Russian full-scale invasion of Ukraine: epidemiological challenges for public health

Summary box The Russian full-scale invasion of Ukraine has led to a significant increase in infectious diseases, including zoonotic and vectorborne diseases, sexually transmitted infections and vaccine-preventable illnesses, exacerbated by disrupted healthcare services and public health interventions. Overcrowding in shelters and unsanitary conditions, coupled with the widespread destruction of infrastructure, has contributed to the rise of communicable diseases, such as scabies and respiratory infections, underscoring the importance of improved living conditions and access to medical care. The prevalence of wound infections and viral hepatitis highlights the challenges of providing medical care in conflict settings, emphasising the need for strict adherence to sanitary practices and protective measures by healthcare providers. The paper calls for comprehensive and coordinated public health strategies to address the multifaceted health challenges posed by the conflict, including bolstering disease surveillance, ensuring vaccination coverage and enhancing access to healthcare services for the affected populations. The full-scale invasion of Ukraine by Russian forces, which began in February 2022, has precipitated an unprecedented crisis with wide-ranging implications for the region and beyond. The negative impact of armed conflicts on public health has been studied in many regions, in particular in Yemen,1 Iraq,2 Congo,3 Afghanistan,4 Syria,5 etc. As we mark the second anniversary of this war, it is imperative to examine the myriad ways in which it has affected public health within Ukraine, posing significant epidemiological challenges. This paper aims to provide a comprehensive analysis of the public health landscape in Ukraine in the wake of the invasion, focusing on the direct and indirect impacts on the health and well-being of the Ukrainian population. The war has not only led to a substantial loss of life and widespread destruction of infrastructure. It has also severely disrupted healthcare services, reducing access to medical care, causing shortages of medical supplies and displacing healthcare professionals.6 These disruptions have exacerbated existing public health challenges and precipitated new ones, including the risk of communicable diseases, mental health issues and non-communicable disease management. Moreover, the displacement of millions of individuals has not only affected those directly involved but has also placed a strain on the healthcare systems of neighbouring countries that are hosting refugees.7 The Russian war in Ukraine has indirectly led to a significant rise in rodent populations due to abandoned agricultural fields and unharvested crops, providing ample food sources for rodents.8 The disruption of natural predator-prey dynamics, with predators consuming the dead instead of hunting rodents, along with the inability to conduct deep ploughing due to mined fields, has facilitated rodent nests’ proliferation. This situation has created optimal conditions for rodents to thrive and reproduce rapidly, exacerbating the challenge of managing their populations. This unchecked growth in rodent populations poses substantial public health risks, notably through the increased incidence of naturally focal infections like leptospirosis and tularaemia. For instance, the reported cases of leptospirosis surged from 141 cases in 2022 to 433 cases in 2023, 409 cases in 2024, and 223 cases in 2025, indicating a more than threefold increase in 2023 and 2024. The rise in rodent populations heightens the risk of diseases directly transmitted by rodents. It elevates the potential for vectorborne diseases, necessitating immediate and effective public health interventions to curb the escalating disease transmission and safeguard public health. The full-scale war has led to an increase in abandoned corpses, which serve as food sources for wild predators such as foxes and wolves, as well as stray animals, creating a conducive environment for the spread of diseases like rabies. This grim reality has precipitated an epizootic of rabies among the animal population, significantly elevating the risk of transmission to humans. The interaction between stray animals and wild predators, fuelled by the availability of corpses, not only exacerbates the spread of rabies among animals but also poses a heightened risk to public health, necessitating urgent measures to address the growing threat of rabies transmission in conflict-affected areas. The conflict has also exacerbated the spread of sexually transmitted infections (STIs) such as syphilis, gonorrhoea and HIV, with incidences of rape and sexual violence being reported as war crimes.9 The chaos and breakdown of social and healthcare infrastructures contribute to an environment where the risks of STI transmission are significantly increased. The reported cases of syphilis rose from 1263 (3.05 per 100 000 population) in 2022 to 1738 (4.24 per 100 000 population) in 2023, 2101 (5.12 per 100 000 population) in 2024 and 1918 (4.68 per 100 000 population) in 2025, indicating a noticeable uptick in transmission rates. Similarly, gonococcal infections increased from 788 cases (1.9 per 100 000 population) to 890 cases (2.17 per 100 000 population) in 2023, and then decreased to 627 cases (1.53 per 100 000 population) in 2024 and 422 cases (1.03 per 100 000 population). This rise in STIs can be attributed to several factors, including disrupted access to healthcare services and sexual violence. The latter, mainly, has been a distressing aspect of the conflict, with rape being used as a weapon of war. This has immediate physical and psychological effects on victims and contributes to the broader public health crisis by increasing the spread of infections. The data underscores the urgent need for comprehensive sexual health services and interventions aimed at preventing and treating STIs, as well as addressing the root causes of sexual violence in conflict settings. The conflict has precipitated severe overcrowding in shelters, where unsanitary conditions prevail due to the widespread destruction of homes, water sources, heating and electricity infrastructures. This dire situation has led to a marked increase in communicable skin conditions, including scabies and pediculosis (lice infestation). Specifically, the incidence of scabies escalated from 2617 cases (6.32 per 100 000 population) in 2022 to 3209 cases (7.83 per 100 000 population) in 2023, 3501 (8.54 per 100 000 population) in 2024, and 3482 (8.49 per 100 000 population) in 2025. Similarly, cases of pediculosis and phthiriosis (pubic lice) rose from 2390 cases (5.77 per 100 000 population) in 2022 to 2940 cases (7.17 per 100 000 population) in 2023, 2484 (6.06 per 100 000 population) in 2024, and 2019 (4.92 per 100 000 population) in 2025. These increases highlight the pressing public health challenges the conflict poses, underscoring the critical need for improved sanitary conditions and access to healthcare in shelters to prevent the spread of these conditions. The Russian full-scale invasion has led to a multifaceted public health crisis characterised by a decrease in vaccination rates for vaccine-controlled infections due to disrupted access to medical care, challenges in monitoring vaccination schedules and the effects of widespread migration.10 This decline in immunisation coverage is compounded by surges in intestinal infections attributed to volunteers preparing and distributing food without proper sanitary controls, including handwashing and appropriate food storage, leading to outbreaks of intestinal infections. Additionally, the situation is exacerbated by an increase in respiratory tract infections, such as influenza, COVID-19 and tuberculosis, fuelled by the lack of vaccinations, mass migration and overcrowding in dormitories and temporary accommodations following missile attacks. The chaos of the conflict has also hindered the registration and treatment of tuberculosis patients, further complicating efforts to manage and contain the spread of infections.11 This confluence of factors underscores the urgent need for comprehensive public health interventions to address the spread of infections and ensure access to essential medical care and vaccinations amidst the ongoing crisis. The full-scale war has also exacerbated the incidence of vectorborne diseases, as evidenced by the significant rise in Lyme disease cases from 3875 (9.36 per 100 000 population) in 2022 to 4911 (11.98 per 100 000 population) in 2023, 5431 (13.25 per 100 000 population) in 2024, and 6748 (16.46 per 100 000 population) in 2025. This increase can be attributed to the disruption of environmental management and healthcare services, allowing vector populations, such as ticks, to thrive and spread the disease more widely. The lack of access to preventive measures, such as tick control programmes and public awareness campaigns about the risks of tick bites, coupled with the displacement of populations into areas with higher tick prevalence, has contributed to this surge in Lyme disease cases. This situation highlights the need for targeted public health interventions to control vector populations and protect at-risk communities from vectorborne diseases amidst the ongoing conflict. Also, the war has led to a pronounced increase in wound infections and healthcare-associated infections, compounded by the emergence of antibiotic resistance.12 The prevailing severe injuries and mine blast wounds are often contaminated with soil and opportunistic microorganisms. While tetanus cases were expected to be prevented due to vaccination efforts, a notable number of cases have arisen: 12 cases (0.029 per 100 000 population) were reported in Ukraine in 2022, 6 cases in 2023 (0.014 per 100 000 population), 12 cases in 2024 (0.029 per 1 00 000 cases), 10 cases in 2025 (0.024 per 100 000 population). Despite the availability of routine tetanus vaccination, this unexpected occurrence of tetanus cases highlights the need to thoroughly investigate the vaccination status and circumstances of cases, drawing attention to the challenges of maintaining vaccination coverage and providing effective wound care in the chaos of conflict. The conflict has significantly impacted the transmission of viral hepatitis, particularly types B and C, which are known for their parenteral transmission routes involving blood-to-blood contact. The surge in such cases is partly due to the increased exposure to blood during conflict situations, where first aid is often provided under suboptimal conditions, including the inconsistent use of protective gloves by first aid responders. This has led to notable increases in reported cases of acute hepatitis B, from 520 (1.26 per 100 000 population) in 2022 to 759 (1.85 per 100 000 population) in 2023, 710 (1.73 per 100 000 population) in 2024, and 494 (1.20 per 100 000 population) in 2025, and acute hepatitis C, from 304 cases (0.73 per 100 000 population) in 2022 to 439 cases (1.07 per 100 000 population) in 2023, 430 (1.05 per 100 000 population) in 2024, 393 (0.96 per population) in 2025. Furthermore, the number of chronic hepatitis cases has also seen a significant rise, from 4600 cases (11.11 per 100 000 population) in 2022 to 7595 cases (18.53 per 100 000 population) in 2023, 9310 (22.71 per 100 000 population) in 2024, 8823 (21.52 per 100 000 population) in 2025, underscoring the escalating public health challenge of managing hepatitis transmission and the critical need for enhanced protective measures and healthcare interventions during conflict scenarios. The Russian full-scale invasion of Ukraine has precipitated a multifaceted public health crisis characterised by increased incidences of infectious diseases, compromised healthcare services and exacerbated public health challenges. From the surge in zoonotic and vectorborne diseases to the spread of STIs and vaccine-preventable illnesses, the conflict has disrupted routine scenarios of disease control and prevention. The rise in wound infections, alongside the alarming increase in cases of viral hepatitis, highlights the dire need for improved medical and sanitary interventions. These findings underscore the urgent need for comprehensive public health strategies that address the broad spectrum of health challenges arising from the conflict, including enhancing disease surveillance through the creation of special national programmes and emergency response teams, vaccination efforts, containing antibiotic resistance in wound infections and access to healthcare services to mitigate the impact on the affected population. Another important measure is to ensure an uninterrupted power supply to medical institutions for the timely registration of new cases of diseases in the electronic epidemiological surveillance system, proper storage of vaccines and medicines, operation of medical equipment, and compliance with hygiene and sanitation rules. Disinsection and deratisation measures should continue to be carried out in areas at risk of zoonotic infections, as in pre-war times. The public health challenges arising from the war concern not only Ukraine, but also other countries due to the large number of refugees and Ukrainian wounded military and civilians receiving treatment in other countries, so assistance from international organisations to Ukraine must be continued and strengthened.