Flooding may affect epidemic situation in Ukraine. Status quo and expert predictions

In the early hours of June 6, 2023, the Russian forces blew up the Kakhovka Hydroelectric Power Plant in southern Ukraine. Evacuations were announced in Kherson Oblast. Ukrhydroenergo stated that the Kakhovka HPP was completely destroyed after the explosion and cannot be restored.

On Wednesday, at an online meeting with journalists, Chief Sanitary Doctor Ihor Kuzin said that the flooding could potentially provoke a worsening of the epidemic situation in Ukraine. This is especially true for the group of acute intestinal infections.

LIGA.net outlines the current situation in southern Ukraine and what risks are on the cards.

Potential health consequences of flooding

Among the main possible consequences of flooding, the sanitary doctor identifies:

• problems with the quality and safety of drinking water;
• disruption of critical infrastructure, especially water treatment systems;
• disruption of the supply chain of medicines and medical devices;
• fish pestilence. The Ministry of Health emphasizes that collecting, cooking, preserving and drying such fish is dangerous to health.

"84 surveillance groups of Kherson, Mykolaiv, Odesa, Dnipro, Zaporizhzhya and Kirovohrad regional centers for disease control and prevention were mobilized. These surveillance groups provide enhanced control over the quality and safety of the manifestations. As of 3:00 p.m. [June 7], no deviations in the quality of drinking water have been recorded," Kuzin said.

In general, surface water and drinking water are tested for several indicators: microbiological and virological, sanitary and chemical (hardness, salt, mineral content, etc.), toxicological (chemicals, poisons), oil products, or surfactants. 

Bactericidal tablets, or means for disinfecting drinking water, have been redistributed to Kherson and Mykolaiv oblasts. According to the health officer, they will be used and distributed to the local population after the water starts to recede. They will also use wells and water delivered from other regions. 

Currently, the stock of bactericidal tablets is sufficient to supply almost the entire Kherson region for at least two months. 

Radiation monitoring has also been intensified, with checks conducted hourly in Zaporizhzhya and Dnipropetrovsk oblasts. As of June 7, there have been no readings above normal levels.

Additional seawater monitoring stations have been set up in Odesa Oblast given that some of the receding waters could flow into the sea.

The risk of some diseases may increase

"Flooding is a serious risk of outbreaks of infections associated with drinking water," Kuzin says.

These include:

• viral hepatitis, which is usually the first to appear in such cases, the sanitary doctor notes;
• botulism, which is potentially associated with the use of fish that died as a result of the mass pestilence;
• acute intestinal infections, including cholera. In such conditions, the ability to wash and cook food well is reduced. In addition, the risk of infections is associated with problematic access to safe and high-quality drinking water. 

"Starting June 1, Ukraine will routinely launch enhanced epidemiological surveillance for cholera. It is the south that is at risk of developing the disease. These are regions such as Crimea, Sevastopol, Odesa, Mykolaiv and Kherson oblasts. Therefore, we do not rule out that there may be isolated cases of cholera among infectious diseases after the water is released. We have done everything we can to avoid such cases," explains Ihor Kuzin.

In the event of an uncontrolled situation, quarantine restrictions will be applied. The laboratory service is now ready to diagnose cholera, the Ministry of Health says. Routine monitoring takes place in all regions of the country to control the situation in a timely manner. 

After the water recedes, preventive measures will be taken. In particular, the areas of destruction should be disinfected and the water should be tested. Local water treatment technologies and facilities will be used for wells and other water sources.

"We have a sufficient number of medical diagnostic products to diagnose any acute intestinal infections, including cholera. That is, the healthcare system is ready to respond. The quarantine may be applied on a case-by-case basis, depending on the situation. We will be able to assess the situation only after the water is gone," concludes the chief sanitary doctor.

As of now, no cases of the above diseases have been recorded. 

How hospitals work in the flooded areas

"As for Kherson Oblast, as of this morning, the healthcare facilities operating in the territory were not flooded. Those hospitals that were at risk evacuated their patients. The vast majority of evacuations are taking place along the routes approved by the civil-military administration," says the sanitary doctor.

To organize the evacuation, 25 emergency medical teams are working in Kherson Oblast. At least 455 beds have been allocated in Kherson city for the evacuation of people with limited mobility. Today, this number is quite enough, says Kuzin.

"Medical care is provided in full at the expense of hospitals operating in the region. The healthcare facilities have formed additional reserves of drinking water for at least two days to ensure the operation of the facilities in case of water supply failure," adds the chief sanitary doctor.

The Ministry of Health has not yet commented on the situation in the temporarily occupied territories. They do not have access and sufficient information.