During the 15 months of the war, almost 12 million crossings of the border between Poland and Ukraine have been recorded. Currently Poland is hosting the largest number of refugees from Ukraine, roughly 1.5 million. The integration of such a large group required joint, multisectoral national response, but above all planned activities, adequate funding and quick changes in the existing law inter alia in the area of healthcare.
Humanitarian emergency and support for Ukrainian refugees from the Polish authorities
The large influx of war refugees from Ukraine to Poland quickly led to a humanitarian emergency. Integrating millions of refugees required a joint, national response involving the Polish government, its agencies, non-governmental organisations and civil society. Since the very beginning of the war thousands of Polish volunteers, families and local authorities have mobilised to help displaced Ukrainians.
Within just one month of Russia’s invasion of Ukraine, the Polish government established the Aid Fund, which secured financing for all activities necessary to help and integrate Ukrainian refugees, including healthcare and education.
Already in March 2022, the Ukrainian war refugees and their spouses received the right to legally stay in Poland for 18 months and to apply for a unique ID number (PESEL). Receiving a PESEL meant in practice the possibility of legally living and working in Poland and enjoying the same benefits as Polish citizens, such as health insurance, healthcare, child allowance and free public education. To ensure the effective coordination of the health aid to refugees, the aid coordinator was appointed at the level of the Ministry of Health.
Worth mentioning is the fact that already before the outbreak of war, there were around 1,35 million Ukrainians working/residing in Poland, most of them men and economically active. Among them more than 300,000 had a valid residence permit. After the war broke out in February 2022, many of the men left to defend their country, but some stayed in Poland. They were soon joined by their families fleeing the war zones in Ukraine.
Polish support to war refugees living with HIV
Russia’s armed attack on Ukraine caused not only a huge wave of refugees but also violated the logistics of antiretroviral (ARV) treatment inside and outside of Ukraine. It caused disruptions in the provision of health services in the occupied territories, destruction of medical units providing health services including HIV/STI counselling and ARV treatment, and a lack of medical staff.
According to the preliminary WHO estimates from the very beginning of the war in Ukraine, in the group of war refugees fleeing to Poland, 16,000 may have needed ARV treatment. But the actual number of Ukrainians receiving ARV has turned out to be lower, currently amounting to 3,300 people as of May 2023.
To ensure continued HIV treatment, the Polish Ministry of Health and the National AIDS Centre started negotiations with WHO and UNAIDS for obtaining a donation of generic drug TLD (tenofovir, lamivudine, dolutegravir) that is the most widely used ARV drug in Ukraine. In addition, the Minister of Health allocated about 30 million USD for the ARV treatment of the Ukrainian refugees. Substantial resources have also been allocated for the support of civil society organisations working in the field of HIV/AIDS prevention and helping refugees. From the very beginning of the war, the Polish Minister of Health assured full access for the Ukrainian refugees to medical care in line with the same standards and rules that apply to the Polish citizens.
Admission of the TLD drug to the Polish market (a drug not previously authorised in the European Union) required a quick change in the national pharmaceutical law, making the TLD drug available to all war refugees who needed it. The change was passed by the Polish parliament in just two weeks. Meanwhile, the Ukrainians HIV+ were able to use ARV drugs usually used in Poland.
In general, ARV treatment became available to Ukrainian war refugees in all the health facilities providing HIV/AIDS services in Poland. The same applies to the Polish voluntary counselling and testing facilities where refugees can test for HIV, and other STI such as syphilis and HCV. These services were supported by a national information campaign, carried out in both Ukrainian and Polish.
In addition, regular data collection on newly registered HIV cases in Poland in a group of refugees from Ukraine and on ARV treatment are carried out. There is an ongoing need for robust HIV surveillance, data exchange and assessment of the epidemiological situation. Especially now in the context of the war in Ukraine, there is an absence of comprehensive and reliable data on the HIV situation at the European level, for example, on the Ukrainians receiving antiviral treatment in Europe and their needs for psychological, educational, professional and legal support.
Long-term stay of war refugees in Poland may generate numerous challenges in the field of general and specialist healthcare, as additional 1.5 million people are currently entitled to use the Polish health care system including HIV/STIs services. Moreover, there is still an ongoing migration process of ARV patients to/from Poland. From the point of view of public health, early diagnosis of HIV and STIs, initiation of ARV treatment as soon as possible and access to care remain crucial for stopping the HIV epidemic.
Poland, as a country that has accepted the largest number of war refugees from Ukraine should play one of the key roles in mitigating adverse health consequences of the conflict related migration.
Ensuring the continuity of HIV services during the war remains crucial. Good information about availability of HIV services, in Polish and Ukrainian, has played a key role in the effective prevention of HIV, hepatitis and STIs among the refugees. Another strategically important issue is close cooperation and systematic data exchange between key stakeholders at the national and international level, including the government, public health institutes, medical and sanitary services, as well as non-governmental organisations.
Text: Piotr Wysocki & Anna Marzec-Bogulawska, National AIDS Centre, Poland.