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What public health risks does delayed healthcare for refugees pose?

Great stress for all public systems, including the health crisis sparked the refugee wave from Ukraine to Bulgaria. So many refugees have not entered the country since the Ratification of the Geneva Convention in 1992 by the NSA, which turned 30 years in April. The mass influx of refugees, and from there the potential health risks, are the result of Russia’s war in Ukraine. This was stated by Dr. Momchil Baev, Chairman of the Astra Forum Foundation during an online seminar held yesterday, 15th June 2022. The theme of the event was “Organization of the health care of refugees from Ukraine – theoretical and practical aspects”.

The adopted status, which is granted to all registered people fleeing war to “temporary protection” and applies throughout the European Union. The status is granted upon arrival in the country and gives the right to access health care, as enjoyed by Bulgarian citizens. Dr. Baev stressed that only in May, two months after the start of the war, were adopted by the Council of Ministers the rules under which refugees can enjoy their health rights, by Decree of The Council of Ministers No 69 of 5 May 2022 on health insurance for persons with temporary protection. This, he says, is a long delay and accompanied by chaos. The change in terms of the realization of the health rights of Ukrainian citizens occurred at the end of May for software reasons. This posed problems for people with uncompensated chronic diseases. There were difficulties in registering refugees on the list of general practitioners.

By accessing outpatient medical care, Ukrainians in the country can also get the right to another important element – immunizations under the mandatory calendar, as well as to allow control of infectious diseases. Other rights of those with protection – their children to attend kindergartens and schools – stem from this.

When asked, Dr. Baev noted that the immunization coverage in Ukraine on the mandatory calendar is only about 40% and it is according to official data. The government portal in the country gives detailed information on various issues. Positive is the fact that the site is available in Bulgarian, Ukrainian, Russian and English. With regard to the possibilities for enrolling Ukrainian children in the education system, Dr. Baev noted that after obtaining “temporary protection” status, the enrollment is made after an application has been submitted to the  respective regional education department and directed by the Head of ruo to a specific school. Importantly, before enrolment, the child must have also met the requirements of the Ministry of Health, which concern mandatory immunizations, as a condition for enrollment in school or kindergarten.

Two parallel emerging crises have the potential to potentiate, Dr. Baev noted. The global pandemic, which has temporarily calmed down, has not disappeared after all. It, along with the refugee wave, can create huge problems for the health system. This is going to be a very big problem for people from vulnerable groups. The difficulties in the functioning of the health care system due to the pandemic have led to a deterioration in immunization coverage in the country. Combining this problem with the entry of large groups of people who have gaps in immunization coverage can create epidemic blasts of measles, polio and other infectious diseases.

The presentation also focused on the recommendation issued by the Ministry of Health to regional health inspections and general practitioners. It noted that children with missing mandatory vaccine documents should be given mandatory immunisations over reimmunisations. Mandatory immunizations in the Republic of Bulgaria are similar to immunizations that apply in the Republic of Ukraine. 

However, there are several main differences:

  • In Ukraine, immunization against pneumococci is not applied;
  • In Ukraine, a live and killed polio vaccine is used, and in Bulgaria – only a polio vaccine is killed;
  • In Ukraine, fewer pertussis vaccine intakes are applied;
  • In Ukraine, fewer receptions of a vaccine against tetanus and diphtheria are administered;
  • In Ukraine, fewer intakes of a vaccine against hemophilus influenza are administered.

With regard to the main immunizations with priority are those against diphtheria, tetanus, polio, measles, mumps and rubella over those against tuberculosis and pneumococci. Where possible, vaccines should be given at the same time (a five-valent vaccine is available) and the two live measles, mumps, rubella and tuberculosis vaccines (M-M-RVAXPRO and BCJ) require a minimum interval of 1 month between them.

Students in psychology, medicine, social work, special pedagogy, speech pedicure, public health, medical informatics and telecommunications from the National University of National And World Economy and other universities, specialists from assisting professions through relations with their professional communities and organizations, organizations and others were involved online. 

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