Florence Gillette On Aid to The Donbas and Coronavirus

The Red Cross is a humanitarian organization that provides aid and relief in conflict zones. Since the start of the Donbas conflict in Ukraine in 2014, the Red Cross has been providing various humanitarian services on both sides of the contact line. We spoke to Florence Gillette, the head of the International Committee of the Red Cross’ delegation in Ukraine, to learn more about what the Red Cross does, and what role it plays in Ukraine’s health system as a whole – especially as the country is facing the threat of the coronavirus. This interview was recorded on March 10, 2020. The following transcript has been edited for clarity.

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Hello, my name is Romeo Kokriatski, speaking from the International Committee of the  Red Cross’ offices in Kyiv, Ukraine. Recent headlines have been dominated by news of a global pandemic – COVID-19, or, as it's popularly known, the coronavirus. The coronavirus has infected at least 116,000 people globally and has resulted in at least 4,000 deaths. It’s spread from its epicenter in China to nearly every continent in the world. Ukraine, so far, has only one confirmed case of the coronavirus, and the government has been taking measures to keep it that way. Today we’re speaking to Florence Gillette, the head of the International Committee of the Red Cross’ delegation in Kyiv.

Before we get to the implications of what the coronavirus can mean for Ukraine, let’s talk a little about what your organization does in the country in general. Can you tell us a little bit about the background of the work you guys do here in Ukraine?

Yes, the International Committee of the Red Cross has actually a mandate and a mission to prevent and alleviate the suffering of people in times of conflict. So the ICRC has been growing its activities since 2014, working closely with people that have been affected by the conflict to try and alleviate the consequences of the conflict on their daily life. This is – the range of response varies a lot. It depends on each person, each community, what their needs are and how we can help them.

So it goes from distributing food parcels, and we still do distribute food parcels to quite a lot of people who are living very close to the line of contact, to help people, households and communities to find a way to resume livelihood to become more self-resilient and sustainable in the way they manage their daily life. We also work on the infrastructure with a big focus on water in the Donetsk and Luhansk region to ensure that the impact of the conflict on the provision of water is as little as it can be, but it still remains a problem and to help the water authorities and the water companies to fix and maintain and repair their water system.

We also assess the health system on both sides of the line of contact, in complementarity to their role. So we are not at all substitute for their role. We are just trying to help health workers, primary health centers, hospitals, to respond to the consequences of the conflict. Because there are people who are still unfortunately being injured because of the conflict but also to try and maintain some health services for the population being in the areas that are still very affected by the conflict.

We also focus on two specific categories of people I would say, and their families. One of the categories, unfortunately is still unaccounted for – went missing in relation to a conflict. We today assist more than 730 families who are still looking for a loved one. So we help them in their endeavor to exhaust their right to know to try and find out what happened to their loved one, but also in their daily life through mental health support, helping them to find ways to access income or livelihood for those who are unfortunately, not benefiting from the support of our organization, and also to gather and be together to cope with very specific issues that are affecting the missing.

And we also focus on those who have been detained in relation with a conflict and their families who have different ways of response.

I did have a quick question about the general status of health services. After 2014, we saw a lot of artillery shelling showing on both sides. And a lot of, I must imagine, the local infrastructure was devastated. How have the communities recovered in the six years that this conflict has gone on?

I would say there are different levels at which the health system in the Donetsk and Luhansk regions were affected. One, you're right, can be the direct destruction of facilities or I would say, very offensive damages that have been done to part of those facilities. So that's one issue but there is a secondary issue and that's a significant one, is that the way the health services are organized, you know, you go from level one to level two to level three care, was organized by region. So you had one system for all of the Luhansk region and one system for all the Donetsk region. And those systems have been actually disturbed, have been cut because of the conflict and the ensuing setup of the line of contact, that is actually breaking that chain of care for people who are sick or people are injured.

So you were supposed to see your general practitioner maybe in your town, but he would then have referred you to hospitals, that's maybe right now on the other side of the line of contact. So that's, that has a very big impact. And we also have infrastructures that were not instantly damaged, but that are currently very close to the end of contact, so too exposed to take care of patients. And we see that in several of those hospitals. So it also forced to revise completely how the health care is set up and the third impact is also that when you have a conflict, very often you have a lot of displacement. You have displacement because you have people who are actually deciding that for the safety of their family and their own safety, they should move away from the conflict. So you also had, unfortunately a significant number of people who were active in the health services that decided to relocate, and we understand that this is to keep their family safe, but still it also lowers the number of people. So you already have those three main impacts on the health system.

And today, what you face is a system that has been weakened by the conflict. Of course over the last few years, I would say the system has tried to reinforce themselves either on their own with the support of more central authorities and with the support of the international community. If you look at how the ICRC has been contributing to that, we've been working with the primary health system to work primarily on non-communicable disease. A non-communicable disease is also a disease that often comes as people get older and they include, you know, high blood pressure and a series of other concerns, like cardiovascular disease that people can have.

So we actually accommodate and try to ensure that all the people in this line of contact have access to those drugs. What we see though is that it's a challenge. It's a challenge because you still have some areas like Vodyane, in the Mariupol district, or other places where there are actually no health services at all right now because the situation is too unstable or too difficult. You also have this another issue which is most of the people living on line of contact should be enrolled on the government side in the affordable drug program.

And if you look for instance, at the region of Luhansk, the problems they face is that it is not fully deployed. This program is not fully deployed because it requires a full digitalization of the patient, doctors, and pharmacies and this has not yet taken place. Because amongst other things, because of the conflict, and the fact that it's much slower to implement. So there we face a system that still has a challenge to reach out to the population.

In regards to the destruction a lot of repairs have taken place. It's not yet fully done. So you know, it will take a while. But a lot of the infrastructures have been partially repaired or or largely repaired, but we not only we have to repair the hospitals, but we also sometimes have to change hospitals so that they can treat the patient that cannot cross the line of contact to the hospitals they were using before, or to the hospital that's right on the line of contact. So you have some hospitals that were small hospitals that were not doing advanced surgery and have now to do much more advanced surgery or much more advanced care than before.

As you know, for instance, treatment for cancer has also been largely affected. So with it, you know, they had to re-dispatch. So we do, amongst other actors, and we did contribute to some places, to repair or to rehabilitate, I would say, operating theatres, but also primary health centers. We also support the blood bank in Donetsk, you know, there are different projects like that. For the fact that sometimes there is indeed an issue with the health staff because there are not enough. So they are very dedicated people and I really wanted to commend the courage and the dedication of the health workers working in the Donetsk and Luhansk region right now, continuing to do their work accompanying the population. But for that unfortunately there's nothing much we can do. This is really up to the health system to ensure they attract the right people.

So I would say the system has partially recovered. I'm not sure it has fully recovered yet because it will take time – it cannot recover as the conflict is still active. So it's a system that still has a lot of challenges.

Now, you mentioned that the Red Cross also engages in humanitarian aid. You mentioned food parcels, exchanging messengers between detainees. I want to ask specifically about the elderly residents in the Donbas region because we know as you said, a lot of people have left the region. Many of those people were not of pension age, you know, not maybe not young, but people who had the capability, the funds and the ability to move. But at the same time, we know that a lot of the people who remain are exactly what we would consider the most at risk populations, elderly people with maybe bad access to mass media, in isolated regions. What's the situation like for them? What's been done in the past six years to rebuild their lives or help them with their medical needs?

And I would say, if you look at the population on the government controlled side, I think there have been well, some efforts by a series of actors that are a combination of the social services, but also indeed, the ICRC in close cooperation with a Ukrainian Red Cross Society. You also have Ukrainian NGO supported by international NGOs or the United Nations that try to accompany those people to ensure that they can cope better.

Now there is one thing that remains extremely difficult for those people. I've met in Krasnohorivka for instance, this man who is only getting older every year, and who was already quite old at the beginning of the conflict. And he lost his wife several years ago and he is alone, but he was in very close connection with his children. Unfortunately, his children live across the line of contact now. Before it took them 20 to 30 minutes to come and visit him to take care of him so they could come even after work, they could come on weekends to help him ensure that he had enough fuel for the heating, to do small repairs, to ensure his fridge was full.

Today, they have to cross the line of contact, it can take six to eight hours. So they cannot come for the day as easily as they would come before actually, they can only come once in a while. And it's highly challenging for them. So for those people, yes, they can have more support from social services but they still lose one thing which is essential, which is the support of their relatives or their loved ones. And that's such a challenge. For those people, what we've done, so they are included in some of our programs.

And for instance, we've worked a lot to prepare the houses for the winter. So we have accompanied some of those people to have heat for the winter. So we bring either fuel to them or we ensure that they get fuel delivery. Fuel can be briquettes, it can be coal, it can be in different forms. But we also work on insulation of at least one or two rooms in the house so that they can use less and make savings and protect most the future investment into heating, but also the environment.

And for those who are actually elderly, we will actually also ensure that people such as the volunteers of the Ukrainian Red Cross Society come and help insulate the house if they cannot do the work themselves. We also had examples where we did house repairs of houses that were damaged by the conflict and as you know, there are still houses damaged by the conflict almost on a daily basis. We brought those windows to an old lady. And we were actually going to send people to install the windows because, of course, this lady was elderly and could not install the windows. And the volunteers were on their way. But the neighbors have also supported this lady to repair the windows and put it. And I think that's something that we see as what has compensated a bit. The effect of the conflict is a very big increase in solidarity in the communities close to the line of contact.

So it's not only people coming from outside whether international or national organization or the social services, but it's actually the communities themselves that create very strong bonds, and together try to face their daily struggle.

What's the biggest challenge that you faced so far in your work in Ukraine?

This is a big question. Ukraine first is a challenge for me because I'm new to the context. So I had to discover a new context and new culture. A fascinating culture at that. And Ukrainians are very nice people. But it's still challenging the fact that it's new for me. But I would say Ukrainians make it much easier. I also had to face a very changing environment.

As we all know, Ukraine has gone through a huge amount of change in 12 months. So it means that it creates a lot of pressure and the need to reconnect all the time because you have to reconnect to new authorities and new stakeholders, new actors every day. One of the very big changes also, I think, for the International Committee of the Red Cross in Ukraine, is that there is a lot of expectation on the International Committee of the Red Cross and sometimes we have to clarify what is our role and what is not our role. And sometimes I have a feeling that when there is a problem, people take their phone and call us and say ‘Find the solution’. And sometimes some of the solutions we are being asked to find are definitely not humanitarian solutions.

We are a humanitarian organization, we are not a political organization. So we can raise humanitarian concerns, we will not bring political solutions. So, and that I would say this huge amount of pressure, is something we have to manage, and we will most likely talk about that later, in the case of the coronavirus, which is not a conflict related issue. It's a global issue that's affecting all the countries in the world, almost or very soon. At least all the continents already. And then we have to see, okay, what is the role of the International Committee of the Red Cross? It will rather be limited to certain needs where we have a specific added value, and we would also like actors to play their role.

Well, before we get to the coronavirus, I did want to ask – as you know, we recently reshuffled the cabinet in Ukraine. And there's an entirely new health minister. Do these kinds of political changes now – not to comment on the changes themselves – but do these kinds of political changes, do they hamper or hinder the Red Cross' work? Or does it slow down the pace of, for example, medical reforms both here and on the contact line?

I would say the ICRC works primarily for the people with the people. The people are not changing. We work with local health services, we work with local social services, we work with the regions. So at that level, things have not changed. There are indeed some elements that are being discussed in Kyiv. But, you know, the Ukrainian administration is a very structured administration. And it's a very rich, I would say, administration, and we still have actually people who are staying with whom we continue to work. And yes, we have to adapt also to potential changes due to those changes. It's part of life. It’s part of life in many countries. And that's part of one of the challenges we have, is that it requires more energy on our side, because you've got a new government, but there are also new opportunities. It's a challenge. It's an opportunity. And this year we will build on that.

Now let's move on to the coronavirus itself. And specifically, I wanted to touch on the situation on the contact line. Now, you mentioned that the wait times are 8-12 hours – really, really long. And the Ukrainian government has recently also introduced some preventative measures like taking the temperature of people crossing at the checkpoints. Do you think these measures are effective? Should more be done? Should less be done? How exactly can we prevent an epidemic breaking out on the contact line or non-government-controlled territory?

It's not up to the ICRC to say those measures are working or not. What I understand is those measures have been closely discussed with the World Health Organization. They have been also discussing, taking a look at the experience of other countries in dealing with this outbreak. So most likely those are relevant measures. Now, it's very important to put in place the right resources to ensure that you indeed don't increase the risk, but to really do the work of prevention, by having people that are trained, by people in a sufficient number to take the temperature, to also maybe take the opportunity to have people going through those points to talk about the virus, what it means, how to prevent it and its spread. And I think a lot about the coronavirus is also about communication, and ensuring people understand what it is. Yes, it's a disease. It's a disease that in more than 80% of the cases is actually very mild. You've got, if I understand well, close to 15% where it starts to be a bit more serious. But the big issue is the 5% that are critical. And that's what I'm understanding from global experts.

And there we are, yes, you have to be very cautious because those 5% are very often amongst the people, the population that are above 60-65 years of age. And yes, it's true that most people that are living close to the line of contact and crossing the line of contact in particular, if you look at Stanytsia Luhanska, are people that are among those age categories. We know a lot of people are crossing because of pension related matters, so they are pensioners, and most of the pensioners are in those categories. We also have to take into account that the people who are crossing the line of contact very often, also people that have been affected by the conflict. So they did suffer also from five to six years of fighting impact on health services that might have weakened their health systems, their own health, their personal health. So that's very important that when looking at those measures, people think that yes, it's possibly good measures but they need to put the right means to implement.

READ MORE: Communication is Key in Coronavirus Prevention in Conflict Zone - Red Cross in Ukraine

What role does the ICRC see for itself in this coronavirus outbreak? Now, I'm not saying maybe in all the country but specifically in the contact zone where you have Red Cross workers going and delivering food parcels aid and so on.

I would say that what matters for us right now is our duty of care. Our duty of care to the population, we are accommodating. So the population for whom we have active services that are being delivered.

So first we have to ensure that we take all the right measures not to be a factor of contamination but the factor of prevention of the disease. That's very important. We also want to see how we can pursue our activities should the outbreak reach Ukraine because as we say, today, the outbreak is not in Ukraine. One case is not an outbreak. (The interview was recorded on March XX --ed.) But we also want to ensure that the most important activities, those on which the life of people depends, can continue. And that's why it's very important, because those populations that are vulnerable need to continue to receive assistance and need a presence to be there. And then we might indeed see whether we want to support a bit more the response in very specific categories. As you know, the response to the coronavirus lies primarily with the health system. In Ukraine with the Ministry of Health, there is a specific task force and they already have been working for weeks now on how to prevent the outbreak, to which countries. They’ve set up a good system that they have coordinated with the World Health Organization that has a lead in the response. We also have the Ukrainian Red Cross Society that has been involved now for several weeks in supporting communication campaigns to explain how to prevent the disease from spreading.

So a very simple message but that's also the right message. Hygiene, wash your hands, ensure that you limit sometimes direct physical contact, but by good hygiene practice, you really play a big role in prevention. And a subtle message which I think is very important is that people that may be suspected to have coronavirus should not be stigmatized. They are people like all of us, it could happen to you, it could happen to me. It could happen to your neighbor. So, stigma is not the right response. People who are suspected to be sick or sick should be protected.

Those who take care of them, their families and neighbors should be protected. And the health system, the health workers really need to be protected. So I think that those messages are very important. So this response is them and of course, we will support our partners, the Ukrainian Red Cross Society, and we have started to support them if they need our support on specific matters.

Now, then we will have to see if they are specific issues that are relating to specific populations where maybe it's difficult for other actors to have access, and that's something we are discussing with the relevant authorities and stakeholders. But primarily it's with the health system, with the MOH on the side of the line of contact, with the health facilities, and they have to be in the lead, and then we will see if there's any support we can bring but we are definitely not in the first place.

The ICRC has a lot of experience with infectious diseases in conflict zones, right? In Africa, I believe with the Ebola virus. What kind of experience or advice can the ICRC provide in general?

I would say that the thing is we have experience, but we also have to be very clear – coronavirus is very different from Ebola, for instance, or from cholera. Coronavirus is not as serious at all, I mean, as cholera or Ebola because I mean, as I said more than 80% of the cases are mild, and it's just through the premises that we'll be ready for those who are most affected by the disease because of their vulnerability. But so it's much – it's not the same, but it's also more contagious. So, we have experience, but this experience might not be the right one in that sense. What is important though is I would say, two things that are relevant in the coronavirus. As I said, but three things: good practice of hygiene are very important. And yes, we are all to remind ourselves how to wash our hands properly. And I know it's certain to sound a bit stupid, but we all forget that we should not sneeze in certain ways and that we should really wash our hands several times a day.

Now there's a bunch of songs that are 20 seconds long just for you to wash your hands.

It takes more than 20 seconds to wash your hands, and that’s the right thing. Stigma, and I think that’s a thing that we really learned a lot in relation with the Ebola crisis, that stigma and violence should be prevented and how you have to talk with the communities in due time, which is in advance to ensure that they understand that, you know, stigma and violence are not going to help prevent the spread of the outbreak. On the contrary. So that's a very important message.

Yes, a very important one. And that's also something that we see right now is happening with the coronavirus outbreak in other countries. No matter how strong the health system is, when you have an outbreak of that scope, what the risk is that it drains all the attention to that disease and the rest of the health system that was at risk, you know, the rest of the health issues are a bit left on the side. And we have to be extremely careful that the people who are suffering from other pathologies can be taken care of, and that's also why it's important to try and limit the spread of the coronavirus, because otherwise you will exhaust your health capacity and health services capacity to respond to the coronavirus at the expense of all the other diseases. And we know that unfortunately there are a lot of other diseases. We were talking about non-communicable diseases, but we also have issues of diabetes, we have a shortage of cancer patients, we also have cardiovascular disease. So it's very important to ensure that the rest of the healthcare system can continue to deliver. And this seems to be one of the major challenges of this new coronavirus, as we've seen in China, in Italy. I mean, we're not talking about weak health systems, we are talking about very big countries with a solid health system, and where you can reach a saturation level much faster than anyone expects. And this is where we think it's very important to put some attention ensuring every sick person in this country can still access medical services.

That's very good advice. So, to end our interview on a lighter note, what have you seen as your biggest success since coming to Ukraine?

Well, I think for us the biggest success is when we see people who start to gain back their joy of life, I would say it's a bit like that. But it's to see all this microeconomic initiative livelihood projects where we see that it's working. When I see a woman who tells me, you know, “Thanks to the project you set up and the milk and the eggs I’m selling, thanks to your support, thanks to that my children are going to school. And I can think about the future. I can think about sending them to university at some point.”

For me, that's what's part of the joy I see. When I see a hospital director who thinks that thanks to the work we've done together they can deliver a better service to the population. That's my joy. Even though we struggle every day on water delivery, I still think it's very important that there is still water flowing in the Donetsk region. You know, I've been with the workers of Voda Donbas in the gray zone where they have to go daily. And the fact that we are a small part, a very small part, what makes them work is their courage and their commitment that we can contribute to help them come to work and deliver water to more than 2 million people. I would say those are the achievements I see and the very positive news I see.

Because I see people, I see proud Ukrainians that are increasingly -- even though they were affected by the conflict -- shaping their own future. And that's what matters.

/Interview by Romeo Kokriatski