This past March, the Japan International Cooperation Agency (JICA) dispatched a survey mission to neighboring Moldova to assist displaced people in Ukraine. Japan’s experience and expertise in overcoming numerous natural disasters, including the Great East Japan Earthquake, and especially the standardization method of disaster medical information introduced after the Kumamoto earthquake, are playing a major role in emergency disaster medical care in the region.
Neighboring Moldova to Host Ukrainian Displaced Persons
The four members of the First Assessment Team, which was dispatched by JICA to Moldova to provide assistance to displaced persons in Ukraine and neighboring countries, returned to Japan on April 10, after 21 days of research activities.
It has been about a month and a half since the Russian invasion of Ukraine began. The number of Ukrainians who have fled the ravages of war and left their homeland is said to be about 4.3 million (as of April 6). A report by a JICA survey team dispatched to neighboring Moldova reveals the current situation and the support needed.
Bordering southern Ukraine, Moldova has 2.64 million people living in a land the size of Kyushu, and its economic infrastructure is fragile, even among the countries surrounding Ukraine that are experiencing an influx of displaced persons. After the Russian invasion of Ukraine, nearly 400,000 Ukrainian refugees entered the country, and it is estimated that 90,000 to 100,000 of them are still in Moldova.
Upon arrival in Moldova, Ukraine’s neighbor, the EMTCC immediately began discussions.
On February 26, two days after the invasion, JICA began to consider and coordinate the dispatch of a survey team, and on March 19, a six-member team headed by Professor Tatsuhiko Kubo, a public health specialist at Hiroshima University, left Japan for Moldova.
It is not easy for a country in turmoil due to displaced people to accept a survey team from another country, but JICA had built a relationship of trust with Moldova through its ongoing support in the agricultural and medical sectors, and the team was quickly accepted.
Accompany an Israeli international medical team operating in the city of Kissinau to check on their activities.
The survey team visited six northern cities, including the capital city of Kishinau and the Ukrainian border area, to inspect the main hospital, a closed movie theater, and a shelter in a former university building. JICA had been cooperating in the medical field (improving medical services for cancer patients, providing medical equipment, etc.) since before the influx of refugees, and had some understanding of the local medical situation. This inspection focused on the aging of medical equipment, the shortage of human resources for maintenance, the shortage of medicines and other supplies, many of which had been procured from Ukraine, and the influx of displaced people with chronic diseases. In particular, the influx of refugees with chronic illnesses requiring advanced medical treatment, such as dialysis, cancer, and diabetes, has placed a heavy burden on the originally fragile medical system as a whole.
Implemented MDS, a WHO-approved method for standardizing disaster medical information, to identify the medical needs of the displaced population.
MDS, an international standard medical record “born in the Philippines and raised in Japan,” contributes to speedy collection of medical information.
In addition, during this survey activity, we also coordinated international medical teams that gathered in Moldova from around the world and collected medical information. When a disaster or war occurs, medical teams and relief supplies gather from all over the world, but it is extremely difficult for the chaotic situation on the ground to accept and properly deploy assistance. The immediate consolidation and analysis of medical information necessary for this purpose, and the establishment of a system to centrally coordinate individual medical teams, were common challenges worldwide.
In 2011, during the Great East Japan Earthquake in Japan, emergency medical teams had to replace one another, which hampered the transfer of medical records to local medical services and the immediate identification of medical needs. Recognizing the need for uniform medical records and daily medical reports, the JDR medical team set out to develop a world-standard electronic medical record for disaster medicine.
In 2013, the JDR medical team that went to the Philippines to support the victims of Typhoon Yolanda faced the same challenges as in Japan. Using their previous experience, they proposed the use of SPEED, a locally-used disaster medical information gathering tool, to medical teams from around the world. The team’s contribution to identifying disease trends and coordinating the activities of each team was well received. After returning to Japan, Professor Kubo and his colleagues came up with the development of the Japanese version of J-SPEED, a standardized medical daily report for disaster medicine, using SPEED as a reference. The first implementation of J-SPEED in the 2016 Kumamoto earthquake brought about a significant change in the field of disaster medicine. The system quantified on a daily basis “where, what kind, and how many patients were treated,” and enabled timely provision of necessary support at that time. Based on these achievements in Kumamoto, a Minimum Data Set (MDS/Standardized Method for Disaster Medical Information) was developed based on J-SPEED in 2017, and was approved by WHO as an international standard.
MDS, “born in the Philippines and raised in Japan,” was adopted as an international standard based on Japan’s knowledge in the field of medical care in natural disasters, and its use was disseminated to international medical teams in Moldova at the initiative of the survey team, which revealed the medical needs and trends sought by the displaced population.
For example, it has become clear that there are more needs to deal with physical ailments and chronic illnesses caused by prolonged evacuation than direct trauma from the fighting. The fact that the percentage of adult males, who are supposed to be restricted from leaving the country, is higher than expected was a surprise to the doctors in charge at the Moldovan Ministry of Health. The fact that even adult males with chronic diseases or disabilities are allowed to leave the country has revealed the background to the exodus of many of them as displaced persons.
It is also becoming apparent that the number of evacuees requiring ongoing treatment is on the rise, although the number of daily treatments itself is decreasing. Referring to the data from the Kumamoto earthquake, those who are forced to continue living in evacuation centers are often economically disadvantaged and have pre-existing medical conditions, and there is a possibility that more cases of health conditions worsening due to prolonged evacuation will continue to increase.
Because of the incorporation of MDS, Moldova was able to capture such data quickly. Currently, they are considering introducing MDS in Poland and Ukraine, where there has been a large influx of displaced persons as in Moldova.
Medical teams and relief supplies have been sent from all over the world.
Sadness that it is not a natural disaster, but a war caused by people.
Professor Kubo, who has been involved in emergency medical care due to natural disasters and has been deeply involved in the development of MDS since joining the medical team in the Philippines, described the differences between the two activities as follows. The overwhelming difference is that it is caused by war, that people are causing it. In the case of natural disasters, there are moments when the city becomes brighter with the passage of time and the music on the radio makes you feel a sense of the future, but what the people of this country are worried about now is the further expansion of damage caused by the ongoing invasion. On the one hand, we feel the sadness of war and the instability of the future, which depends on the war situation.” On the other hand, he emphasized that the emergency medical care needed by evacuees will remain the same regardless of whether the cause is war or natural disaster, and that Japan’s disaster medicine techniques and knowledge of health risk management, which have faced and overcome emergency disaster medicine such as earthquakes and torrential rains, stand out in the world.
Interviews with evacuees
We will continue to cooperate with Japan’s experience and knowledge.
Professor Kubo and other members of the survey team were surprised and respectful of the government officials who worked through the night to coordinate their efforts, and of the reality in Moldova, where about 90% of the displaced people who remain in the country are accepted by ordinary volunteer families. The answer to the question, “What can we do in Japan? JICA will continue to provide prompt assistance and report back.
The second survey team has already arrived in Moldova on April 6, and has started its activities by taking over from the first survey team. In addition to continuing support to the Emergency Medical Team Coordination Cell (EMTCC), we will continue our activities in the field until April 29 in order to further specify the details of cooperation based on the direction of cooperation identified by the first survey team.
© Source JICA
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