In response to the conflict between Russia and the Ukraine, the New Zealand Government announced the 2022 Ukrainian Special Policy which allows the estimated 1,600 Ukrainian-born citizens and residents in New Zealand to sponsor family who ordinarily reside in the Ukraine. The government expectation is that all arrivals would have full access to publicly funded health and disability services. To support this, all arrivals will be granted either a two-year working visa or two-year student visa.
All health requirements for entering New Zealand have been waived for this visa. This information is intended to provide a high-level overview to primary care professionals to be able to assess and address the health needs of patients those arriving in New Zealand under this visa.
- Support Ukrainian arrivals with registering with a GP practice. Explain to them how New Zealand’s health system works as well as their entitlements to health care. This includes when and how to use primary care and emergency care.
- Ensure that all patients are up to date with the NZ immunisation schedules, focusing on measles, polio, COVID-19, and TB.
- Refer pregnant women for antenatal care.
- Due to the relatively high incidence of TB in Ukraine (including MDRTB), TB screening should be encouraged. This would include a screening Chest X-Ray for anyone over 11 years of age and TSTs or IGRAs for children as appropriate.
- Ascertain any risk factors for hepatitis B infection that may indicate the need for screening
- Due to the higher prevalence of hepatitis C and HIV in the Ukraine compared to NZ, offer screening for both.
- All GPs have access to EziSpeak and are encouraged to utilise this resource and work with an interpreter where a language barrier exists.
- Assess individuals’ mental health and wellbeing as those affected by war and conflict are at higher risk of mental disorders. When appropriate use a trauma-informed approach.
- Refer to ‘Counselling and support service for Ukrainian and Russian-speaking communities’ for a list of organisations that are happy to support and help in this time of need.
These arrivals will have escaped a conflict zone, which may contribute to various mental health issues. These may not manifest until weeks after displacement.
Ukraine has a higher estimated suicide rate than the Eastern Europe regional average (29.6 deaths per 100,000 population) and the global average (10.4 deaths per 100,000 population). The rate of suicide is particularly high among men (56.7 per 100,000 vs. 8.4 per 100,000 among women). Men also have a higher estimated prevalence of alcohol use disorders than women (11.5% vs 1.4%). Women have a higher estimated prevalence of MDD (3.9% vs 2.7%).
Primary care professionals should recognise the context of mental health support in Ukraine, and that this may have an impact on nervousness in accessing help due to the levels of stigma surrounding mental health in the Ukraine.
- The Ukrainian population has low immunisation rates and are at an increased risk of vaccine preventable diseases. A distrust of health professionals and vaccines is a factor that has contributed to these low rates.
- Primary care professionals should assume that patients aren’t immunised unless they have vaccination records.
- Patients should be informed that vaccination is free in New Zealand, reassured about the safety of vaccines and offered vaccination as soon as possible after arrival.
- According to WHO estimates, Ukraine has the 4th highest TB incidence rate among the 53 countries of the WHO European Region2
- Ukraine has one of the highest burden of multidrug resistant tuberculosis (MDR-TB) in the world3
- Offer vaccination against TB (who are <16, are tuberculin negative and don’t have a history of BCG vaccination)
- There was an outbreak of poliovirus (circulating vaccine-derived poliovirus type 2) in October 2021 in Ukraine 4
- If the individual is unvaccinated or requires further vaccine doses, please arrange a polio vaccination as soon as possible.
- In Ukraine, measles is of concern as vaccination coverage is below the threshold to prevent measles outbreaks. There was circulating measles in Ukraine during 2021. If the individual is unvaccinated or requires further vaccine doses, please vaccinate them ASAP.
- If there is any doubt about vaccination status, offer an additional dose.
- Due to the current refugee situation, consider measles as a differential diagnosis for anyone in this population presenting with fever and rash illness.
1.4 Sexually transmitted and blood borne infections
- HIV rates in Ukraine are much higher than in the NZ with the epidemic most prevalent among men who have sex with men, people who inject drugs, and sex workers.
- All new arrivals should be offered an HIV test. For patients who are sexually active chlamydia, gonorrhoea, and syphilis should also be tested for. If injecting drug use is disclosed hepatitis C should also be tested for.