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LODZ, Poland — Three days after Russia’s invasion, Zoia, 42, was hiding in a bunker amid an onslaught of Russian missiles. She had hoped to stay in Kyiv, but after eight hours in the shelter, she decided to escape with her five-year-old daughter, 61-year-old mother, and 14-year-old nephew.
They left with nothing, heading towards Poland after a relative invited them. After four days at the border, in the middle of winter, they finally entered Poland.
But shortly after settling in, Zoia’s daughter caught a virus, which led to a high-grade fever, gastrointestinal complications, and a severe earache. The rest of the family also got sick. Because she had to take care of the kids, Zoia could not work.
Yulia, 34, had a similar experience escaping from her home in Kherson when the war began. She traveled by train, car, and bus to the border towards the Polish border, hoping to join her sister. Her husband joined her for half the journey, but she made the rest of the journey alone since he was forced to stay in-country due to emergency regulations.
After arriving in Poland, Yulia received news that family members had been killed.
“I needed to get psychological support,” Yulia said to Direct Relief. “I had never sought mental health care before, but it was a very tough period in my life,” she said.
Her sister was working in the same office as a translator for the Health4Ukraine program, a nonprofit initiative set up by a Polish healthcare company, Pelion, which offers free telehealth visits, pharmaceuticals, and certain medical supplies to Ukrainian refugees.
Yulia decided to register. “It was very effective,” she said about the five sessions she had with a mental health care provider on the platform.
“There is really a need for this kind of help,” she said.
For Zoia, the program enabled her to obtain therapeutics for her daughter and other family members.
“We really needed help and, before, I couldn’t access any drugs. Since I signed up, we’ve had to use it consistently… I can just go to the pharmacy and use the code they gave me,” she said, noting that her daughter had to go to the hospital four times in a single month.
An Industry Responds
The Health4Ukraine Program was spun up in the days and weeks following Russia’s invasion of Ukraine.
Executives at Pelion, Poland’s largest healthcare company, began looking at their existing programs and systems to see which ones might be suitable for this newly-needed charitable use. Two programs emerged as candidates — a telehealth platform called Dimedic, which was built out during the Covid-19 pandemic, and a fintech system called epruf, which allows users to determine the co-pay and final cost of pharmaceuticals.
Pelion decided to adapt both programs to help address the healthcare needs of millions of people who were entering Poland. In total, over 7.5 million border crossings have taken place from Ukraine to Poland, out of a total number of 12.5 million crossings out of Ukraine into European countries since the war started, according to UNHCR data. The data does not include Ukrainians who went to Russia, willingly or under force.
Today, about 1 million Ukrainian refugees from Russia’s invasion are currently living in Poland, according to data provided by Meta’s Data for Good program, which was analyzed by Direct Relief. About 19% of all displaced Ukrainians are in Poland, making it the most popular choice for those who fled the war, which began on February 24.
Poland has a population of about 38 million people and spends the least amount of government funding per citizen on pharmaceuticals compared to all other European Union members, providing an average of 36% of the cost of drugs, compared to the EU average of 57%, according to OECD data from 2021.
The high number of new arrivals and Poland’s decision to both host them and provide them with a PESEL number (akin to a U.S. Social Security number) presented the nation with a challenge regarding how to provide services and medicine for a group of people representing about 20% of their existing population.
Health4Ukraine, which is supported by a $15 million grant from Direct Relief, $1 million from Pelion, as well as donations from the Polish Red Cross, the ING Dzieciom Foundation, the Deloitte Polska Foundation and private donors, was established to address the health care access gap in Poland among Ukrainian refugees.
The program started accepting registrations on April 22, just weeks after the decision to move ahead, according to Robert Socha, vice president of finance and operations at Pelion, who oversees the charitable program.
“IT HELPS. IT REALLY HELPS”
To date, Health4Ukraine has signed up about 276,000 people, according to data provided by Pelion. The program has been used by participants in just about all but three of Poland’s 380 local districts and more than half of all the nation’s pharmacies.
Demographically, 55.3% of registrants are women over 18 years old, 37.7% are people under 18 years old, and about 7% are men over 18 years old. Despite being an online-focused system – the program’s barcodes are only given out online due to challenges and costs associated with mailing items to many people who might not have a permanent address – the greatest proportion of the population that has signed up are people over 65 years old.
Data from Pelion shows that $7.1 million has been spent by Health4Ukraine participants through the end of October. Of this amount, 36% was spent on non-pharmaceutical products in pharmacies, such as vitamins, medical devices, skin treatments, and supplies such as bandages. 35% was spent on over-the-counter drugs, and 29% on prescription drugs.
Among children, antibiotics were the most common purchase. For adult men and women, it was cardiovascular therapies. Socha said that the first group of registrants purchased more medical supplies and devices than the general Polish population since they, “left in such a rush that they didn’t bring these supplies with them,” he said.
However, as the year went on, data showed that the needs of program participants reflected those of the general population, suggesting that later refugees had time to pack more essentials. Most participants, Socha pointed out, are women and children since military-age men were, and are, obligated to stay in Ukraine.
Because the Health4Ukraine team did not know what participants would need to buy and did not want to keep funds locked in unused cards, they decided to make the barcodes valid for 120 days. Since the program began, about 15% of issued barcodes have gone unused by the registrant.
Each card is loaded with 500 Polish zloty (about $110 USD), of which 350 zloty is earmarked for prescription drugs and 150 zloty is earmarked for over-the-counter drugs and other medical products. A standard-sized package of Tylenol runs about 20-30 zloty in Poland. The program covers 100% of prescription co-payments and 85% of non-prescription drug costs at all Polish pharmacies.
As the barcode is linked to an individual’s identification number, the system allows for transparency and reduces fraud. Socha also noted that doctors play a role in reducing unintended usage of the program, as they are responsible for prescribing medicines.
Socha’s colleague, Project Manager Michalina Łubisz, said that one of the aspects she hopes to change, based on past findings, is that they allow participants to apply for a third 120-day period to use the barcode, given the ongoing need she and her team have seen, based on usage.
Heading into winter, Łubisz and Socha said that the weather to date has been relatively mild and that flu cases have not started to pick up more than usual, both of which have helped mitigate any greater public health crisis in the country. Socha said that he expects weather – Ukraine’s civilian infrastructure has increasingly been directly attacked by Russia – and military action to be the key drivers of any renewed emigration from Ukraine.
For those Ukrainians already in Poland, the wait continues – along with pain, in many cases, even as they work to continue their lives.
“The situation and new life here can be tragic, but I have to find myself in order to be able to go into the future,” Yulia said. “It [access to mental health care] helps. It really helps.”
In addition to $15 million in direct support for Ukrainian refugees through the Health4Ukraine program, Direct Relief has provided more than 2.1 million pounds of medical aid to Ukraine and other countries receiving refugees since Feb. 24.