War in Ukraine and the challenges it brings to the Polish healthcare system.

Poland is witnessing the largest migration crisis of this century. The ongoing war has forced millions of people to flee Ukraine. The refugees hope to find shelter in other European countries, most often choosing those neighboring ones in the west and south (mainly Poland) as their first destination. 1.7 million people had left Ukraine in the first 12 days of the military operations and nearly 1.1 million of them, mostly women and children, came to Poland, whose population prior to crisis was 38 million. For some of them, Poland is only a transit point on their way to Western Europe but a vast majority of them are expected to stay in Poland which has a decent Ukranian poulation—about 1.3 million in 2021.

Such a huge influx of people in a short time poses additional challenges to the Polish healthcare system, which was already facing the COVID-19 pandemic burden and shortage of the healthcare staff. Apart from the obvious difficulties of providing the refugees with appropriate shelter and access to basic livelihood, another critical necessity is ensuring them access to medical services. A lot of these people need immediate medical assistance as they were deprived of food and water and exposed to freezing temperatures. Others with underlying diseases, comorbidities need special medical assistance and medication including pregnant women and children. Polish healthcare system also urgently needs to prepare for the huge demand for mental health specialists, in particular those working with children who, may require psychological or psychiatric support due to post-traumatic stress disorder, among others. Since Refugees most often communicate only in Ukrainian or Russian, and these languages are not widely known in Poland, language becomes another crucial barrier for healthcare providers.

We welcome the decision of the Polish government who declared on February 26th, 2022, that each person from Ukraine who crossed the Polish border since the onset of war would have access to free medical services under the same conditions as Polish citizens. This decision secured reimbursement of costs provided to Ukrainian refugees by hospitals and primary care. Nevertheless, several fundamental issues are not clear yet, such as the principles of drug reimbursement, preventive vaccinations in children or chronic care for patients, which significantly hinders the provision of these services.

Another challenge is the low COVID-19 vaccination coverage among Ukrainians: 34.5% versus 58.6% in Poland, which may further increase the number of SARS-CoV-2 cases in Poland. Obviously, people crossing the Polish-Ukrainian border are currently exempt from the obligation to take a COVID-19 test and undergo quarantine. Free COVID-19 testing and access to COVID-19 vaccinations, in accordance with the regulations applicable in Poland, have been secured.

Further, routine vaccination coverage among Ukrainian children are much lower than in other European countries, which has even led to local outbreaks of diseases such as polio and measles. The influx of unvaccinated people into Poland creates the risk of emerging diseases, despite the fact that a high percentage of Polish children are vaccinated and effective herd immunity exists.

Since the greatest burden of long-term service provision will ultimately fall on primary healthcare, the Polish Society of Family Medicine has prepared a number of 'on the spot’ solutions for doctors and patients, including a nationwide search engine for medical entities that can provide services in Ukrainian/Russian, on-call translators, many useful materials for patients as well as interview and physical examination questionnaires in various languages.

The initial impulse to bring help is enormous, however, the question is how long will it last? Polish healthcare system urgently needs systemic solutions prepared by both the state and local governments so that we can move from spontaneous actions to implementation of statutory measures. On March 7th, the government has adopted a special act on aid for refugees from Ukraine. Currently, it is being processed as a "fast track" to obtain formal acceptance by the Polish Parliament.

Appropriate systemic solutions need to be implemented urgently. They should include well-defined principles of health services provision for refugees, clearly defined regulations on drug reimbursement and a preventive vaccination program for children. It may be worth considering an expedited procedure to recognize qualifications and diplomas from Ukrainian healthcare professionals who would then be able to quickly access the labor market and would also help ease the burden on the Polish healthcare system.

So far, in the 21st century no European country has faced a challenge as the one Poland has to take on now - over a million of war refugees coming into the country in less than 12 days. With the war still going on and an unknown future of Ukraine, there is no doubt that this emergency situation requires urgent support and enormous help from all the members of the European community.

Author contribution

All authors contributed equally.

Declaration of interests

All authors declare no competing interest related to this paper.