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Inside Ukraine’s stroke neuro-rehab units

The Russian invasion causes stroke cases to spike in Ukraine, as neuro-interventions hit an all-time low



As the war in Ukraine drags on, stroke incidence in the country is on the rise, Professor Yuriy Flomin of the Oberig Universal Clinic in Kyiv tells SR Times.

The prevalence of stroke in Ukraine is one of the largest in Europe.

The Center for Medical Statistics of the Ministry of Health of Ukraine reported 134,477 cases of stroke in 2021 – the highest incidence since 2017 – with over 130,000 Ukrainians having a stroke every year.

But these figures are no longer accurate. The number of strokes in Ukraine has surged since the outset of the war, while the lack of hospital facilities has left many with no access to neuro interventions and therapy.

“The war has ushered in an era of challenges for Ukrainian residents and major among them will be the limited access to healthcare,” says Professor Yuriy Flomin, head of the stroke and neurorehabilitation unit at the Oberig Universal Clinic in Kyiv. 

“We’ve seen that the incidence of stroke per 100,000 population in Ukraine has increased, especially in the up to seven million internally displaced people.

“But because an estimated six million refugees have been forced to abandon their homes and flee to neighbouring European countries, the absolute number of strokes in 2022 may seem lesser than in previous years.”

Exposure to military combat has been shown to significantly increase the risk of stroke.

A recent systematic review by the World Bank has shown that conflicts are associated with increased cardiovascular disease and the associated risk factors, including smoking, hypertension, hypercholesterolaemia and alcohol consumption.

Another systematic review by Imperial College London and the London School of Hygiene and Tropical Medicine has found that people living in war zones may have a higher risk of stroke and heart disease even years after the conflict has ended.

Flomin and his team have noticed much poorer control of vascular risk factors, including hypertension, hyperlipidemia, smoking, atrial fibrillation, and diabetes as well as increased stress and anxiety and a less healthful diet.

“The Russian invasion of Ukraine is one of the most devastating crises in recent history,” he explains. “The barbaric attacks have resulted in substantial morbidity and mortality and created a catastrophic health and humanitarian crisis that affected everyone, including civilians, health facilities, transport, personnel, patients, supplies and warehouses.

“Obviously, these attacks have had a devastating effect on stroke and rehabilitation care in Ukraine, particularly in the areas no longer under the Ukrainian government control or those close to the frontline.”

Above all, stress and anxiety as a direct result of the trauma of war are also likely to exponentially increase the risk of stroke. According to research from the American Heart Association, even a slight increase in stress and anxiety levels may raise stroke risk.

Despite the terror and uncertainty of war, stroke wards are working together to support survivors. “While most physicians and health professionals have not experienced the challenges of practicing during war or civil conflict, those in Ukraine are bravely doing just that,” says Professor Flomin.

As recurrence rates can range from five to 51.3 per cent, depending on stroke subtype, doctors are working collectively to lower the risk of recurrent stroke.

The European Stroke Organisation (ESO) is also actively supporting organisations in Ukraine. In March, ESO has formed a Task Force to address the needs of the stroke community in Ukraine through information channels and support groups.

However, the supply of medications and equipment for thrombolysis, vascular-neurosurgery, and endovascular treatment remains an issue.

In areas like Kherson, almost 90 per cent of the pharmacies remain closed, jeopardising the storage conditions of medicines purchased before the war.

“Although the situation in July and August has seemed a bit more stable and predictable than in the spring months, it may worsen over the autumn and winter because of financial issues, insufficient staffing and short supplies,” says Flomin.

“Under the current circumstances, humanitarian support is of utmost importance.”