“Barbaric attacks in Ukraine have devastating consequences on neuro-rehab”
As the war in Ukraine heads into its seventh month, civilians continue to bear the brunt of the conflict. NR Times reports on the growing brain injury burden facing neuro-rehab specialists in the country.
This week Kyiv will celebrate independence day and mark half a year of fighting.
While the ripples of the conflict will undoubtedly be felt for many years to come, the impact of the trauma is already being felt by thousands with brain injuries and neurological conditions.
Blast-related traumatic brain injuries (TBI) in both civilians and soldiers have become a daily occurrence.
According to a study from the JAMA Network, up to 28 per cent of armed forces experience TBI, with over 47 per cent of them being diagnosed with post-traumatic stress disorder (PTSD).
However, the neurological consequences for civilians are difficult to establish.
A study published in the National Library of Medicine found that 67 per cent of the civilian population exposed to conflict are likely to experience symptoms of depression while 42 per cent are at risk of PTSD.
The medical cost of the war on Ukraine is likely to engulf millions of civilians, but is yet unclear.
“The Russian invasion is one of the most devastating crises in recent history,” says Professor Yuriy Flomin, head of the stroke and rehabilitation unit at the Universal Clinic Oberig in Kyiv.
“The barbaric attacks affecting Ukrainian civilians, destruction of residential areas and health care centres have resulted in substantial morbidity and mortality and created a catastrophic health and humanitarian crisis. They have ushered in an era of challenges for Ukrainian residents and major among them, will be the limited access to healthcare.”
For those with advanced neurological conditions, access to neuro-rehab services are scarce, says Flomin. “Attacks on health facilities, transport, personnel, patients, supplies and warehouses have had devastating effects on rehabilitation care in Ukraine, particularly in the areas no longer under the Ukrainian government control.
“Since the war started we’ve seen people with MS, Parkinson’s disease, epilepsy, dementia or headache who suffer from limited access to specialised care,” he explains.
“We’ve also 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.”
Nanette Mellor, CEO of The Brain Charity, says that the number of mental health conditions following head and brain injuries during the war are also likely to grow.
“We know that these types of injuries can have far worse impacts than physical disabilities. Although there is an assumption that brain injury survivors are okay because they can talk and walk, there is an awful lot of damage caused to people’s brains within war zones that unfortunately, we can’t see.”
While military personnel are significantly exposed, Mellor says that civilians are, in fact, much more vulnerable.
“We are only starting to see how repetitive exposure to blast results in very debilitating neurological changes both in soldiers and civilians. However, if you look at a blast in the city centre, for example, the civilian population are much less protected than the military forces.
“Children and elderly people are especially at high risk of brain injuries, as they have no training and protective equipment. The fact that they’re not going to be able to get that immediate treatment due to the lack of hospital facilities and affected infrastructure will have really long lasting impacts on them.”
Professor Michael Barnes, consultant neurologist, says that brain injury is a forgotten injury during conflict. “Because often people look relatively normal, TBI is highly under-recognised. Although people seem to manage, they manage very badly. They look okay, but they’ve got this hidden disability that many are not aware of.
“There must be an awful lot of people in Ukraine who are barely surviving simply because rehabilitation is not deemed a priority,” he adds.
The long-term effects of TBI can vary, but they include problems with logic, speech difficulties, trouble understanding others as well as physical and social problems. But employment and family problems are also common, says Barnes.
“Although, TBI can lead to many complications, people in war zones often lack that badly needed support – they may not have family support or they may even struggle to access hospital facilities. That is why conditions like PTSD and other mental health disorders are very common and we are clearly starting to see that in Ukraine.”
Mellor says that the trauma will also be felt by the over 12 million Ukrainians who fled the war. “They may not have experienced combat, but they will also be likely to develop PTSD, depression and have suicidal thoughts,” she explains.
“Being exposed to war will really shake the Ukrainians’ foundations. The war will be a seismic shift in the way they view the world and how safe they feel within it.”
Ukraine’s destroyed health facilities are likely to cause harm for a long time to come.
Disruption to healthcare services, severe shortages of medications along with a rise in medical emergencies have heightened the challenges for hundreds of Ukrainian physicians. Many doctors have fled the fighting, but others like Flomin have stayed.
“While most physicians and health professionals have not experienced the challenges of practicing during war or civil conflict, those who remained are bravely doing just that.
“July and August have seemed a bit more stable and predictable than the spring months,” he adds. “However, over the autumn and winter the situation may worsen because of financial issues, insufficient staffing and short supplies.
“Under the current circumstances humanitarian support is of utmost importance to help us reduce disability in both military and civilian casualties and save lives.”
