Weekly Update #144
December 2, 2024

General Figures

Refugees from Ukraine recorded across Europe 

6,225,700

Last updated November 18 2024

Covers those granted refugee status, temporary asylum status, temporary protection, or statuses through similar national protection schemes, as well as those recorded in the country under other forms of stay 

Refugees from Ukraine recorded beyond Europe

560,200

Last updated November 18 2024

Covers those granted refugee status, temporary asylum status, temporary protection, or statuses through similar national protection schemes, as well as those recorded in the country under other forms of stay 

Refugees from Ukraine recorded globally

6,785,900

Last updated November 18 2024

Estimated number of internally displaced people (IDPs) in Ukraine (as of Aug 2024)

3,669,000

Humanitarian Situation

According to UNHCR protection profiling and monitoring, a notable increase in cross-border movements from February 2024 onwards was observed, followed by a significant decrease after the summer.

In September, outbound movements surpassed inbound, reversing a trend from July - August. As of 23 October, less than 25 per cent of surveyed individuals reported leaving Ukraine for the first time since the beginning of the full-scale invasion in February 2022, a slight increase from the two months prior. While security and energy-related concerns continue to be the most commonly cited reasons for departures, shelter-related issues have emerged as the third, accounting for 22 per cent of departures from August – October.

According to the Donetska region administration, since 1 August over 128,000 people have reportedly left the region, including over 24,000 from areas experiencing active hostilities. Approximately 330,000 residents remained in Ukraine-controlled areas of the region, with an estimated 63,000 residing in zones of active hostilities. UNHCR and NGO partners are supporting transit sites for evacuees through refurbishment, supply of equipment, coordination and management. UNHCR is also providing lifesaving protection and multisectoral assistance to evacuees both inside and outside these centres.

Humanitarian Response

As millions in Ukraine brace for the third winter since the full-scale invasion, UNHCR and partners have stepped up efforts to deliver assistance to help peoplestay safe and warm. As part of the inter-agency response, and in support of Government vulnerable people cover additional winter needs, providing essential items for winter, and helping people to insulate their homes. UNHCR aims to support 550,000 displaced and war-affected people in Ukraine with cash for energy and heating needs during the 2024-25 winter season.

Source: UNHCR

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UNHCR supports Human Rights Centres opening across the country through its partnership with the Ombudsman of Ukraine

The strong cooperation between UNHCR, the UN Refugee Agency, and the Office of the Ombudsman of Ukraine, includes support to the establishment of regional human right centres, bringing human rights work closer to the people.

On Friday, a regional Human Rights Protection Centre was opened in Chernivtsi city by the Ukrainian Parliament Commissioner for Human Rights, Dmytro Lubinets together with Head of Chernivtsi Regional State Administration Ruslan Zaparaniuk, Head of Chernivtsi Regional Council Oleksii Boiko, Mayor of Chernivtsi city Roman Kluchuk and UNHCR Representative to Ukraine, Karolina Lindholm Billing.

The facility has been refurbished and equipped with support from UNHCR through its NGO partner Rokada. It will serve as a resource to people in the region – including internally displaced people, returnees and people at risk of statelessness – by providing counseling services, public initiatives and information on access to fundamental rights.

Jointly with other UN partners, UNHCR is continuously supporting the opening of regional Human Rights Protection Centres and Offices across the country by refurbishing the premises, including by making them accessible for people with low mobility, and providing furniture, IT-equipment and other basic amenities. UNHCR has for example supported facilities in Cherkasy, Chernihiv, Chernivtsi, Ivano-Frankivsk and Vinnytsia, while work is ongoing in Uzhhorod and other regions like Khmelnytskyi, Odesa and Volyn.

By establishing these regional centres, the crucial work of ensuring human rights for all people in Ukraine, including through information and outreach to those groups or individuals who may need it the most, is moving even closer to the people.

The partnership and joint work between the Ombudsman of Ukraine and UNHCR dates back to 2010 and was further consolidated with the signing of a Memorandum of Understanding in August this year. In the midst of the full-scale war, with dramatic human consequences, the commitment to safeguard the rights of all people living in Ukraine involves a special focus on people who have become particularly vulnerable or at-risk due to the war, including those forcibly displaced and people with disabilities or low mobility.

Since the beginning of the full-scale invasion, the cooperation between UNHCR and the Office of the Ombudsman of Ukraine has spanned from the development of information material for specific vulnerable groups to raise awareness about their rights, for example how to register as an internally displaced person or access medical assistance, to capacity building and strategy development, and, importantly, advocacy for the rights of forcibly displaced and stateless people. In addition, hundreds of joint monitoring visits have been carried out in collective sites to inspect the living conditions of the IDPs hosted there.

Source: UNHCR

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Key Findings of Caritas Ukraine Research

Caritas Ukraine carried out a Needs Assessment survey among their recipients in 10 regions of Ukraine:

1. Dnipro (Caritas Donetsk in Dnipro, Caritas Kamianske)

2. Donetsk (Caritas Kramatorsk)

3. Zaporizhzhia (Caritas Zaporizhzhia)

4. Kirovohrad (Caritas Kropyvnytskyi)

5. Mykolaiv (Caritas Mykolaiv)

6. Odesa (Caritas Odesa)

7. Poltava (Caritas Poltava)

8. Sumy (Caritas Sumy)

9. Kharkiv (Caritas Kharkiv)

10. Kherson (Caritas Kherson, Caritas Beryslav)

These were the key findings of their interviews with both men and women respondents.

1.  Top 5 priority types of assistance:  Respondents considered the following as the most important and relevant types of assistance:

• Multipurpose cash assistance (88%)

• Payment for utilities

• Services (51%)

• Medicines (50%)

• Hygiene products (46%)

• Food (39%)

2.   Areas where the needs of the population are least met: 

• Medicines and medical services (75%)

• Hygiene products (65%)

• Payment for utilities (electricity, centralized heating, centralized gas supply) (65%)

• Basic household goods and seasonal clothing (50%)

• Food (45%)

• Decent housing and living conditions (36%)

• Purchase of heating materials (33%)

• Drinking water (19%)

• Technical water (8%)

3.   Employment needs: 25% of respondents are engaged in agricultural practice as a primary source of income, while 5% consider it for supplemental income.  The highest rates of agricultural practice are in Mykolaiv (35%), Sumy (35%), Dnipro (34%), Kherson (33%) and Zaporizhzhia (32%) regions.  The average expected salary for job seekers is UAH 13,925.  At the same time, these amounts range from UAH 2,000 to UAH 40,000 and have regional differences.  9% of respondents are actively looking for a job. This requirement is higher in Poltava and Dnipro oblasts, at 14% and 19% respectively. The

4.  Operation of key networks:

• Electricity supply. 96% of respondents report that the power supply in their households is working properly - there is electricity all the time or there are short-term power outages.  According to the survey, the most difficult situation with the energy sector is in Zaporizhzhia, Sumy, Kharkiv and Kirovohrad regions, where more than 5% of respondents indicate that at the time of the survey there were long power outages or significant interruptions in electricity supply.

• Water supply. 78% of respondents have regular access to centralized water. Problems with water supply are most relevant for residents of Dnipro, Kherson and Zaporizhzhia regions, where 9%, 7% and 4% of respondents report a lack of water, respectively. ave the highest. 0th respondent (5%) uses agriculture as the main or additional source of income.

• Heat supply. According to the survey, 76% of respondents use district heating services, and 36% use it as the main method of heating their homes. 73% of the 76% of respondents did not face any serious problems with the district heating system last season - heat was available all the time or most of the time.

Source: Caritas

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Employment, Mobility and Labour Market Dynamics in Ukraine - Thematic brief series: Livelihoods and economic recovery (November 2024)

working conditions do not meet their needs (23%)

Unemployment among recently displaced ukrainians reached 24 per cent, IOM report shows. As Ukraine marks a thousand days since the start of the full-scale invasion, the International Organization for Migration (IOM) has released a new report detailing the profound impact of nearly three years of war on the employment, mobility, and labour market dynamics in the country.

According to the report, people who had been recently displaced within Ukraine were more likely to be unemployed (24%), compared to those who had been displaced for one year or more (13%). This disparity highlights the challenges of economic integration for newly displaced individuals, who often lack the networks, resources, and stability needed to secure employment in unfamiliar or disrupted environments.

The report shows that working-age IDPs recorded a higher rate of unemployment (15%, compared to a national average of 11%), as well as a higher proportion of unemployed job seekers (61%) compared to returning migrants and non-displaced individuals.

The report also highlights the impact of the full-scale invasion on the wider population of Ukraine. The employment rate among working-age respondents (18-60 years old) stands at 67 per cent, six percentage points lower than prior to February 2022, despite the massive decline in labour supply in the country due to the forced international migration of more than 6.7 million people.

The most significant challenges faced by job seekers in Ukraine are the lack of local job opportunities and low wages. Women, who are more likely to work in the public sector such as education and healthcare, are disproportionately impacted by the low salaries and payment delays prevalent in these institutions—a stark reminder of how economic inequities often carry a gendered burden.

The report draws attention to the ongoing livelihood needs of millions of Ukrainians despite ongoing efforts. From January to October 2024, IOM provided nearly 5,000 people with grants for micro-enterprises, vocational training, and livelihoods. So far this year, the Organization has provided direct assistance to half a million people.

In Ukraine, IOM has been collecting data on displacement, needs and vulnerabilities of those affected by the war. In a rapidly evolving context, this data has been crucial in ensuring that aid reaches those who need it most.

In recent days, attacks have intensified in the country. Since 17 November, dozens of civilians, including children, have been killed as a result of Russian missile strikes on multiple cities on the frontline and beyond. Recent attacks on energy infrastructure have ravaged 65 per cent of Ukraine’s energy generation capacity, severely disrupting electricity, heating, and water supplies across the country, as well as businesses and employment.

The need for action is more urgent than ever. More than 3.5 million people remain internally displaced and 14.6 million people need humanitarian assistance, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA), IOM calls on the international community to continue supporting its efforts to provide life-saving assistance and build the Ukrainian population's resilience.

Source: IOM

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Health financing in Ukraine: Reform, Resilience and Recovery

A new report from the WHO and the World Bank, Health Financing in Ukraine: Reform, Resilience and Recovery, has revealed that despite the economic, demographic and epidemiological shocks caused by the war, the health financing reforms have strengthened the resilience of Ukraine’s health system.

Ukraine has maintained universal population coverage under the Program of Medical Guarantees (PMG), ensuring that all citizens and permanent residents can access health services included in the PMG improving protection against financial hardship from cost of healthcare. Central pooling of funds and their management by the National Health Service of Ukraine (NHSU) enabled continued financial coverage in territories affected by war that had lost their own locally generated revenues.

Launched at a joint event in Kyiv, the report highlights the impact of the war on Ukraine’s health system and the challenging context in which health financing reforms continue to be implemented. This report is the third in a series of reports, jointly produced by WHO and the World Bank, assessing progress in reforming Ukraine’s health financing system since the reforms were launched in 2017.

The report highlights that health financing reforms, initiated in Ukraine in 2017 are on the right track. These reforms have played a critical role in strengthening the resilience of the health system during the COVID-19 pandemic and the war. The report underscores the importance of safeguarding public financing and investment in health, particularly in the challenging war context. Preserving human capital is essential for Ukraine’s long-term economic recovery and social cohesion.

However, the fiscal space for government health spending will remain limited due to the war’s economic impact and the need to prioritize defense and security spending. Moving forward, health financing reforms need to prioritize efficiency of spending, maximizing health for the money while also emphasizing equity in access, financial protection against catastrophic out-of-pocket payments, and improving quality of services.

The review recommends several policies and actions from a health financing toolkit to help take reforms forward, and improve health system performance across these key health financing objectives.

Strengthening primary health care (PHC)

Strong PHC is important for efficiency and equity of health system. The review recommends actions to make it easier for the people to sign-up and change their PHC providers, to support sustainable financing of PHC, implement incentives for improved performance, update clinical guidelines to improve quality and cost-effectiveness of care, provide additional measures to support PHC in the areas of high IDP concentration as well in war-affected areas with very low population.

As PHC is the gateway to the rest of the health system for the population, the report highlights that Ukraine needs to build on its success of 86% of population having signed declarations with PHC providers and achieve universal registration. Internally displaced people require special attention to ensure their access to PHC as less than 20% of IDPs had changed their registration to a provider at their new location.

Ensuring transparent and accountable institutions

The report suggest that the National Health Service of Ukraine (NHSU) can step up policies and actions as a more proactive purchaser of services based on oblast level health needs assessments, increasing NHSU capacity in regional offices, consolidating purchasing of complex services in higher volume and better quality facilities while maintaining geographical access for population, and improving financial incentives for efficiency and quality.

Strong, transparent and accountable institutions are crucial for reform success. The review recommends establishing a governance body for strategic oversight over PMG processes and NHSU performance; and, to revise regulations and internal procedures to ensure transparent, evidence-informed, formal and timely processes for decision making concerning the PMG. To be able to execute its functions properly, the NHSU needs to be adequately resourced beyond the current 0.11% of total PMG expenditures, 10 times less than in comparable European countries.

The report also outlines policy considerations for Ukraine to "build back better," with a focus on modernizing health service delivery, optimizing hospital networks, and strengthening institutions.

 The report has been produced with the financial support from the Swiss Agency for Development and Cooperation through the “Sustaining Health Sector Reform in Ukraine” project; the Government of Canada, and the European Union as part of the project “Health System Development in Ukraine” and within the Universal Health Coverage Partnership.

Source: WHO, World Bank

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1000 days of war in Ukraine: resilience in health response, recovery and reform efforts despite attacks and ongoing challenges

19 November 2024, marks 1000 days since the Russian Federation’s full-scale invasion of Ukraine. The toll on the health of the Ukrainian population and its health-care system has been immense.

The war has escalated health needs, especially in areas such as mental health, trauma care and noncommunicable diseases (NCDs), affecting millions who face continuous attacks, trauma and restricted access to health care due to ongoing hostilities and financial barriers. Ukrainian citizens are bearing increased physical and psychological strain, heightening the need for accessible care across all health services.

With over 6 million Ukrainians displaced as refugees and an additional 3.5 million internally displaced, health-care worker shortages, especially near frontlines, have deepened. These shortages include doctors, nurses, midwives and other essential personnel, who are crucial for delivering care in a system under severe stress. Despite the challenges, Ukraine’s health workforce has shown remarkable resilience, working tirelessly to sustain services and support both the country’s recovery and ongoing health-care reforms.

This war remains the largest ongoing emergency in the WHO European Region, with 2134 confirmed attacks on health care as of 18 November. WHO has actively monitored and reported these attacks, noting a troubling rise in both frequency and severity this year again.

These attacks severely impact health-care delivery and have resulted in the tragic loss of health-care workers. The highest casualty levels were seen in early 2022 at the beginning of the war, with a new peak observed from July to September this year. In 2024 alone, 27% of health-related attacks led to injuries, and 8% to fatalities. Casualties and fatalities of health workers and patients from these attacks have nearly tripled compared to last year, with 65 deaths reported this year, up from 24 in 2023, and injuries increasing from 132 in 2023 to 377 this year.

As Ukraine faces a third winter of war, attacks on health and public infrastructure will bring additional challenges, including lack of heating, water and electricity. WHO is supporting the delivery of uninterrupted health-care services by installing high-capacity heating units and water stations.

Workforce challenges and initiatives: building resilience through human capital

The health-care system’s resilience relies heavily on its human capital – the collective skills, knowledge and dedication of health professionals across the country. The war has critically affected Ukraine’s health-care workforce, especially in rural areas, where the availability of family doctors, nurses and other health-care workers has sharply declined. There is a worrying trend in relocation and migration of health-care professionals to cities or abroad, and there has been a sharp decline in those entering medical professions, threatening the future supply of skilled workers.

Recognizing these challenges, WHO has expanded its support for workforce development by strengthening data collection and workforce planning, focusing on human capital as an essential element of a resilient health system.

Supporting health system recovery and community stability with focus on primary care

WHO’s support has shifted this year from emergency relief to capacity-building across critical areas such as managing NCDs, mental health, antimicrobial resistance, HIV, tuberculosis and infection control, in addition to providing ongoing training on trauma care and mass casualty response. The focus on primary health care is one of the priorities. WHO collaborates with Ukrainian authorities to strengthen health responses, provide expertise exchange, and enhance recovery and reform efforts.

WHO’s commitment to Ukraine’s health recovery underpins national rebuilding efforts. Investments in resilient health-care facilities and community infrastructure enable residents to remain in their local areas, fostering community stability. WHO has installed 24 modular primary health-care clinics across severely affected regions, providing a mix of immediate and long-term health-care solutions.

In supporting broader health reforms, WHO is working with Ukraine on financing improvements, primary care enhancements, procurement transparency and expanded NCD care initiatives. A recent analysis reveals that pre-war reforms and ongoing efforts are paving the way for a more resilient health-care system.

In the area of health finance, WHO is supporting with capacity-building and strategic planning, with regular reviews, establishing costing models with a focus on primary care, mental health and medical rehabilitation financing. Collaborating closely with Ukrainian policy-makers, WHO promotes data-driven decision-making and aligns efforts with development partners to streamline health policies. This includes support for introducing essential tools to aid the National Health Service of Ukraine in contracting health-care services effectively.

Ukraine’s recovery journey is a unique example of how a country can implement health reforms and innovative solutions, such as digital health systems and emergency response tools, even in the face of war. WHO is also collaborating with the European Union to strengthen Ukraine’s access to the Early Warning and Response System to improve health security management in the country.

WHO’s support for Ukraine’s long-term recovery aligns with the Sustainable Development Goals, with a focus on building a stronger, more resilient health system capable of enduring current and future challenges.

Source: WHO

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UKRAINE RESPONS FUNDING TRENDS