With all that is happening in Ukraine, I have been wondering for a few weeks what happens to dialysis patients or transplant patients who see their daily lives shaken up by war. In addition to injuries, the collapse of the health system is one of the greatest threats to the health of its inhabitants. In times of war, health services are limited, both because of the physical damage to hospitals and because of the lack of equipment and employees (who have fled the country, are hiding or even dying).
Patients requiring dialysis or who have received a transplant are particularly at risk. Indeed, their condition requires the need for constant care to stay alive. In Ukraine, they represent more than 10,000 patients, and I tried to understand their current reality.
- Dialysis patients who remained in Ukraine
- Transplant recipients
- People who managed to flee
- The war wounded
- All other chronically ill patients
Dialysis patients who remained in Ukraine
Even if it is a war crime, hospitals are not spared in this war by Russian troops. Even Red Cross centers are targeted during attacks, even though they are very clearly identified, as shown in this video. Nevertheless, a report shows that 4 out of 5 employees are still present at work, still caring for and operating people who need it in this cardiology center in Kyiv.
When you are on dialysis, you must receive treatments either daily (peritoneal dialysis) or 3 times a week (hemodialysis), for several hours each time. It requires machines, linked to electricity. It requires special liquids, including a lot of clean water. It requires cleanliness and sterile equipment. And often, it requires access to a hospital and trained health professionals. All these things are missing right now, in many cities of Ukraine.
Without dialysis, a person who needs it will die after a few days or weeks, depending on how much kidney function they have left from their kidneys. On average, a person who stops dialysis lives between 5 to 10 days. Without a functional kidney or dialysis, nothing filters the waste produced by your body. The person will become drowsy, only to eventually fall into a coma from which he will never wake up.
Un réseau hospitalier en déroute
Le 31 mars 2022, l’ONU nous indique que plus de 90% de tous les hôpitaux et écoles de Marioupol, dans le sud de l’Ukraine, ont été endommagés. 40% d’entre eux ont été complètement détruits. Comme le rappelle l’organisme Médecins du monde, la guerre en Ukraine est une guerre de siège sur les villes, et les hôpitaux ont donc perdu la majorité de leur chaîne d’approvisionnement en matériel et médication.
10 million Ukrainians have been moved to other cities in Ukraine. Hospitals in the west of the country, in a better position, are overburdened by growing demand. They are not yet short of supplies, but many fear shortages.
During the annexation of Crimea in Ukraine in 2014, some dialysis centers gradually turned into hospitals used to treat wounded fighters. Patients on dialysis there were moved to other cities to continue their treatments. An article from the International Organization for Migration told the story of a dialysis patient who went one morning for her dialysis session. Instead of that, the team on site put her on a train to continue her treatments in another city, for an indefinite period! It gives us an idea of what the current centers can put in place to move their patients around the country.
Transplant recipients
A person who has received a transplant needs several drugs every day, at a fixed time, so that the body does not reject the foreign organ (the graft) that allows them to stay alive. Without this medication, the body will start working to destroy the graft. So even if they find the necessary medication a few days later, it is probably already too late: the graft will be lost. The person will need to start dialysis again immediately (if available to him/her…), and will need a new transplant eventually.
Blockades of trade routes also mean a shortage of medication. Again, this means that these people leave their homes and try to find a hospital that can provide them with the necessary medication. They can travel to western Ukraine, or choose to leave their country to get help elsewhere. They just have no choice; they leave, or die.
People who managed to flee
Les réfugiés qui nécessitent des soins continus doivent non seulement quitter leurs maisons et tout ce qu’ils possèdent, mais également leur centre de soins où ils reçoivent leurs traitements. Lorsqu’ils quittent tout, c’est sans savoir où et quand ils pourront avoir leur prochaine dialyse, ou un accès à leur médication. Imaginez vous dans cette situation, devoir quitter son pays pour avoir une chance de rester en vie, tout en devenant de plus en plus faible en raison des symptômes d’insuffisance rénale. Heureusement, certaines initiatives (site en anglais) facilitent cette transition, telles que cette liste de professionnels dans 4 pays (en anglais) qu’il est possible d’appeler pour obtenir les traitements nécessaires.
Comme le souligne Michel VanRooyen (en anglais), directeur de l’Initiative humanitaire de Harvard, les pays limitrophes à l’Ukraine comme la Pologne, la Hongrie et la Moldavie risquent également de voir leurs capacités hospitalières réduites en raison de l’influx de réfugiés nécessitant une prise en charge urgente. D’ailleurs, en Pologne, le pays a accueilli plus de 2 millions de réfugiés depuis le début mars grâce à un grand élan de solidarité de leur population. Les médias commencent à poser des questions (en anglais) sur l’impact de cette arrivée massive de gens sur les systèmes administratif, de santé et d’éducation de leur pays.
Mieux se préparer à l’accueil de réfugiés nécessitant des soins
Pour le moment, on ne sait pas combien de gens n’ont pas pu obtenir les soins nécessaires pendant leur fuite du pays. Par contre, plusieurs organisations militent haut et fort afin que les pays qui voient la situation dans un pays voisin s’envenimer préparent des plans d’urgence pour accueillir convenablement et sécuritaire ce flot de gens, pas toujours en santé. Le Journal of Nephrology recommande également de former les néphrologues du monde entier à la néphrologie de catastrophe (en anglais). Cette pratique pourrait améliorer le prognostic de plusieurs patients. Dans un monde où les catastrophes naturelles sont de plus en plus fréquentes et les conflits armés constants, je pense que de se préparer mentalement à un jour accueillir des réfugiés en situation critique de santé n‘est que du gros bon sens.
Let us not forget the war wounded
Au début, quand je cherchais sur la guerre et la dialyse, j’ai lu beaucoup d’articles sur le fait que plusieurs guerres précédentes (la seconde guerre mondiale et la guerre de Corée, par exemple) ont permis de grandes avancées dans la possibilité de faire de la dialyse. Lorsqu’une personne se fait blesser aux reins, il est possible depuis moins de 70 ans de lui fournir des soins de dialyse péritonéale directement où il se situe (en anglais) si le matériel nécessaire est disponible, avec un taux de survie de plus en plus élevé.
After the war, some of these people will need dialysis afterwards, too. They will need access to specialists and special care. Their lives will be changed forever.
What about other patients requiring ongoing care?
Yes, renal patients need extra care, but I can’t not write about people who have other chronic diseases and need other treatments or ongoing medication. Think of all the people who have diabetes, problems with their blood pressure, or who have any other chronic diseases that has to be treated regularly. Think of pregnant women. Think of sick children. Think of those who are fighting cancer.
And that’s just one of the armed conflicts in the world, all of which are equally serious…
That’s a lot of people who need care to stay alive, and who can no longer access it.
And all this, for imaginary lines on a map ...
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