Running the health response to Ukraine’s emergency: Interview with WHO Representative Jarno Habicht

Jarno Habicht has worked with WHO for the last 19 years and served as WHO Representative (WR) in Ukraine since 2018. He answers questions about WHO’s preparation for armed conflicts in the country and its health-related humanitarian response since the Russian military offensive and war began.

What was your experience in Ukraine before the current Russian military offensive started?

“Ukraine has been the most dynamic country to work in from a health perspective. Since 2014, 3.4 million people in the Donbas region of south-eastern Ukraine have needed health-related humanitarian assistance. In addition, when I started working here, the measles outbreak in the country was the second largest in the world, before our team helped in efforts to respond to it. And of course, we then had COVID-19 to deal with since 2020, so I have been working closely with the government to develop a national COVID-19 Strategic Preparedness and Response Plan, and been active in our pandemic response across the whole country. Then, late last year, a polio outbreak was detected, so we started working, together with the Ministry of Health and partners, to get all children from the ages of 6 months to 6 years vaccinated. Since 2016, Ukraine has been in a process of reform and, even with all these health emergencies going on, government reforms of the health system to move towards universal health coverage didn’t stop. New institutions have been created and new practices applied. All in all, as a public health professional, it has been very challenging, but very rewarding, to be working in Ukraine all these years.”

How long has WHO been preparing for the possible escalation of the conflict in Ukraine?

“In Ukraine, we have always worked on emergency preparedness, but we started to do more hands-on work in October/November last year. This included visits to oblasts in the eastern part of Ukraine, filling our warehouses with supplies and delivering to selected hospitals, and bringing in colleagues from the Regional Office and headquarters to assess our operations. In December, we also set up our emergency medical teams, briefed authorities, and translated WHO guidelines and materials focused on armed conflicts into Ukrainian.

Early this year, we also pre-positioned trauma supplies – essential life-saving materials and treatments for injuries – in our warehouses and hospitals, and Dr Hans Kluge, the WHO Regional Director, made a special visit to the country to discuss what needed to be done from a health perspective in the face of escalating violence.”

How did you feel when the Russian military offensive started?

“At the end of February, when the military offensive started, it was the school holidays, so people were perhaps feeling more relaxed than usual – making the attack even more of a shock. We had just signed a Biennial Collaborative Agreement between WHO and the national health authorities in January to take the health agenda further, so were really looking forward to all the positive changes we could make. We were also supposed to have a WHO- and World Bank-supported national conference on hospital reforms at the end of March, and were preparing to celebrate World Health Day on 7 April to make progress on primary health care. All of these initiatives had to be put on hold. The last weeks have involved learning, reflecting and coming to terms with the situation, because even though we have been preparing for hostilities for a long time, and more intensely in the last 4 or 5 months, none of us thought this would actually happen to such an extent.”

How has the WHO Country Office adapted in response to the war?

“We have a very agile, dynamic team – we work from wherever we are. Some colleagues have relocated; some colleagues have temporarily evacuated; some colleagues have also arrived into Ukraine. One thing we learned from the COVID-19 emergency is that, wherever you are, you are virtually connected to colleagues. We have daily online meetings involving staff in 20-plus countries. We also have more than 60 colleagues in Ukraine, some in Kyiv, some elsewhere.”

What has WHO been able to do to support the health response in Ukraine?

“I'm very proud that, due to our experience and team spirit, we are one of the UN agencies which has been able to deliver goods to Kyiv and other cities. Moreover, in all my 19 years of experience with WHO, I have never felt the 3 levels of WHO – headquarters, Regional Office and Country Office – come so closely together, listen to each other and prioritize the response. We are finding solutions and we really are getting our best brains and people together to respond. That’s how we got medical supplies from Dubai to Poland, from Poland to Ukraine, and from Ukraine to individual hospitals across the country. Our WHO Country Office is just a small team, but we are able to mobilize thousands across the whole organization to support Ukraine.”

How would you describe the current health and humanitarian situation in the country?

“It's changing daily. In less than a month, over 3 million people have left the country and nearly 2 million have been internally displaced. This has happened faster than in any previous European crisis. There is no safe place in Ukraine right now, yet we need to ensure that health services are available.

Meanwhile, the military offensive continues, with a number of cities being entirely isolated – people are running out of food and water, and hospitals might not have electricity. Worse still, we have seen many attacks on health workers and health facilities as well as patients. This is happening daily and is unacceptable. So, if you ask me how to describe it, every day things are getting worse, which means every day the health response is becoming more difficult.”

How are you and your staff coping with the situation?

“Personally, I tend to work. It’s also important to sleep – fortunately for me, the more stressed I am, the better I sleep! Honestly, though, it's difficult, especially as everything I own is in Kyiv: my clothes, my apartment. But most importantly, I have my health and energy to support Ukraine.  Dealing with all of this is hard and all of us have stories to be told at a later time.

Over the last week we have been refocusing and regrouping to respond to the enormous health challenges the country now faces. 3 weeks ago, we dreamed that we could still do some of our development work, but the huge scale of the humanitarian crisis must be recognized. Right now, we need to focus on the humanitarian response, but also start thinking about the recovery phase, not knowing whether this war will end in the near future, or if it will last for a long time.”