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We cannot allow HIV and tuberculosis to explode in war-torn Ukraine


4 min read

On a recent trip to Ukraine organised by the Halo Trust, I saw the very real impact their work is having and how effective British support can be.

Their de-mining of Ukraine’s fields and forests has enabled them to progress against Russian forces but also prevented countless deaths of Ukrainian civilians.

I was also reminded how British support should not stop on the battlefield but be foundational to Ukraine’s recovery and future.

War disrupts every part of life. Education and recreation stop, food and medicines become scarce. Infrastructure is attacked, destroyed, or repurposed. Hospitals fill up. Logistically, keeping the country going requires immense external support in the face of destruction.

It would be hugely unjust for Ukrainians to survive Russian bombs and bullets, only to die from preventable diseases

Since the Russian invasion began, more than 380 health facilities have been damaged or destroyed, including three tuberculosis hospitals, leaving health care workers and patients displaced, injured or killed.

This threatens progress in the fight against HIV and tuberculosis. Great progress had been made in Ukraine; since 2002 when the Global Fund was founded, AIDS-related deaths have dropped by 65 per cent and the tuberculosis incidence rate had fallen steadily from 2015 to 2020, from 91 to 73 cases per 100,000.

Despite this, however, the prevalence and mortality level of tuberculosis remains high in the country and drug-resistant tuberculosis remains a public health threat. And as the war began, people living with HIV faced difficulty knowing how they would continue to access their treatment.

With the Russian invasion and with the devastation to health systems, there was - and remains - a huge risk of these diseases exploding across the region.

This is why, within weeks of the Russian invasion, in an action of global solidarity, The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) rapidly released emergency funds to ensure life-saving drugs continued to reach Ukrainians in need of them.

Today the Global Fund still ensures the provision of life-saving HIV and TB treatment to over 140,000 patients and key prevention services to 170,000 in Ukraine. Ongoing funding support continues to deliver impact; from providing generators for regional laboratories where power is at risk, to retrofitting vans to deliver essential medicines, to helping community-led organisations support affected and displaced members to access services.

The Global Fund’s ability to do so is in part thanks to its effective strategy that places great emphasis on challenging operating environments (COEs).

COEs are countries or regions that experience armed conflicts or civil unrest, infectious disease outbreaks, weak governance, natural disasters, climate change-related crises and/or mass displacement.

Despite hosting less than 14 per cent of the world’s population, COEs account for approximately one-third of the global disease burden for HIV, TB and malaria.

A focus on these environments is essential to rebuild and strengthen health systems, save lives, as well as to prevent surges in transmissions that spread through neighbouring regions, knocking back global progress against epidemics. This is particularly important when you consider the 6.6 million refugees who have fled to other countries since the war started, without knowledge of existing health networks they could access.

As warfare tears cities, health facilities and families apart, we cannot separate our military support from our international development efforts. Taking a flexible approach within the humanitarian-development-peace nexus is important, but our necessary support for Ukrainian refugees being at the expense of other life-saving programmes under a fixed aid budget constrains our ability to lead against global crises. Our approach is therefore currently lacking and to withdraw funding from multilaterals like the Global Fund who have a proven track record risks harming our progress under the UK’s international development strategy.

We must not forget a known truth about these diseases. They are beatable. Our world is fragile; any number of places could be rocked by conflict, natural disasters or other crises. It is a question of when, not if, that will happen.

If we invest now to eradicate these diseases, then we eliminate the risk of them surging when crises hit – removing another factor to address in the response. It will unburden health systems, free up vital capacity of health care workers, hospital beds, and other resources for those in need.

Indeed, this will reinforce our ability to counter malign actors on the world stage and stamp out other crises as they occur. We should stand with our allies, many of whom such as the United States, Canada and Germany have increased their pledges to the Global Fund, to help make Ukraine the greatest example of what global cooperation can achieve.

Ultimately, it would be hugely unjust for Ukrainians to survive Russian bombs and bullets, only to die from preventable diseases. The UK can, and should, play a leading role in this fight.


David Mundell, Conservative MP for Dumfriesshire, Clydesdale and Tweeddale and co-chair of the APPG on HIV and AIDS.

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