Public health experts say the 'burden of disease and death' will face Ukrainians fleeing Russia's invasion

• Over a million Ukrainians have fled the country amid Russia's invasion so far. 
• Public health experts told Insider that there's a correlation between war and public health. 
• They're concerned that infectious diseases could spread and chronic illnesses will get worse.

Where there's war, a public health crisis follows, and as Ukrainians flee Russia's invasion they're at risk of infectious diseases and worsening chronic conditions, public health experts say. 

"It's been well documented that war leads to all kinds of public health problems most importantly, infectious diseases, but also worsening of any kind of chronic disease that people have," Dr. David Eisenman, the director of the UCLA Center for Public Health and Disasters, told Insider. 

Dr. Howard Hu, the chair of the Department of Population and Public Health Sciences at the Keck School of Medicine of USC, told Insider that as civilians face the anxiety of fleeing war, it becomes harder to do things like isolate or socially distance. 

"Well, with most wars the civilian population is always at risk and the burden of disease and death is usually much greater from the side effects of war than the actual people being killed by bombs and bullets, because war typically destroys the infrastructure and changes that behavior, it creates crowding conditions that will increase the risk of disease," Hu said.

Hu said another setback is that the war creates an inability for countries to carry out their typical vaccination policies that would limit the impact of COVID-19 once an infection happens. 

"So it's a disaster all the way around," Hu said. 

According to data compiled by Our World in Data as of February 23, only 35% of Ukraine's population is vaccinated. 

Additionally, some countries accepting Ukrainian refugees, like Poland, have waived COVID-19 testing and quarantine protocols. 

Máire Connolly, a global health professor at the National University of Ireland Galway told The Washington Post that she's also concerned about polio: Ukraine was dealing with a re-emergence of polio cases due to low immunization rates, UNICEF reported. 

However, Eisenman told Insider many refugees so far have been housed in homes or hotels and not encampments, "so they should have good access to sanitation and clean water. I'm not so sure if that will be a big problem if they settling in those kind of situations in well-developed countries like Poland," Eisenman said. 

Hu told Insider he's concerned about the spread of tuberculosis during the conflict, noting that Ukraine has the highest incident rate of the respiratory disease among the 53 countries in the World Health Organization's European region. 

"So in 2020, for instance, there were 17,593 new cases of tuberculosis and to manage that you need to reduce crowding. You have to be able to have a health system that can screen patients. All that's gonna be gone and not only do they have this unfortunate tuberculosis problem in Ukraine, but a lot of the tuberculosis cases are so-called drug resistant tuberculosis," Hu said. 

Additionally, both Hu and Eisenman noted that stress and anxiety play an impact on immunity, meaning both Ukrainians fleeing and those who remain in the country are more suspectable to getting sick and could have a harder time fighting off an infection. 

Both Hu and Eisenman told Insider people with chronic conditions will also face problems getting medication or routine care. As health infrastructure gets destroyed, or as people shelter to avoid the fighting, they most likely won't venture out to refill prescriptions or get check-ups. 

Eisenman said that could lead to people going to clinics or hospitals after their conditions deteriorate, which could also further strain systems. For people still in Ukraine, Eisenman said healthcare systems are being targeted and impacted by the war, which could leave hospitals without power or water.

"One would hope that the war will not disturb the ability of healthcare personnel to attend to the wounded, do what they need to do to try to reduce the impact of the loss of civilian infrastructure," Hu said. "But violations of medical impartiality, neutrality happen all the time in conflicts."

Both Hu and Eisenman also warned that there would be an impact on mental health. 

"This is always overlooked and with a million refugees now going out of Ukraine the trauma of that always has to be dealt with right away," Eisenman said. 

Hu said that the trauma can lead to a number of conditions, including PTSD, anxiety, or depression. 

Eisenman noted that for people with pre-existing mental health disorders, the war could mean they're unable to get necessary medications, and a gap in taking prescribed drugs could lead to a relapse in symptoms. 

Countries and organizations accepting refugees should keep in mind that those fleeing the war are "shell shocked" and may need mental health support alongside care for physical ailments, Hu said.