the problems . And coming back to initial state, because it looks like with those resources we have in Ukraine, this reforms absolutely impossible to implement. And it's not only about funds, it's also about specialists. The core idea of this reform is to introduce another system for infection control and prevention. And that means every hospital must have specialists in infection control and IMR. And we simply do not have enough specialists in Ukraine. So this reform starts without a financial background, without, you know, number of specialists which could be employed by the hospitals.
So still so many, so many questions about this reform. So definitely now the main, I would say like, it's my personal opinion, but the main problem is availability of antibiotics and the cost of the treatment, which is like evidence based treatment.
14:32
14:33
14:33
Speaker 1
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Speaker 1
True. I mean, because because the idea it looks like this reform, I mean, the idea how to distribute the funds through the hospitals has been inspired by, I would say, by American system, when all the patients I mean, the treatment of the patient is covered by the insurance company. So our insurance is a state. But in fact, instead of covering the whole cost of the patient's treatment, the state decided to allocate a specific budget for every nosology, for every, let's say, disease. And this real cost absolutely does not do not respond to the real, you know, expenses of the treatment.
And that's why all this reserve antibiotics really cannot be covered by the budget. They are in there, but simply money is not enough. I mean, that's the main problem. So now we're just balancing between the very limited resources for every disease and the real cost of those disease. Say nothing about the salary for the staff because like I already mentioned, the shortage of the nurses, of clinicians of doctors are really impact made a strong impact on the IPC infection prevention control situation. The last year we have , the less the less safe years. Let's say we.
Our hospitals are. So this is a direct correlation between the salaries, availability of nurses and quality of medical care, I would say.
And that's why all this reserve antibiotics really cannot be covered by the budget. They are in there, but simply money is not enough. I mean, that's the main problem. So now we're just balancing between the very limited resources for every disease and the real cost of those disease. Say nothing about the salary for the staff because like I already mentioned, the shortage of the nurses, of clinicians of doctors are really impact made a strong impact on the IPC infection prevention control situation. The last year we have , the less the less safe years. Let's say we.
Our hospitals are. So this is a direct correlation between the salaries, availability of nurses and quality of medical care, I would say.
14:36
14:36
Speaker 1
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Speaker 1
Right. Okay. Should I say that the reform was intended to bring Ukraine healthcare system to the best Western European standards? But in fact, like I said, I already mentioned we Ukraine was not prepared well for this system. And I really fully support the idea to improve the healthcare system on a Western standards because they are much better than the system we used to have before. But like I said, all this preparation should be done, and the very transformation from the old standards to the current Western European standards potentially could spend like for 15, 20 years.
And this is not only about money, it's about time. And we didn't have this time. I mean, this reform started to be implemented quite, quite fast. And those requirements really we have now they do not match the dedicated fundings, resources, personal anything and say nothing about the war. Even without the war it could be very, very difficult because, you know, this reform really should last for at least 20 years. So this is a problem. And I again , would like to briefly remind you that, first of all, that those established infection prevention control teams, we need a lot of, I mean, enough personnel to complete those teams.
We do not have. And another problem is I should also mention this because this is something which I do experience myself. One of the part of this reform is to make the prescription of prescription requirements for antibiotics strong. I mean, in a stronger way just to reduce inappropriate use of antibiotics. And that would work in Western countries, I don't mind. But again, this is not in Ukraine that the current Ukraine that is not adequately accompanied by measures to ensure the access to medical consultations. So from one side, antibiotics are strictly restricted. I would say from the other side, no medical assistance is available.
So and this is something which I saw myself during winter blackouts, heating disruptions in at least in Kiev. And all these difficulties, many people, specifically elderly people, have not been able to to visit the doctor. And I have personally, I was I have personally become aware of deaths in Kiev reportedly associated with the pneumonia. And it's simply because patients being absolutely unable to visit doctors and to get antibiotics, those which could treat the pneumonia. And really, we do not have epidemiological data about that. But this is something which I saw myself. And that's really very sad because like two years ago, this people could really go to chemistry shop and to buy antibiotics to support themselves.
Like I said, that's not an appropriate for Western countries, but in in countries such as Ukraine in need, perhaps this priority should be should be given. And what should I really what should I suggest to W.H.O. if I, if I may? Of course, first is really this healthcare reform cannot cannot simply transfer transfer Western European standards into countries with very different financial, institutional and security conditions. Well, second, new standards must be accompanied by realistic fundings, workforce development and resources needed for implementation that are super important. And of course, the third reforms should be flexible.
That is again very important to to understand those reforms should introduce should be introduced progressively and tested before nationwide implementation, which again was not done here. So the impact of those reforms, reforms must be continuously monitored with the possibility to adjust policies when some problems are noticed. So this is again maybe my final conclusion. I should also say that international organizations such as WTO must listen to healthcare professionals working on the ground in Ukraine. That's again, I do not observe a lot. It looks like we've been. We've been told what to do instead of being discussed, what to do.
But again, it's absolutely my personal opinion. I. I might be wrong. It's just like my my feeling. So maybe someone would not agree with me. Thank you.
And this is not only about money, it's about time. And we didn't have this time. I mean, this reform started to be implemented quite, quite fast. And those requirements really we have now they do not match the dedicated fundings, resources, personal anything and say nothing about the war. Even without the war it could be very, very difficult because, you know, this reform really should last for at least 20 years. So this is a problem. And I again , would like to briefly remind you that, first of all, that those established infection prevention control teams, we need a lot of, I mean, enough personnel to complete those teams.
We do not have. And another problem is I should also mention this because this is something which I do experience myself. One of the part of this reform is to make the prescription of prescription requirements for antibiotics strong. I mean, in a stronger way just to reduce inappropriate use of antibiotics. And that would work in Western countries, I don't mind. But again, this is not in Ukraine that the current Ukraine that is not adequately accompanied by measures to ensure the access to medical consultations. So from one side, antibiotics are strictly restricted. I would say from the other side, no medical assistance is available.
So and this is something which I saw myself during winter blackouts, heating disruptions in at least in Kiev. And all these difficulties, many people, specifically elderly people, have not been able to to visit the doctor. And I have personally, I was I have personally become aware of deaths in Kiev reportedly associated with the pneumonia. And it's simply because patients being absolutely unable to visit doctors and to get antibiotics, those which could treat the pneumonia. And really, we do not have epidemiological data about that. But this is something which I saw myself. And that's really very sad because like two years ago, this people could really go to chemistry shop and to buy antibiotics to support themselves.
Like I said, that's not an appropriate for Western countries, but in in countries such as Ukraine in need, perhaps this priority should be should be given. And what should I really what should I suggest to W.H.O. if I, if I may? Of course, first is really this healthcare reform cannot cannot simply transfer transfer Western European standards into countries with very different financial, institutional and security conditions. Well, second, new standards must be accompanied by realistic fundings, workforce development and resources needed for implementation that are super important. And of course, the third reforms should be flexible.
That is again very important to to understand those reforms should introduce should be introduced progressively and tested before nationwide implementation, which again was not done here. So the impact of those reforms, reforms must be continuously monitored with the possibility to adjust policies when some problems are noticed. So this is again maybe my final conclusion. I should also say that international organizations such as WTO must listen to healthcare professionals working on the ground in Ukraine. That's again, I do not observe a lot. It looks like we've been. We've been told what to do instead of being discussed, what to do.
But again, it's absolutely my personal opinion. I. I might be wrong. It's just like my my feeling. So maybe someone would not agree with me. Thank you.
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Sarah Champion
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Sarah Champion
Thank you very much. Your personal opinion is is valuable. And I think those points that you made were were. Well said Luke, I wonder sort of stepping back from specifically focusing on Ukraine and looking at a more global. I think at the moment we're at about 130 conflicts that are happening around the world. I know that Amr infections and resistance is is ever increasing. So I wonder, what would your advice be to the World Health Organization when it comes to dealing with the consequences when you have mass casualties and Amr, but also when you are looking, how should countries around the world insulate themselves from the risks that Amr face?
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Speaker 2
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Speaker 2
Okay, look, so I guess there's several different ways to think about that way back in 2015 seems a many moons ago now, the W.H.O. launched their global action plan on antibiotic resistance. And they said all 200 ish member states should write their own national action plans. Fast forward to now, about 150 of the 200 have done that. I've spent most of the last three years analyzing the different 150 ish national action plans are out there trying to find what good looks like. I've learned several things from that. There is no good. There are different elements that work for different countries.
There are some countries, national action plans that appear to have lifted en masse, things that have worked elsewhere, thinking this would be a good idea, tried to plug it into their own and it does not work as Eleanor said. So piece of advice, number one to W.H.O. is thank you for commissioning all 200 ish member states to write your own national action plans. Please now review that and have a think about how we can all learn from each other's national action plans. That does not mean copy. That means learn from each other's point .
Number one. Point number two was in that analysis of how different people are trying to address antibiotic resistance. Some people have tried to run before they can walk again. That resonates with what Eleanor was saying. So there is no golden answer to antibiotic resistance. And that golden answer doesn't have to be for any given country, an expensive, all singing, all dancing solution. There are some examples in different countries national action plans, which are really low cost and have worked far better than some elements of our own National action plan to address specific areas of antibiotic resistance.
What a shame that WHO isn't facilitating that learning between countries. Point number two. Point number three is around resilience and technology and AI. And I'm not clever enough to know anything about AI, but it seems to me that we have huge numbers of data streams in healthcare in general, in civilization in general, that we can use other things that are perhaps better than human brains to elicit answers from to feed forwards into antibiotic resistance. So in certain areas of the world, such as us, such as much of North America, we have huge electronic healthcare records.
Why are we not leveraging AI in that format to extract ways to improve non-communicable health? And I know that certain elements of AI are doing that for diabetes, for renal disease. Lovely. But where is that for antibiotic resistance? And if W.H.O. has flagged Amr as being a global silent pandemic, where are we with leveraging technology to help with that? Now, in my research group, I've I've got the most fabulous research fellow I've ever come across who has traveled up mountains in Greenland that have never been climbed before, gone to Antarctica before shrunken technology to to be able to diagnose pathogens, antibiotic resistance genes in areas of the world that you would never think was possible.
That's lovely. But where can we do that en masse? Where can we do that at scale? So that if there is a conflict in a cold area or a catastrophe in a hot area or a remote area, how can we deploy diagnostics to be able to improve infection management and Amr, but infection management in general in those remote areas. So that's kind of a high tech specific funding issue. And I think the answer is, as I said, there is no single answer, Mr. Champion, but it ranges from policy through all the way through to R&D.
We in the UK have expertise. We have leadership with Sally Davies in the field of Amr, but we need to we need to live up to that and and work where we can to feed up to WHO that. We can help with this.
There are some countries, national action plans that appear to have lifted en masse, things that have worked elsewhere, thinking this would be a good idea, tried to plug it into their own and it does not work as Eleanor said. So piece of advice, number one to W.H.O. is thank you for commissioning all 200 ish member states to write your own national action plans. Please now review that and have a think about how we can all learn from each other's national action plans. That does not mean copy. That means learn from each other's point .
Number one. Point number two was in that analysis of how different people are trying to address antibiotic resistance. Some people have tried to run before they can walk again. That resonates with what Eleanor was saying. So there is no golden answer to antibiotic resistance. And that golden answer doesn't have to be for any given country, an expensive, all singing, all dancing solution. There are some examples in different countries national action plans, which are really low cost and have worked far better than some elements of our own National action plan to address specific areas of antibiotic resistance.
What a shame that WHO isn't facilitating that learning between countries. Point number two. Point number three is around resilience and technology and AI. And I'm not clever enough to know anything about AI, but it seems to me that we have huge numbers of data streams in healthcare in general, in civilization in general, that we can use other things that are perhaps better than human brains to elicit answers from to feed forwards into antibiotic resistance. So in certain areas of the world, such as us, such as much of North America, we have huge electronic healthcare records.
Why are we not leveraging AI in that format to extract ways to improve non-communicable health? And I know that certain elements of AI are doing that for diabetes, for renal disease. Lovely. But where is that for antibiotic resistance? And if W.H.O. has flagged Amr as being a global silent pandemic, where are we with leveraging technology to help with that? Now, in my research group, I've I've got the most fabulous research fellow I've ever come across who has traveled up mountains in Greenland that have never been climbed before, gone to Antarctica before shrunken technology to to be able to diagnose pathogens, antibiotic resistance genes in areas of the world that you would never think was possible.
That's lovely. But where can we do that en masse? Where can we do that at scale? So that if there is a conflict in a cold area or a catastrophe in a hot area or a remote area, how can we deploy diagnostics to be able to improve infection management and Amr, but infection management in general in those remote areas. So that's kind of a high tech specific funding issue. And I think the answer is, as I said, there is no single answer, Mr. Champion, but it ranges from policy through all the way through to R&D.
We in the UK have expertise. We have leadership with Sally Davies in the field of Amr, but we need to we need to live up to that and and work where we can to feed up to WHO that. We can help with this.
14:56
Sarah Champion
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Sarah Champion
Can I say I really like that you say antibiotic resistance. It makes it a lot easier to understand. Secondly, what I think you're saying is that there is a role for the WHO to provide that sort of global guidance, which then becomes tailored at a country and situation specific, and you're not seeing that happen.
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Sarah Champion
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Sarah Champion
Okay. That's very concerning. Unless committee members have additional questions for our witnesses. No, thank you very much. That has been hugely interesting, really quite scary. And thank you ever so ever so much for sharing your knowledge and experience. You're you're most welcome. If you want to sit in the gallery for the second panel order, order. We'll just suspend the session while we chat. We are now continuing our session on the humanitarian humanitarian situation in Ukraine. Thank you very much. Witnesses for coming before us. I wonder if I could ask you to introduce yourselves. Amelia, could I start with you?
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Sarah Champion
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Sarah Champion
Thank you very much. We have one more witness who we're expecting to join, and when he does, I'll ask him to introduce himself. But I wonder, Elena, could I start with you? Could you sort of. The first panel, we looked very much at the health situation in But I wonder, Elena, could I start with you? Could you sort of. The first panel, we looked very much at the health situation in particularly antibiotic resistance in Ukraine.
I wonder if you could describe to .
I wonder if you could describe to .
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Speaker 1
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Speaker 1
This year, in comparison to the previous years, is discussed within the humanitarian sector as. accelerated protection crisis. Last year we were talking about it, but this year we are seeing the increased numbers of the. civilians who have been targeted with a. different weaponry, with longer range missiles and longer range drones.
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Speaker 1
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Speaker 1
The monthly number of children killed this summer, this July is the four year highest that we have faced in Ukraine. And when we are talking about long range missiles and drones, they cause up to almost. 50% of civilian. casualties in August this year. And we are talking about even about big cities like Kyiv, Kherson and Zaporizhzhia, some frontline areas as well. So not only frontline areas, but also the center of the country and the west of the country.
And also, if you overlap it with attacks on energy.
And also, if you overlap it with attacks on energy.
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Speaker 1
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Speaker 1
And I wanted to give you an example. Since we are moved out from health care session we consulted before coming here, we , as NGO platform consulted NGO members who are working on health care issues, and we asked them like in conversation with them, we understand that the. severity of the attacks on. humanitarians and also on.
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Speaker 1
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Speaker 1
The war impacting on my life? So the first change that you will observe and see is the change in the air raid alerts and kind of, we call it no longer resilience. We call it adaptation to the point when people do not react to the air raid alerts because they they last for 24 hours. And in frontline areas, the schools are moved into the underground facilities. And maybe you have heard that there was a severe attack in one of the small settlements, Mishawaka, which was the missile hit the. underground school facility where the aid was provided to people.
So there was a number of people collected there to provide them the aid. So the underground facilities is becoming the target as well. So if I would be a mom with two in frontline areas, allegedly, and presumably my kids would go either into underground facility to study or they would stay with me at home. online trying to study online. And we hear like. different concerns about both. approaches and coming up on top of that, that would also limit my.
economic income because.
So there was a number of people collected there to provide them the aid. So the underground facilities is becoming the target as well. So if I would be a mom with two in frontline areas, allegedly, and presumably my kids would go either into underground facility to study or they would stay with me at home. online trying to study online. And we hear like. different concerns about both. approaches and coming up on top of that, that would also limit my.
economic income because.
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Speaker 1
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Speaker 1
Your kid to a school. And can I feed my children in terms of the feeding in the markets are functional in frontline areas, but access to markets can vary. Honestly, it depends on the city. Let me give you an example. If I'm a resident of Kherson, you probably know Kherson. It becomes. significantly difficult to access markets under the constant drone surveillance and so-called .
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Speaker 1
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Speaker 1
Usually called. So but then. Yeah, what's that relating to? Oh that is yeah. Let me. explain this term and terminology that was used in one of the Human Rights Watches reports. And this is the. terminology that the. citizens or Kherson started to use in regards to. targeted drone attacks on civilian population. When the drone picks a target, a civilian as a target or a vehicle as a target , and attacks without regard and with without respect to IHL principle of. distinction and to the point where access to hospital, access to. markets and market. functionalities are threatened because of those attacks.
And now in the.
And now in the.
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Speaker 3
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Speaker 3
Which is at the very large scale. compromising the lives of the. millions and life being of the millions in Ukraine. Also, right now, we are expecting the numbers of. evacuees or people that will need evacuation from the frontline areas and those areas, I would say from. 0 to 20 to. 30km from the front line. Given the attacks on energy and. utilities and water.
infrastructure to increase. So if I would have to distinguish the area, it would. definitely be protection. However, we cannot. undermine the. effects on the healthcare. Overstretching the.
infrastructure to increase. So if I would have to distinguish the area, it would. definitely be protection. However, we cannot. undermine the. effects on the healthcare. Overstretching the.
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David Mundell
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David Mundell
Ukraine Ukrainian population is dealing with. Thank you. I wanted just to ask you a specific question and perhaps, Alina, you might have something to say since it relates to to what you were saying, and it was how, you know, the crisis in relation to HIV in Ukraine, which was already prevalent before the war, how that was being dealt with, because I had noted, for example, in recent months, I mean, one Russian attack on Kyiv destroyed more than $2.6 million worth of a medicines and equipment to combat HIV, which is consistent with what you were saying in relation to attacks on medical.
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Speaker 1
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Speaker 1
Facilities and medical storage. I would on HIV. I have no specific data to provide you with, but to reiterate the comment, and I think maybe Ilya will have more. insights on your particular question. But to reiterate the comment, yes, we do see more hits on the storages. And one of the asks that the NGOs and one of the mitigation measures that NGOs are trying to develop is to develop.
underground storage.
underground storage.
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Speaker 3
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Speaker 3
Yes, I think from from humanitarian partners, quite a few. warehouses have has been damaged. I would say it's close to five, and it depends also on the size. So for Ukrainian Red cross, two large warehouses has been damaged, but the. warehousing in the front line is under the constant pressure. And I would say same goes for the. businesses as well. And we also can monitor that the attacks are rather from the. economic as well nature. So the attacks I would say would have would be targeting the economy and the logistics chain in Ukraine. And this is kind of a new.
dimension from, I would say, mid this year when the. missiles or. ammunition that is being used is not targeted only for the front line, the the targets moving to the. logistics and moving to the bigger cities, the urban cities as well. And this is what we also need to closely. consider . that there are. much more. attacks on the urban settlements, and also the attacks .
dimension from, I would say, mid this year when the. missiles or. ammunition that is being used is not targeted only for the front line, the the targets moving to the. logistics and moving to the bigger cities, the urban cities as well. And this is what we also need to closely. consider . that there are. much more. attacks on the urban settlements, and also the attacks .
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Speaker 3
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Speaker 3
The. provision of. humanitarian aid? E I would give a conclusion that this is an economic warfare, right? So the targeting is not. particular looking to. deflect or. deteriorate some abilities for the government to deliver on something. But there is a it seems to be that if there is, you know, even even I think a month ago there was a toy, a big toy warehouse that has been for children, toys has been attacked, and it seems like it was attacked. deliberately because not because for some reason there is a and. very big need of toys to be delivered and the government reliability.
But because when you attack a bigger or a large company or mid-size company, you can inflict the damage. You can put more pressure on the.
But because when you attack a bigger or a large company or mid-size company, you can inflict the damage. You can put more pressure on the.
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Speaker 5
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Speaker 5
So it's great pleasure that he's guesting with us today. Alex, over to you. Thank you. Thank you, Sarah, so much. Mila, as you know, the UK has. committed loan guarantees worth around. £4 billion to support the world Bank lending Ukraine and another. 4 billion for the international Bank for Reconstruction Development last week in the budget, a further uplift to the world Bank. guarantees was announced. Next three years, as well as. £500 million grant to the world Bank International Development Association Crisis Facility. So bringing that to a total of. 1.5 billion of support through that for Ukraine.
In terms of the aid that you've already .
In terms of the aid that you've already .
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Speaker 6
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Speaker 6
Had, what impact has it had for Ukraine? Thank you so much. And I just would love to say that we speak only about humanitarian crisis, but we need to think not only about this, but about development as well, because our people don't live in fragments like we live. So it's very important to create this bridge between. humanitarian and development part. And that's why this UK actually policy and. implementation of programs is very important because you support us with both.
humanitarian and development. And for.
humanitarian and development. And for.
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Speaker 6
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Speaker 6
Or we have support for. humanitarian zinc. And we understand that we need to combine this. Ilya and Alina already mentioned that we need to have support in the frontline areas, but. Center of. Ukraine or west of Ukraine, not so actually popular. And that's important to highlight. because if you would love to keep people there, we need to.
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Speaker 6
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Speaker 6
And how we can build. relationship between private sector and civil society and government, because this triangle actually this is really solution. And we would love to actually. present this year such. model for Fcdo work. because Ukraine not only how to say like beggars, we provider of solutions. And that's. important not only like used as funding what you support us with, but as well create this.
programs what you .
programs what you .
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Speaker 6
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Speaker 6
Able to undertake because of those funds? So for us, this is actually a question now because world Bank worked with government and with private sector, and we need to think how to include civil. society to this. Triangle. And because we we have such programs like work work programs. And this is they use.
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Speaker 6
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Speaker 6
Government for this. So that's it's very important to introduce civil society as really a good partner for this, because we already have such a project like Livelihood projects where we. provide grants for private sector for people. So that's important to have civil society on board. This is still an issue, and I think that we need to work very close with government. We need to. I think world Bank work with, of course, with government as a really partner, one window, and this is very hard to create a lot of different.
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Speaker 6
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Speaker 6
But I think that's important. So pull funds, for example, what we create in Ukraine, and we would love to present together with NGO. platform such as. solutions maybe could be an interesting option for this because funds this is not only for. humanitarian partners, but actually. investment or private .
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Sarah Champion
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Sarah Champion
Capital could be such a partner to support. Mila. It would be very interesting to to see your report and. recommendations on that. But also, when the war first broke out, this committee did a session on. humanitarian needs, and it became very apparent that the government didn't know where all of civil society was, where all the volunteers were, where all the NGOs were. And so weren't that. forthcoming in leaning on you and .
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Speaker 6
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Speaker 6
Now we are thinking how to I already mentioned this. cross-sectoral concept. We working together with. ministries and what is important. They really see in US partners. And just two months ago they came to us that Parliament committee and. provided law. This draft of law. This is very. controversial and we understand that we will support and provide our comments and we need to improve this. But what is important that see they see in us very important partner because we continue and continue support and we don't want to actually kick them out from the space. We understand the importance of government.
Some things like evacuation, for example. It's really something what we took. But we, we, we need to. understand how in the future we can work together and create such a system, which will be really for long .
Some things like evacuation, for example. It's really something what we took. But we, we, we need to. understand how in the future we can work together and create such a system, which will be really for long .
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Speaker 1
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Speaker 1
The new strategy was developed and was launched. But also on top of that, it's going to depend where in the process of conversation with the government on how the bylaw is going to look like, how they are going to describe all the solutions for the IDPs in to provide them with durable solutions in the longer term. But I do believe this is more like this strategy , where the UK support for the government and NGO support to the government can create longer sustainable solutions for the IDPs who are brought from the evacuation point , through the transit and collective sites, to longer .
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Speaker 3
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Speaker 3
It's see if we can speed up the. recovery aspect, see if we can as well, look at the. humanitarian needs and the recovery needs jointly, and see how we can cross both and how we can and understand that the people that are going through. displacement and people that are going through a a complex. humanitarian needs, how do they enter into the recovery? What kind of. programs or approaches we need to introduce? What are the best practices? But I think very much it would be. interesting and. absolutely needed to bring this. dimensions of. humanitarian and recovery.
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Speaker 1
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Speaker 1
And it is very much important to have a correct. and a great. partnership that can support Ukraine into. developing correct documents, correct. approaches and looking as well, where what are the gaps and where can we speed up? But of course, the gap number one, that I can say I see this is the crossing between the.
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Speaker 3
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Speaker 3
Thank you, thank you. I think I completely support this point. And maybe to reinforce this point, we can say that we see that human resources capacity, as we heard in the previous session, but we also know from our members in at the level at community level is very strained. Salaries are also not very high. So to complement the the local authorities and to complement the government capacity, some projects are developed jointly, as I'm sure you know, and what we see as essential is that social and public services are continued to be. supported in either through projects or through the support to the local.
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Speaker 3
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Speaker 3
Because without them, it's going to be really hard for the. NGOs to provide humanitarian assistance in. complementary way. And sometimes it's not going to be possible. If we are going to take example of healthcare. facilities in the front line, the healthcare needs right now, this according to the data that we see from this year, we see that the. majority big number of the population in the frontline, almost half is people or 60 plus age and.
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Speaker 3
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Speaker 3
And many of them are single women. And it means they are exposed to protection risks. They are. exposed to healthcare. So if we were looking at the health care needs and according to impact initiatives, the data and research think tank, they were mentioning to us that almost the half of the healthcare needs in the frontline are.
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Speaker 3
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Speaker 3
The travel to the healthcare. facility can take from 15 to 45 minutes. Even if the healthcare facility is not located in your settlement, but in the neighboring settlement. But let's say we are approaching the winter. The fuel prices might ramp up. Then the. Attacks as we security situation can exacerbate. And then we are looking at the place where there is no service. provision in the.
community without the need to travel. And the limited income doesn't allow you to travel to far. So then we're going to see the pockets of the healthcare needs.
community without the need to travel. And the limited income doesn't allow you to travel to far. So then we're going to see the pockets of the healthcare needs.
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Speaker 4
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Speaker 4
Authorities or the government authorities. Yeah, very bleak. And to add, so Fcdo has really such a rich. portfolio and very diverse portfolio. And that's very important to. introduce all different bubbles to each other. Like I mentioned, for the Alex, like a world bank, they believe in their partners and they work just in this framework. And that's very important to facilitate and support these connections between different.
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Speaker 4
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Speaker 4
As well as actually a license funded from the beginning by Fcdo. And that was very actually impactful because as a Ukrainian civil society, now we as a. laboratory for. solutions and for. different products, what we can provide like minimum package of duty of care, for example. And now this is a great solution not only for. Ukraine as well as it's. important to drive this practical nexus like magic word, but it doesn't mean that it's very important to just mention work together with different .
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David Taylor
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David Taylor
Because a number of charities that I work with are primarily UK based charities that are trying to bring in a range of different. supplies into Ukraine. And I've myself been out on the journey with them in the past. The the border delays apparently are getting worse, particularly the border with Poland. specifically with delays of up to a week in some cases. And that then obviously has knock on effects for their ability to deliver their the commitments they've made within Ukraine. Is that something that as an issue that you've come across, and what, if anything, can the UK government do to put pressure on, say, the Polish.
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Speaker 1
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Speaker 1
I would say, for all of the borders and especially maybe a bit more for the Polish border, because anyhow, it remains the main. transportation and logistics hub into Ukraine. What are the solution for. humanitarian aid here? Because the. humanitarian or any other support that is coming up into Ukraine for. organizations like ours, it's also staying there at the border. There are a bit of.
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Speaker 1
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Speaker 1
Or generator solutions, to procure. anything in Ukraine will take months. I would say three, four months. And of course, we we are now already in the stage when we're. relying for some of the. movement of cargo from outside of Ukraine. I would say it's critical, but I'm not aware of any possible. solutions because there are many different.
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Speaker 1
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Speaker 1
Supplies that are going into into Ukraine. So I would assume that and also very important to mention, you probably know that for the past two months, there has been a tax increase in attacks at the borders as well. And right now, and maybe it's as well a. deliberate fly over fly zone for drones and borders need to close specifically. So once, once again, it's a bit I would say it's a bit of a economic pressure here as well. When the when drones from the Russian Federation are as well going very close to the European borders in order to inflict that, Ukraine will close or.
temporarily wait until the air alerts goes down. So there is also an additional. pressure in order to postpone the .
temporarily wait until the air alerts goes down. So there is also an additional. pressure in order to postpone the .
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Speaker 4
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Speaker 4
Thank you, thank you. Yeah. Thank you. And just I would love to support Ilya with idea to use actually. Ukrainian like, for example, farmers to support. We have a lot of projects like. livelihoods projects, and we have a really great private sector right now and the solutions. So that's very important to use. And this is not only like support, but as well pushing economy. So that's one question. Another question. We already have different state CSOs. Mechanism like for example, office of president driving that question with ministries of and with CSOs and this question on board as well.
So we try to think we try to solve these.
So we try to think we try to solve these.
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David Taylor
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David Taylor
Farmers in any way, shape or form, this is goods that would otherwise be thrown away or etc.. But just a follow up question I had was actually regarding Nova Poshta, if I've pronounced that right, apparently they used to. provide free delivery. No longer do that. They feel like that's hampering their efforts. Is it hampering yours? Do you have a view on that and whether or not Nova Post .
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Speaker 1
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Speaker 1
Bulk items, I'm assuming, but certain items. Yeah. Look, we also Ukraine, we do have a partnership with the Nova Post because anyhow, it's the biggest logistics provider in. Ukraine and they do support pro bono. I would say some humanitarian. organizations or they can support. And I think in the beginning, in.
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Speaker 1
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Speaker 1
Based on what I know. But they're quite open for the partnerships and the discussions. I once again, I cannot comment on the value of volume, what's increased, what's what's not. We have been . And I'll be open with you. We have a good. partnership with Nova Post and they providing us free. warehousing and as well the logistics capacities.
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Speaker 4
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Speaker 4
Either or choice. Mila, maybe you can add on top of this. Yeah, I can add because we have only Ukrainian civil society on board. And just I would love to say that when war started and for now, we had lost. 57% of charitable foundations. So what does it mean? That means that people don't want to be volunteers. They would love to. professionalize and. institutionalize this support. And we have a lot of. different volunteer initiatives. And now they have a budget like those and millions of euros. Why? Because these people came from private sector, from medical sphere, from, you know, very different.
professional areas. And that means that they provide very technical, interesting solutions, very creative solutions. So now we have a really very, I think, new.
professional areas. And that means that they provide very technical, interesting solutions, very creative solutions. So now we have a really very, I think, new.
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Speaker 4
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Speaker 4
Very easy to change their shoes and will start to work with development, with recovery. They already work in this. So that's why I just maybe repeatedly a bit annoying, like speak about. introduction because that's important to. introduce this. organizations like very reliable partners to private sector, because now they think that we like or beggars or maybe. competitors to them because they would love to drive this.
Everyone would love to drive funding. So but we need and actually how we survived in.
Everyone would love to drive funding. So but we need and actually how we survived in.
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Speaker 4
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Speaker 4
Our horizontal connection supported us. So now we need to. continue and we need to build this. triangle in an equal manner, and we need to invest in this relationship. So for example, you have investment agency. It will be very. interesting when agency can not only work for your members like and invite only private sector to some meetings, but as well combined because now for example, we had just very specific example.
I was invited to.
I was invited to.
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Speaker 1
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Speaker 1
It gives you a privilege to. support the. very also being a very difficult situation and very support the government and the and the. humanitarian efforts. So from one point, I think it's very. privileged position. From another point, it's very difficult position. I do see a lot of our. volunteers and staff, especially in the.
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Speaker 1
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Speaker 1
In terms of the staff, but. volunteers tremendous, I would say by ten times because the people were ready to go in and. support the their neighbors. And we were just one of the. organizations that provided the platform to do probably to do it a bit better and a bit structured. However, I would say the the society itself mobilized very quick, of course, being. mobilized for years, for five years in a row. It's very difficult. Some people can do it. Some people cannot do it depends as well on your economic status, on the possibilities. Even I would say last.
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Speaker 1
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Speaker 1
Or other commitments that they have in professional personal life. So but of course it is difficult. But when you have a system, and I very much hope that we have some sort of the system already to manage the. volunteers and engage with the civil society. And, and I would mention maybe to the previous question that you had, I think the civil society of. Ukraine is still very much capable to respond.
All very fatigued. But I think and especially when we're talking about the winter and the.
All very fatigued. But I think and especially when we're talking about the winter and the.
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Sarah Champion
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Sarah Champion
Both of the Red cross, but also civil society and the NGOs that are working in this field. I don't think any of us. realized or could believe how long this has been going on for. So the endurance that you've shown, both as a nation and as individuals is truly remarkable and something to be honored. So please express our gratitude to everybody that works alongside you,
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Speaker 4
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Speaker 4
What are you seeing NGOs doing in the. humanitarian field? They're like first responders. When war started, actually, who actually who started this response? Local actors, and I already mentioned you just left that we started like a volunteers, but a lot of. organizations become very strong and capable.
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Speaker 4
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Speaker 4
They do everything. So but that's very important that they don't want to duplicate. They just try not only like fill the gaps. What we have, for example, evacuation, I already mentioned this is a really big part of our work. This is very dangerous area. But and I already mentioned winter, but every day we have actually different messages from our members. They they are , they were targeted every day. So they like with this safari , they target with emblem, with. humanitarian emblem. All this. And this is very important to. support because it's just a slogan. Now like.
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Speaker 4
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Speaker 4
We work around localization. We have localization strategy in Ukraine. And we are thinking how to improve different. streamlines to share this access actually with local actors, because for them, this is very hard to be part of this, like pull funds, like Ukrainian humanitarian funds, for example. And that's why we are thinking how to support them because with strong. representation on national actors, but how we can have them on board because they not only providers of needs as well as important.
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Speaker 3
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Speaker 3
The services vary from actually going into communities and bringing out people, evacuating people, providing them with information assistance, providing them with different kinds and types of assistance, including mental health support for those people, but also including like renovation and shelter. repairs in the collective sites, in the transit sites that people are going to visit in transit sites for 2 to 3 days, and then transit sites becomes the windows for Ingos and NGOs to come and to provide, to meet the population and to provide the assistance to the population. With one caveat there are self evacuees.
There are people who are evacuating on the on themselves by their own means, and they are falling out and they're falling through the cracks. We do not see them in the system. And what we know about them is that they deplete their own resources. And it means that they're like having more.
There are people who are evacuating on the on themselves by their own means, and they are falling out and they're falling through the cracks. We do not see them in the system. And what we know about them is that they deplete their own resources. And it means that they're like having more.
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Speaker 3
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Speaker 3
Engage, or is that a weakness in the systems that they're not being picked up? That's a good question. I think it's a combination of both, honestly, because on one hand, it's a choice because people choose not to. What we see, according to, again, our members and their data collection and in conversation with Protection Cluster. And I'm referring too much to this I know today, but it's more. evidence like that I can rely on .
What we see is first, personal reasons. Some people have their.
What we see is first, personal reasons. Some people have their.
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Speaker 3
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Speaker 3
Their pets, but also some have hands, chickens and whatever they want to have and to evacuate with the the animals that they have requires more resources. So they either choose to stay and delay the evacuation to the last minute, or they ask for the information for the living conditions with the animals. And these this is the limitation that had been identified in the.
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Speaker 3
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Speaker 3
Like in August this year. Then there is also a second group. And a different reason for non. evacuation is when people. evacuated spend some time either abroad or in central western Ukraine, and decided to return back once they returned back, they express less willingness and less. readiness to. evacuate up to the point when the conditions become.
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Speaker 4
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Speaker 4
Actually, that's why they don't want to leave. They would love to support and actually protect. That's why actually, I know people who didn't have any. vacation during this war time because they even feel shame and how I can leave this space because my people need this support. So that's what is very important. Not only. support like people like.
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Speaker 1
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Speaker 1
The timeline and. considering the changed nature of warfare and impact. So definitely what we see now and what we try as NGO platform to facilitate as well is like, it's not, I'm not answering your question. I'm giving a different answer, but maybe it will help or it will give you the idea where what are people thinking of now?
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Speaker 1
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Speaker 1
As Mila earlier said, for different stakeholders to meet and what we as platform do. And also Alliance does, and we sometimes do jointly as well. We put Ramadas and CSOs or NGOs. together for them to. identify the needs that are existent in Ramadas and resources that NGOs have to complement those needs. That's why earlier I was talking about those opportunities. If the business is brought there, then we are talking about the nexus and development. If the business is not there, we're talking, at least in my vision, and I might be wrong. Please correct me. We are talking about.
humanitarian assistance. Another track is and I'm coming again to IDPs and their. adaptations is basically the whole response right now is trying to look at the whole IDP journey and to see with. We need. We understand the need to hyper. prioritize within the. humanitarian plan because of the limited resources, because of the need to choose and select whom to provide the assistance. We also know, as I mentioned earlier, that some people are going to fall through the cracks. So what we are jointly in the response trying to do is to. identify the places where those people might fall through the cracks, and to see whom to bring into the conversation, how to build the dialogue around those.
issues so that we can see how to support that transition. I think to like, my one sentence answer would be, I do believe that all the same issues we see right now are going to.
humanitarian assistance. Another track is and I'm coming again to IDPs and their. adaptations is basically the whole response right now is trying to look at the whole IDP journey and to see with. We need. We understand the need to hyper. prioritize within the. humanitarian plan because of the limited resources, because of the need to choose and select whom to provide the assistance. We also know, as I mentioned earlier, that some people are going to fall through the cracks. So what we are jointly in the response trying to do is to. identify the places where those people might fall through the cracks, and to see whom to bring into the conversation, how to build the dialogue around those.
issues so that we can see how to support that transition. I think to like, my one sentence answer would be, I do believe that all the same issues we see right now are going to.
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Sarah Champion
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Sarah Champion
To breaking. Thank you. I really appreciate all of you making the time to be with us today. It is a horrific. situation that you find yourselves in and not of your own making. You've represented your organizations and members very well, and you've given us a very, very clear picture of the daily grind and horror that people of Ukraine are enduring. Thank you for your work.
Thank you for being with us today, and thank you for giving us an insight into what you're .
Thank you for being with us today, and thank you for giving us an insight into what you're .
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