As Ukraine works to strengthen its ties with the European Union through new visa-free arrangements and deeper integration, health experts are sounding the alarm over a persistent public health challenge: tuberculosis (TB). Particularly in cities like Odessa, the country faces rising infection rates, drug-resistant strains, and a healthcare system under pressure—all of which pose risks not only to Ukraine but to the broader European region.
“Ukraine should pay special attention to TB—it’s a very sensitive issue for Europe,”
— Alexey Bobrik, Technical Officer for HIV, TB, and Hepatitis, WHO Ukraine
📍 Odessa: A High-Risk Hotspot
Located on the Black Sea, Odessa is both a popular tourist destination and a convergence point for diverse populations: internally displaced people, migrant workers, students, and individuals from Central Asia, the Caucasus, and Africa. Unfortunately, the region also reports some of the highest TB rates in Ukraine, with 110 cases per 100,000 people as of 2016, and numbers continuing to rise.
TB transmission is closely linked to migration, poverty, overcrowding, and health system disruption—all of which are prevalent in Ukraine due to the ongoing conflict in the east and a fragile post-Soviet health infrastructure.
🧬 A Resilient Disease with Evolving Threats
Ukraine declared a TB epidemic in 1995. Despite significant international funding and efforts, the country continues to struggle with multidrug-resistant TB (MDR-TB). According to the World Health Organization, 25% of newly diagnosed TB cases in 2016 were MDR-TB—a rate among the highest in the world. These drug-resistant forms require longer, more complex treatment and have a cure rate of just 38% nationwide, and only 43% in Odessa.
Compounding the problem is a high rate of TB-HIV co-infection, which further weakens the immune response and complicates treatment.
🏥 Systemic Challenges: From Sanatoriums to Stigma
Much of Ukraine’s TB care system remains rooted in outdated Soviet-era models, relying on extended in-patient treatment in under-resourced hospitals and sanatoriums. In Odessa, TB patients are often treated in deteriorating facilities lacking proper isolation wards, raising concerns about cross-infection.
“We can’t provide proper treatment conditions,”
— Dr. Oksana Leonenko-Brodetskaya, Odessa TB Clinic Director
Modern best practices emphasize early diagnosis, ambulatory (outpatient) treatment, and community-based support, as most TB patients stop being infectious within weeks of starting treatment. Yet, Ukraine’s model often requires patients to remain in hospitals for months—an unrealistic expectation for many, particularly migrants, the homeless, or uninsured workers.
🚷 Treatment Disruption and Stigma
A significant challenge is treatment retention. Many TB patients in Odessa register with false addresses or abandon treatment once they begin feeling better—either due to stigma or financial hardship. Stories of individuals continuing to work while infected, using forged health certificates, underscore the urgency of a more patient-centered approach.
While TB treatment is officially free in Ukraine, patients frequently report hidden costs due to informal payments. One patient, Maria Kochetova, shared that she paid more than ₴1,000 (about €33) during the first days of hospitalization—roughly two weeks’ salary for a junior healthcare worker.
💡 Innovative, Community-Based Solutions
To address these gaps, Odessa city authorities and NGOs have introduced incentive programs and social support models:
In 2022, the city awarded 200 bonuses from 1,113 newly diagnosed cases, and plans are underway to shift more TB care into primary health services.
These changes align with broader healthcare reforms aiming to move away from institutional funding based on staffing and infrastructure, toward patient-centered, outcomes-based financing. However, national legislative approval remains stalled, and resistance persists within parts of the medical community.
🌍 A Regional and Global Concern
Ukraine’s ongoing health crisis presents broader implications for Europe’s public health security. With over 5 million Ukrainians working abroad, and 1.5 million internally displaced, uncontained TB cases can cross borders if not systematically addressed.
“We’re talking about global security and the cross-border transmission of TB,”
— Alexey Bobrik, WHO Ukraine
Moreover, with the Global Fund to Fight AIDS, TB and Malaria preparing to scale back support in the region, Ukraine has limited time to establish a self-sustaining national response.
🛑 The Path Forward
While Ukraine’s TB crisis presents formidable challenges, it also offers opportunities for innovation and reform. Community-based care models, integrated health financing, and increased political will can shift the trajectory—especially if aligned with international support and sustainable investment.
“I see more political commitment now than a year ago,”
— Michel Kazatchkine, UN Special Envoy for HIV/AIDS in Eastern Europe and Central Asia
If Ukraine is to meet EU standards, both for public health and human security, addressing TB must be a national priority—with Europe watching closely.
📝 Reference
Euractiv. (2023). Ukraine’s TB problem is ticking time bomb for Europe. Retrieved from https://www.euractiv.com/section/health-consumers/news/ukraines-tb-problem-is-ticking-time-bomb-for-europe
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