(Formerly IRIN News) Journalism from the heart of crises

  • How Ukraine’s war is driving up HIV infections

    When Mikhail and his girlfriend were living in rebel-held eastern Ukraine, they were afraid for their lives every day. But not just because of the shelling.

    “We could easily get shot just because we were drug users,” said Mikhail, who did not want to give his last name.

    When the rebels closed down a centre where he had been receiving drug substitution therapy for his addiction, he returned to using. In September last year, he and his girlfriend decided to leave in the hope of restarting the treatment in a government-controlled area. This meant passing through a rebel checkpoint, where they were told to explain their reasons for leaving. The rebels responded by ordering them onto their knees where they remained for hours before being told to lie on the floor.

    “We spent several hours on the ground with the guns of the rebels pointed at us,” said Mikhail.

    Eventually, they were released and reached the government-controlled town of Sievierodonetsk, where they were helped by social workers and encouraged to test for HIV. They both tested positive.

    NGOs are warning that HIV infections are on the rise in eastern Ukraine, where nearly two years of conflict between pro-Russian separatists and government forces has hit prevention and treatment efforts.

    “More babies [are] born that are HIV-positive and more people are dying from HIV [related illnesses] compared to before.” said Oleg Pronin, executive of the board of the Luhansk regional branch of the Ukrainian NGO, People Living With HIV, which is based in government-controlled territory and partners with UN's refugee agency, UNHCR.

    Even before the conflict, Ukraine had one of the highest rates of HIV infection in Europe. According to the World Bank, 1.2 percent of Ukrainians aged between 15 and 49 were infected with HIV in 2014.

    About 30 percent of new infections were in the Donetsk and Luhansk regions, now partially under rebel control, where tuberculosis – a common opportunistic infection in people with HIV - is also a major health problem.

    Due to the lack of data being gathered in rebel-held areas, there are no official statistics to support the anecdotal reports by NGOs that HIV infections are on the rise.

    Reports from the ground

    On World AIDS Day on 1 December, a group of NGOs partnered with the government to offer HIV testing at train stations throughout government-controlled Ukraine. According to preliminary results, out of 544 people who were tested, three percent were HIV-positive. 

    “It was much higher than we expected because generally… not more than one percent of the adult population [has] HIV,” said the policy director for the Alliance for Public Health, Pavlo Skala.

    Based on his organisation’s contact with clients and with groups in rebel-held areas that are working with people who are HIV-positive, Pronin estimated that the number of people infected with HIV in eastern Ukraine may have doubled.

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    Kristina Jovanovski/IRIN
    Oleg Pronin of local NGO, People Living With HIV believes the number of people infected with HIV in eastern Ukraine may have doubled

    Olga Rudneva, executive director of the Elena Franchuk ANTIAIDS Foundation, also believes new infections are on the rise.

    One reason may be that sex workers and fighters on the frontlines struggle to access condoms, which are either expensive or unavailable, said Rudneva.

    Some NGOs are supplying condoms to fighters, but Andriy Poshtaruk of the United Nations Population Fund warned that their efforts were not enough.

    “If you want [condom distribution] to be sustainable, we have to make sure it’s part of the government procurement system… unfortunately in Ukraine we still don’t have that system,” he told IRIN.

    Not only are fighters and sex workers at risk, but also the partners of fighters when they return home.

    “We are not isolated from each other… We think that the whole [of] Ukraine will be affected,” said Rudneva.

    Clinics closed and hospitals hit

    Another factor behind the likely increase in HIV infections is that many rehab centres have been closed down in rebel-held areas. With syringes either inaccessible or too expensive, drug addicts have resorted to reusing needles or sharing them. According to government statistics, about 70 percent of HIV infections in Ukraine were sexually transmitted in 2014 while transmission resulting from sharing needles accounted for most of the remaining 30 percent of infections.

    Worries about a rise in new infections come amid a breakdown in the health care system in eastern Ukraine due to the war. Some hospitals have been damaged by shelling, while many staff have left conflict-affected areas, making it more difficult for people to get tested or treated for HIV-related illnesses.

    “These are people with very weak immune systems… apart from ARVs (antiretrovirals) – a constant supply of ARVs that they have to take – they have to receive good overall health care,” said the UNFPA’s Poshtaruk.

    In one case, said Rudneva, a tuberculosis hospital in rebel-held Luhansk that was treating many HIV patients was hit during the fighting. Staff and patients were warned beforehand so they were able to leave, but no one knows where the patients have gone. Interruptions in TB or HIV treatment can lead to people developing drug-resistant strains of the disease that can then be passed on to others.

    Doctors in rebel-held territory are already dealing with an increased prevalence of drug-resistant TB, according to Pronin.

    War cuts down access

    At the start of the conflict in 2014, ARVs were only available in the city of Luhansk, which was inaccessible at the height of fighting. Although the drugs are now more widely available thanks to the efforts of NGOs and aid agencies, the disruption in treatment has caused lasting complications for many people.

    Evgeniy, who also preferred only to give his first name, had been living with HIV for 16 years and was getting ARVs in his hometown before rebels took over the area and the hospital closed down.

    “Nobody provides supplies there and [the] Russian federation doesn’t… ship medication to these areas,” he said.

    After contracting TB, Evgeniy decided to leave the rebel-held area in October 2015.

    Pronin said that while anti-retroviral drugs are more accessible in rebel-held areas now, there is a shortage of diagnostic equipment for measuring viral load and CD4 count, which are crucial for the provision of successful treatment.

    Pressure builds on government side

    Increased demand from HIV-positive patients who have fled rebel-held areas is now putting pressure on health services in government-controlled areas of eastern Ukraine.

    According to Rudneva, government funding to provide treatment and support to so many new patients is lacking.

    Oleksandr Yurchenko, head doctor at a Kiev hospital housing an HIV/AIDS centre, confirmed there was a shortage of government funding for ARVs last year, partly as a result of so many new patients arriving from rebel-held areas of the east. He said there was currently enough medicine to last for two months but no guarantees there would be enough in six months’ time.

    Mikhail is one of the lucky ones. Through the People Living with HIV NGO, he was able to get psychological help and restart substitution therapy for his drug addiction at a government-run centre in Sievierodonetsk, where he now lives. He said his health has improved and he’s gained some weight back. For those stuck in the rebel-held east, the outlook is not so good.

    “It’s hard to live in such conditions,” he said. “Half of the pharmacies are closed [and those that are open] don’t even have the most basic medication.”

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    How Ukraine’s war is driving up HIV infections
  • Ukraine's wounded warriors

    In addition to the 8,000 people who have lost their lives in the conflict in Ukraine, thousands more have come home with horrific injuries. The medical system was not prepared to handle the psychological effects of the war. The organisation Wounded Warrior Ukraine runs workshops in Kiev to help wounded veterans, volunteers and paramedics deal with the effects of the war.

    See the photo feature.

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    Ukraine's wounded warriors
  • Aid freeze promises hard winter in Ukraine

    At the end of May, we reported on the desperate situation facing civilians in eastern Ukraine, trapped near the frontline in rebel-held parts of the Luhansk and Donetsk regions with little or no access to basic services.

    See: The struggle for survival on Ukraine’s frontline

    Four months later, winter is approaching and another lifeline has just been taken away: 10 of the 11 international aid agencies operating in Luhansk were ordered out last week by the rebel authorities. In the rebel-held part of Donetsk, many operations had already been suspended for months.

    Separatist forces seized parts of the Donetsk and Luhansk regions in April 2014, months after Russian-backed president Viktor Yanukovych was driven from power by a popular uprising, which led Russia to annex Ukraine’s southern Crimea peninsula.

    We are extremely concerned about the wellbeing of the thousands of innocent civilians trapped in the crossfire of the conflict, especially with winter and its harsh conditions on the horizon

    Almost a year-and-a-half of war, which displaced more than 1.4 million people, has left hospitals in frontline areas short of essential supplies, while the elderly and the sick struggle to get by as they can’t access pensions or services provided by the Western-backed Ukrainian government. Many have been relying on aid from the Russian side or from a Ukrainian oligarch.

    “We have little supply from Ukraine… much of the food is coming from Russia,” Donetsk resident Natalya Chervinskaya told IRIN. “People are worrying that there will be a fall in supplies. The prices are getting higher and higher… prices are sometimes too high.”

    The Ukrainian government has also put limitations on commercial cargo entering rebel-held territory and restricted the movement of civilians, leading to long queues of vehicle and people at frontline checkpoints – including for aid agencies – and less stock in stores. 

    “Many people buy extra food as a result of the winter because people are afraid a little bit about food supply in the winter,” Chervinskaya said.

    In the winter months, people can’t rely on growing food in their fields while at the same time they need more calories due to the cold. Dwindling supplies will push prices at stores even higher while people will also need to spend more money on gas for heating, if they have that luxury.

    Organisations ordered out of the rebel-held side of Luhansk include UNICEF, the World Food Programme (WFP), UNHCR, Médecins Sans Frontières, People In Need and Mercy Corps.

    Shortages of medicines are a particular concern as chronic diseases like diabetes are prevalent among vulnerable groups of people still living in towns and villages near the frontline, many of whom are elderly.

    MSF said it had closed its offices in rebel-held Luhansk, where it supported 109 health and social facilities with medicines and equipment. It also ran mobile clinics in 35 locations and donated medicine and supplies to help treat up to 37,500 people.

    Several agencies and organisations expressed dismay at the rebel move, which comes after almost 8,000 people have been killed in almost 18 months of fighting.

    “We are deeply disappointed by the disruption to our operations and are extremely concerned about the wellbeing of the thousands of innocent civilians trapped in the crossfire of the conflict, especially with winter and its harsh conditions on the horizon,” Mercy Corps spokeswoman Lynn Hector said in a statement sent to IRIN.

    The UN’s refugee agency, UNHCR, said it had been working as normal in rebel-held Luhansk until last Wednesday and had received no prior warning it would have to stop its activities 48 hours later. 

    “We were told that our application to work in [Luhansk] had been rejected and that we would need to leave,” UNHCR spokesman William Spindler told IRIN. “We were given until Friday… and that was the case for many, many other agencies as well.”

    Of the 11 UN agencies and aid organisations operating in rebel-held Luhansk, only the International Committee of the Red Cross said it had not been ordered out. However, it did say it had suspended its activities there until it could get further clarity on the situation from the rebel authority, known as the Luhansk People’s Republic. Its operations in rebel-held Donetsk were also suspended at the start of August but resumed about a week ago.

    “Now, we’re not working (in Luhansk)… but we’re following all these administrative procedures and we’re hoping to resume soon,” Ashot Astabatsyan, ICRC’s spokesman in Ukraine, told IRIN.

    WFP and UNICEF said they had not worked in rebel-held Donetsk since the end of July and were still awaiting permission from the Donetsk People’s Republic (DPR). All the UN workers contacted by IRIN said they were not working in rebel-held Luhansk but that there was some confusion over whether a final decision had been made.

    UNICEF has suspended psychosocial support for 30,000 children. It estimates that 1.3 million people’s access to water is at risk and 200,000 children are more vulnerable to death or injury due to restrictions on landmine education. Some 500,000 children up to 10 years of age urgently need polio vaccination in rebel-held areas, and many of the 8,000 tuberculosis and HIV/AIDS patients will die unless medicine is provided, the UN agency said.

    WFP had been providing food assistance to about 45,000 people in rebel-held Luhansk. The emergency food provider says it had 20,000 food parcels ready to be sent to both Luhansk and Donetsk, but they are now on hold.

    There are fears too that the rebel authorities might start imposing greater bureaucratic hurdles on local NGOs, forcing them to increase their cooperation with the separatists.

    Olga Kosse, with Responsible Citizens, which provides food, health and household items to civilians on both sides of the frontline, said she was worried that if this is the case the Ukrainian government might not let her NGO work in the territory it controls because it would suspect her group of colluding with the enemy.

    “Now it’s really complicated to be neutral in this conflict. So if you for example work with DPR accreditation because you don’t have any choice… [it] seems like you work with terrorists. That’s why we are a little bit afraid about this.”

    Kosse also said it was impossible for local groups like Responsible Citizens to replace the work of some of the suspended international agencies because they have much smaller budgets.

    Responsible Citizens has one staff member in rebel-held Luhansk who is a local and can continue operating but is limited because the work was in cooperation with international agencies that have now been ordered out.

    Without the help of those agencies for the last two months in Donetsk, Kosse said many locals had been trying to figure out how to cope on their own. One community had been getting help rebuilding a school and several houses, but that aid has now stopped.

    “Because winter will now be very soon… these people are now thinking about how to do this by themselves, or find a new place where they can live, or how to rebuild their house, so that’s why they are really sad.”
     
    But not all are unhappy with the latest turn of events.

    Such is the level of suspicion that Kosse said many locals agree with the rebels’ decision because they believe the aid workers are spies.

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    How the aid freeze will hit Ukraine
  • Any such thing as a ‘safe’ country?

    At the same time as European Union nations consider opening their doors to more Syrian refugees, they are looking for ways to close them to asylum seekers from other countries.

    When home affairs and justice ministers gather for an emergency summit on the refugee crisis in Brussels next Monday, one item on the agenda again (they've been mulling it for years) will be the drawing-up of a common list of “safe countries of origin” (SCO) that would be applied to asylum seekers across the EU.

    According to the EU’s Asylum Procedures Directive, a member state can designate a country “safe” if it is generally free of persecution, indiscriminate violence and armed conflict (all EU states are automatically considered SCOs).

    Many EU countries already have their own SCO lists, which are used to help officials decide which asylum claims are less likely to be genuine and can therefore be fast-tracked or processed at borders. But SCO lists currently vary from one member state to the next, with a country like Senegal, for example, featuring on lists used by France and Germany, but not on those used by Britain and Belgium. A number of countries don’t make use of SCO lists at all.
     
    “The benefit of [a common] EU list would be to avoid one state being regarded as more attractive by asylum seekers, compared to other member states,” said Céline Bauloz, doctoral affiliate of the Refugee Law Initiative at London University.

    But critics of the idea warn that it would disadvantage many genuine asylum seekers. 

    The UN’s refugee agency, UNHCR, stresses that applications from safe countries should still be examined “individually on their merits”. But Bauloz said the reality is that the speed at which claims from SCOs are handled makes it very difficult for asylum seekers to prove their need for protection. 

    “In my view, an EU list will institutionalise further the practice of accelerated decisions which do not provide appropriate safeguards for asylum seekers to have their applications properly determined.”

    Ukraine’s rejected asylum seekers

    In the past year, violence in eastern Ukraine has claimed the lives of 7,000 people and left 16,000 more wounded, while five million are in need of humanitarian aid. 

    See: The struggle for survival on Ukraine’s frontline

    Yet Ukraine remains on SCO lists in Britain, Bulgaria and Luxembourg, despite the UN’s recommendations to remove it. Between April and June, out of the 76 Ukrainians who applied for asylum in Britain, only one was successful. 

    Anton did not feel safe in Ukraine. In 2014, he left his home in the war-ravaged city of Donetsk for Belgium, where he is awaiting a decision on his refugee status. 

    “Even though I think Ukraine is safe for most of the population, for some people it is definitely not safe,” Anton told IRIN. “I left because of threats and intimidation by pro-Russians because of my pro-Ukrainian active position. I was on many blacklists with all my information: my picture, my phone number, my address and links to my social media.” 

    He is hopeful his application will be successful in Belgium, which does not include Ukraine on its SCO list.

    Minorities persecuted in ‘safe’ countries 

    Countries in the western Balkans, including Serbia and Kosovo, are expected to feature on any common EU list. In 2014, asylum applications from western Balkan nations were second only to applications from Syrians in the EU, but were rarely recognised. The Balkan countries could be joined by places such as India, Georgia, Haiti, Algeria and Mongolia – nations that also have very low refugee recognition rates in most member states. 

    Germany, which receives by far the most asylum applications in the EU, is pushing for an EU-wide list of safe countries. Last year, it controversially added Serbia, Bosnia-Herzegovina and Macedonia to its own list of safe countries and German politicians are now keen to add three more – Albania, Kosovo and Montenegro.

    Germany has been inundated by asylum applications from the Balkan states. The president of the Federal Office for Migration and Refugees, Manfred Schmidt, recently told Der Spiegel that 40 per cent of Germany’s current asylum claims are from the Balkans. He pointed out that they are rarely recognised as refugees. 

    Most are fleeing hopelessness and poverty at home, but Marko Knudsen, a Roma activist based in Hamburg, said it is a mistake to assume all asylum applicants from those countries are economic migrants. Minorities such as the Roma community are often trying to escape systemic discrimination. 

    “Safe states can be safe for the majority of the community, but not for the Roma community. The situation of the Roma in the Balkans is even worse than [elsewhere] in Europe,” he said.

    The UK Lesbian and Gay Immigration Group represent another minority that is often penalised as a result of being from countries on SCO lists.

    “Nigeria, South Africa, Sierra Leone and Ghana are all countries where we have clients fleeing persecution because of who they are and who they love, yet they are all countries that are on the UK’s list of safe countries,” explained the group’s executive director, Paul Dillane.

    He believes an EU-wide SCO list would increase the risk of unfair refugee status decisions being made.

    “Every individual person has to be assessed on their own merits. If somebody says their life is at risk, then their claim deserves very serious assessment. SCO lists encourage generalisations.”

     James Hathaway, a leading authority on international refugee law from the University of Michigan, argues that the whole concept of SCO lists is wrong-headed.

    “Europe has been operating under a false impression that it is possible to designate an entire country as safe. There is no such thing as a safe country of origin. Every country in the world – Canada, the US, and the UK – has produced refugees.”

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    Fast-track deportation of asylum-seekers
    Fast-track deportation of asylum-seekers
  • Scars deepen for Ukraine's children

    Natasha is spending her summer break like any other teenager: hanging out with friends, playing at a youth club and arguing with her parents. But her situation is far from ordinary.

    In January, rockets fell on her neighbourhood in Mariupol in southeastern Ukraine during a rebel attack that Kiev says left 30 dead in the government-controlled city of 500,000.

    Fortunately for 15-year-old Natasha, she was in another part of town when the missiles hit, but when she returned home she still had to see the devastating effects of the bombardment.

    “After that episode, it was at least a week until I dared to go out into the street because I was scared to leave my home,” she told IRIN.

    Mariupol is a strategically important port that would give the pro-Russian fighters a land corridor from rebel-held territory through to the annexed peninsula of Crimea.

    Despite the supposed February ceasefire, recent fighting has been intense near the city, especially around the village of Shyrokyne. The conflict, which started in April 2014 when separatist rebels took over parts of eastern Ukraine, has led to more than 6,500 deaths.

    See: Unexpected aid in eastern Ukraine

    See: The struggle for survival on Ukraine’s frontline

    Natasha said she regularly hears shelling but has become so used to the sounds of war that she no longer jumps or looks out the window after every sudden burst of noise.

    The effects are more subtle now. She says the conflict has made her more irritable and her moods more erratic.

    ”I am very easily infuriated. Even small things that never used to bother me before make me shout at my family. Sometimes, I become aggressive with them.”


    ‘Everything will be fine’

    UNICEF launched a program at the end of last year to help children, like Natasha, caught up in Ukraine’s conflict. By partnering with schools and community centres, they offer psychosocial support, providing therapy through art, games and group discussion.

    It is only a first step. Children in need of more support are given in-depth psychological assistance.

    “This strategy has proven actually to be quite effective. It helps them to communicate and to open up… to basically alleviate their suffering,” UNICEF representative in Ukraine Giovanna Barberis told IRIN.

    The program has so far reached 30,000 children, but UNICEF estimates there are at least 100,000 in the Donetsk and Luhansk regions in need of support. A study by the UN agency found that 37 percent of children interviewed had been exposed to adverse or threatening events related to the conflict.

    In the outskirts of Mariupol, the program takes place in a former school in partnership with the Mariupol Youth Union, a drop-in centre that has been running for 15 years.

    The school, built in the first half of the 20th century, is in the middle of being renovated, but it was the best location in the city with enough space for all the children.

    Tiles are missing from the floor at the entrance, while new lockers stand in the hallway waiting to be unwrapped.

    In one room, psychologist Eugenia Stupnika gathers eight children around her, forming a circle while holding hands.

    They kneel down and start chanting, “Everything will be fine, everything will be fine, everything will be fine.”

    All at once, they leap up and shout, “Everything will be fine!”

    Children here don’t talk so much about usual kids’ stuff.

    “Now, there’s a whole different theme that emerged and children talk about war and conflict and they talk about who heard what kind of shelling,” Stupnika said.

     

    The influence of parents can create conflict among the children because they inherit their different political views and end up arguing.

    And on other occasions, the children have difficulty expressing themselves, struggling to socialise or be creative.

    To combat this, one game has children move around the room without opening their eyes. Once they bump into another child, the pair has to navigate together which improves team-building and communication skills.

    Stupnika says she can see a difference as early as the second week of the program. Children in one group started as complete strangers, but by their second meeting they were coming up with ideas together for art therapy, a completely new concept for them.


    Displaced children get added benefit

    A group of internally displaced teenagers was told to sketch creatures made up in their imaginations. One picture showed a red-and-black bat-like animal with its fangs showing.

    Parents just don’t feel like they need to talk to them since they weren’t directly affected… but it nevertheless causes kids stress.

    Sharp teeth and jagged features were dominant aspects of the drawings, representing aggression and a need to protect oneself, according to Mariupol project coordinator Katarina Dochkina.

    The centre is often visited by children who are internally displaced and do not have a settled social circle to fall back on. The group dynamic of the program is especially valuable for them.

    “They left everything behind. Some of them moved just with their mothers, some just with their grandparents,” said Dochkina.

    According to the Ministry of Social Policy, 168,019 children were internally displaced in Ukraine as of June.

    Just because children are living at home with their families it doesn’t necessarily mean they are getting the proper support. Some parents feel that if their child hasn’t been close to the frontline, no discussion about their psychological or social well-being is necessary.

    “Parents just don’t feel like they need to talk to them since they weren’t directly affected… but it nevertheless causes kids stress,” said Stupkina.

    During one meeting, a child said her favourite thing about the day was that she was able to talk about war and peace even though she had not seen shelling.

    Some parents are too afraid to bring up the conflict with their children. Because of this, the program conducts field visits to families up to 10 kilometers from the frontlines, helping them learn how to talk to their kids.

    UNICEF is also training psychologists, social workers and teachers to be able to spot the signs of stress in children. Parents and NGOs have responded with increasing interest, said Barberis. “The demand is definitely growing.”

    Fuelling demand is the ongoing violence, which has increased since an initial lull in fighting following the February ceasefire. Central parts of Donetsk city were shelled on Saturday for the first time since the agreement, killing one person. Both sides blamed each other.

    With the ebbs and flows of the conflict, children like Natasha in Mariupol do not want to think too much about their future, knowing it is in constant limbo.

    Natasha’s family is making plans to leave the city if the situation gets worse – what to bring and where to go.

    She dreams of becoming a teacher, but without knowing if her hometown will be safe in years to come, she doesn’t know where she will go to university.

    Only if, and when, her family resettles can she begin to think more concretely about her future.

    “It is really very uncertain here, nobody plans anything.”

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    Scars deepen for Ukraine's children
  • Crisis Brief: Unexpected aid in eastern Ukraine

    As our special report outlined in May, civilians in rebel-held eastern Ukraine are cut off from government-controlled territory and have highly restricted access to goods, basic services and cash. 

    This new IRIN/HPG Crisis Brief finds that the limited aid that does reach those in need often comes from unusual sources. A Ukrainian oligarch with an anti-separatist past is helping to keep hundreds of thousands of people in rebel-held areas alive, while aid from across the Russian border is supporting soup kitchens, hospitals and schools. This assistance may be highly politicised, but what are the alternatives and are traditional aid delivery mechanisms lagging behind?

    Read: The IRIN/HPG Crisis Brief to find out more

    Produced jointly by IRIN and the Overseas Development Institute’s Humanitarian Policy Group (HPG), Crisis Briefs combine field reporting with research to address critical issues in the world’s most urgent crises. Our pilot briefing – about aid in areas of Iraq controlled by self-declared Islamic State – can be found here.

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    Unexpected aid in eastern Ukraine
  • Ukraine tightens restrictions on rebel-held east

    Galina Vodzinskaya, 60, has been walking for five kilometers in 27 degrees Celsius weather in eastern Ukraine but is nowhere near done her journey.

    She used to travel by bus for this monthly trip from her home in rebel-held Horlivka to the government-controlled town of Artemivsk for supplies, including the bag of meat she is carrying, but public transport is now suspended.

    Instead, she has up to five travel legs, from taxis to private cars – whatever she can get – then walks part of the way through a government checkpoint, where she lines up amid dozens – if not hundreds – of queued cars and piles of garbage strewn along the road. Some people wait 10 hours or more at checkpoints in the summer heat without access to water or washroom facilities. 

    “Three days ago… there was a crazy queue, just crazy,” she says. “Why is it so difficult?”

    The situation is so bad that the International Committee of the Red Cross is planning to provide water and other services for civilians waiting in the long lines at checkpoints.

    Tank tracks are imprinted on the road, a reminder of a conflict that has killed 6,500 people since it broke out in April 2014 when pro-Russian rebels took over parts of eastern Ukraine following Moscow’s annexation of the southern peninsula of Crimea. 

    In mid-June, Ukrainian security services issued an order prohibiting public transportation into and out of rebel-held territory, which has complicated travel for people crossing the frontline in search of supplies and services that are much more expensive, or altogether non-existent, on the rebel side (See IRIN’s longread on conditions in the rebel-held areas).

    In what critics call yet another move in a blockade on rebel-held regions, the government also blocked commercial cargo from entering rebel-held Ukraine at any of the six official road checkpoints. This has slowed the delivery of basic goods – including food – for the last three weeks. 

     

    The government says it is trying to prevent “terrorists and their accomplices” from leaving the conflict zone and to protect civilians. In January, 13 people in a passenger bus were killed when a government checkpoint came under attack.

    These two orders follow a previous order in January, which required people entering or leaving rebel-held areas to apply for a special permit, a system that has limited people’s ability to access humanitarian aid and leave the conflict zone, according to the Organization for Security and Co-operation in Europe (OSCE).   

    Congested checkpoints 

    Last month, a popular crossing point near the town of Maryinka was closed after a battle there that saw some of the fiercest fighting since February, when a ceasefire agreement was reached (violence has continued since). 

    That closure has added to the congestion at remaining checkpoints - with hundreds of cars lining up on a daily basis as early as at 4am. On one side of the Horlivka government checkpoint, the driver of a white van and a Ukrainian guard yell at each other over paperwork as frustration boils over.

    Without buses, many people have to use taxis, which are not only expensive but add yet more traffic to the checkpoints. Since many drivers do not have the special permits required, some riders have to get out of the taxi, walk across the checkpoint, and hire another taxi on the other side. 

    “Civilians have to go often long distances with a lot of luggage [they themselves are] carrying physically across the contact line because of these restrictions in place,” the deputy chief of the Special Monitoring Mission of the OSCE, Alexander Hug, told IRIN. 

    Hitching a ride 

    At the checkpoint, Aram Gugasyan stands by the side of the road with food and supplies, his thumb pointed up in search of a ride. 

    He normally takes his car when he makes the trip between government-held Kramatorsk where he works and rebel-held Donetsk where his wife lives with their young children. But queuing at the checkpoint in his car took too long. Now he hails taxis or other cars passing by. 

    “[The trip] has become worse and worse… it’s much more expensive now.” The car he is trying to flag down will be the third vehicle he uses on this trip. The ride, which normally takes an hour and a half one-way, now takes about four hours – more if he’s unlucky.

    Monitors have seen up to 800 cars lined up at government checkpoints; and at one checkpoint, they noted that 20 percent of civilians attempted to cross without a valid permit and were refused passage. 

    There are some exceptions to the new rules: joint transportation can be used to take internally displaced people fleeing the conflict across the frontline; humanitarian agencies can bring supplies in; and amid both confusion about rules and alleged bribery, commercial cargo is at times let in on an ad-hoc basis.

    “[Authorities] decide what the destination and purpose of the cargo is. If documents are indeed not false and [are] legal, the cargo is let through. Otherwise, it’s stopped and seized,” Ukrainian military spokesman Andriy Lysenko told IRIN. 

    Aid delivery affected

    But the orders have complicated aid delivery, Only one checkpoint can now accommodate humanitarian trucks; and it has some of the longest line-ups and is sometimes closed.

    The UN’s World Food Programme (WFP), which was not able to bring in any aid for two weeks in early June due to an increase in fighting and the related closure in the Maryinka checkpoint, is now facing additional delays in distributions. 

    “We’ve already been affected because we are not able to move in the amount of food we would like to put in and this will [increase] if the situation remains,” said Giancarlo Stopponi, head of WFP’s office in Ukraine. 

    WFP is facing higher needs as an increasing number of internally displaced people return to their homes in rebel-held areas, where many can no longer afford the higher food prices. This month, the agency plans to assess food security, including the availability of food at markets. 

    Food stocks running low

    The ban on the travel of commercial goods is likely to increase pressure on aid agencies to deliver food, which is already running low.

    “There is two times less meat than there used to be and three times less [dairy] products,” Babenko Yevgeniya, a manager with the Amstor chain of supermarkets, which has 14 locations in rebel-held Donetsk region, told IRIN.

    Suppliers from government-controlled areas have not delivered anything in the last month so the company is now relying on local suppliers and shipments from Russia. The only way to get through from government-controlled areas, Yevgeniya said, is for drivers to pay bribes to Ukrainian guards.

    Now, she stocks her shelves with whatever products she has: Boxes of tea fill one side of an aisle; water bottles fill the shelves that cheese used to occupy; bags of chips and beach toys lay where packets of meat once were. 

    If documents are indeed not false and are legal, the cargo is let through. Otherwise, it's stopped and seized. 
    Yevgeniya says she also faces major problems trying to import non-food products like school supplies for students. 

    Prices have already doubled in rebel-held regions but the new orders will further limit supplies and push prices even higher.

    The rebel-held region had already been isolated by the withdrawal of state services including the funding of hospitals and schools, forcing citizens to pick up pensions and benefits in government-controlled towns.

    "Green corridor" for aid agencies 

    Still, there are some promising signs. Last month, the Prime Minister of Ukraine Arseniy Yatsenyuk met with aid agencies regarding the humanitarian situation in the east and promised a "green corridor" and to simplify procedures for allowing aid to get through.

    But the restrictions on civilians and cargo already in place are increasingly angering locals who have been caught in a conflict which, according to the UN, has seen indiscriminate shelling in residential areas on both sides of the frontline. 

    Back at the government checkpoint, Vodzinskaya complains that despite decades working at a telecommunications company, she now has to make these long journeys just to get her pension.

    Her voice shakes and her lips quiver as she talks about not wanting to leave her home. But for now, her first concern is how to get there, unsure if she will be able to grab a bus or hail a taxi once she passes the checkpoint.

    “Ukraine is against us,” she says. “I was working 40 years for Ukraine and now they don’t need me.”

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  • EU toughens stance on migrant returns

    More than 125,000 migrants and asylum-seekers have crossed the Mediterranean so far this year, all carrying the hope that they will be able to start new lives in Europe. Many more will have arrived by other means using forged documents or will have overstayed on their visas.

    Those from countries subject to conflict or severe human rights abuses such as Syria and Eritrea have a good chance of being able to remain in the European Union as refugees. But the majority will be classified as irregular migrants who, in theory, can be returned to their home countries. 

    In practice, many member states lack the capacity to round up and return thousands of undocumented migrants and failed asylum-seekers to home countries that are often reluctant to receive them.

    In 2014, more than half a million third-country nationals were found to be “illegally present” in the EU. The vast majority were issued with so-called return decisions ordering them to leave within a prescribed period. Those who didn’t comply were supposed to be removed by force, but in reality only about 40 percent were, according to Eurostat figures.

    In some countries, the percentage was considerably lower. Italy, for example, only returned 5,310 irregular migrants in 2014, despite being the most popular landing point for migrants arriving by sea. By contrast, the UK returned 46,610 migrants - 71 percent of the total number of people it issued with return decisions.

    Faced with increasing chaos at its borders, the EU Commission is urging member states to take a tougher stance on returns. Draft conclusions from Thursday’s EU summit in Brussels note that “all tools shall be mobilised to promote readmission of illegal migrants to countries of origin and transit,” and that an increased budget will be made available to support more effective returns.

    In a 9 June letter to interior ministers, EU Home Affairs Commissioner Dimitris Avramopoulos pointed out that, “Economic migrants pay high prices to smugglers to bring them to Europe… knowing that once they are in the EU they have a good chance to stay here, even if they are ordered to leave.”

    In an effort to increase return rates, Avramopoulos urged EU leaders to make use of “coercive measures,” including the use of detention to prevent migrants absconding before they can be returned.

    Increased use of detention 

    He called on countries confronted with large numbers of arrivals to take advantage of an emergency clause of the EU Return Directive that allows irregular migrants, including families with children, to be detained in prisons rather than in separate immigration detention facilities, for up to 18 months.
    Italy is the only country that has ever applied the emergency clause, during the influx of migrants and asylum-seekers to Lampedusa Island as a result of the Arab Spring in 2011.

    The detention of migrants, including minors, for longer periods in prison settings would be viewed as a major retrograde step by rights groups, who have long campaigned for an end to immigration detention altogether. Not only, they argue, does it have negative effects on those detained, particularly children, but there are also more humane alternatives that would cost the taxpayer less.

    “I think it represents a hardening of attitudes as part of a general concern about trying to manage the big increase in numbers,” Steve Peers, a law professor at the University of Essex, told IRIN.

    Forced fingerprinting

    Writing for the UK non-profit website Statewatch, Peers pointed out that the EU Commission also recently published a paper providing guidelines for the use of force – as a last resort – on migrants who refuse to be fingerprinted.

    “To say the least, this is hard to square with the EU’s frequent professions of support for the human rights and decent treatment of migrants,” he wrote.

    The issue of fingerprinting and identifying migrants on arrival is crucial to improving return rates, noted Avramopoulos in his letter. It is also central to the soon-to-be launched “Hotspot” approach outlined in the European Agenda on Migration, which will see the European Asylum Support Office, Europol and Frontex deploying staff to frontline states, Greece and Italy, to assist with the screening and identification of new arrivals.

    Faced with record numbers of boat arrivals in the past year, Greece and Italy have been accused of neglecting to register and fingerprint large numbers of migrants who have then proceeded north through Europe’s border-free Schengen zone to countries such as France and Germany. Under the EU’s Dublin Regulation, asylum-seekers can be returned to the first member state where they were registered, but without fingerprint records such returns are impossible.

    EU leaders are expected to reach a decision about a deal to relocate 40,000 asylum-seekers from Greece and Italy to other member states by the end of July. Key to the agreement will be a commitment by the two frontline states to implement the Hotspot approach and fingerprint all new arrivals.  

    “In a way it undercuts the relocation process because it could mean that more [asylum-seekers] will end up in Italy,” said Peers, adding that Greece has remained exempt from returns under the Dublin Regulation because of the poor state of its asylum system and detention conditions.

    Return agreements with third countries

    Other measures aimed at improving return rates include amending the role of EU border agency Frontex so it can initiate return operations. Currently, Frontex is limited to coordinating returns after being approached by member states. 

    The EU also plans to offer various incentives such as trade agreements and development aid to persuade countries of origin, particularly those in North and Sub-Saharan Africa, to take back their citizens through readmission agreements.

    Avramopoulos described the EU’s eastern flank as “well-covered” by such agreements with Russia, Ukraine, Turkey and nations in the Western Balkans, but pointed out that “the EU has no readmission agreements in force with the North African countries,” although, “not for lack of trying.”

    While discussions about migration at Thursday’s EU Summit focused on how to improve return rates, rights groups and NGOs called on EU leaders to rethink policies that are failing to provide protection and adequate reception facilities to large numbers of asylum-seekers and vulnerable migrants. 

    Referring to “a crisis of human suffering” at EU borders, Médecins Sans Frontières (MSF) accused member states of neglecting their humanitarian duty.

    “The current system, which includes the Dublin Regulation, is clearly not working. Returning vulnerable people to Italy under the Dublin Regulation should immediately be suspended,” said Loris de Filippi, president of MSF Italy. 

    “Urgent action should be taken to allow asylum-seekers entering through EU’s southern borders to get the assistance and protection they are entitled to according to EU directives.”

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    EU toughens stance on migrant returns
  • The struggle for survival across Ukraine's frontline

    The 13-month conflict between government forces and pro-Russian separatist rebels in eastern Ukraine has claimed more than 6,300 lives, displaced 1.3 million people and left hundreds of thousands in need of urgent food aid. Despite a February ceasefire, the fighting hasn't stopped.

    In March and April, Kristina Jovanovski had rare access to rebel-held areas to investigate the humanitarian disaster that has unfolded on Europe's doorstep. Click here for our exclusive report on why aid isn't getting through.


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    Surviving across Ukraine's frontline
  • Cost of clinical trials worries donors

    The more medical successes there are, the more it costs to find the next one, prompting donors to demand more from researchers carrying out large-scale trials of drugs, vaccines and global health impacts.

    “As a funder, I hate clinical trial applications,” said Jimmy Whitworth, head of international activities at the science funding division of UK-based Wellcome Trust, which finances health research.

    Clinical trial costs have spiralled in recent years - one recent report estimated a 70 percent cost rise per patient between 2008 and 2011 - but without sound evidence of beneficial medicinal effect, regulatory agencies will not approve.

    A clinical drug trial can take up to 12 years, enrol thousands of participants across continents, and cost from as much as US$1.3 billion to nearly $12 billion for each new drug before it is approved for public use.

    And the costs keep climbing. “We need other ways of funding that are more flexible, quicker,” said Geoff Garnett, deputy director of the HIV Department at the US-based Bill & Melinda Gates Foundation.

    “I think a lot of what we should be doing is public health trials rather than clinical trials,” Garnett commented. “If we bog down our public health trials with clinical trial requirements, then we miss out on some of the important behavioural and organizational interventions that make clinical care and prevention work much better.”

    Why so costly?

    A greater number of participants must be tested in more settings, including those living where reports of a particular disease are falling, to determine whether improvements are the result of the proposed intervention or are being produced by existing ones.

    Bloated trials mean more researchers, institutes and funders, which in turn increases regulatory requirements.

    “The reality is, trials are getting steadily larger and more expensive… regulation is becoming ever more complicated,” said Chris Witty, research director at the UK Department for International Development (DFID). “We’re paying more and more for less and less.”

    Too ambitious

    As researchers compete for dwindling research and development dollars, donors criticize overly ambitious proposals.

    “The timetables are often extremely optimistic, so there is a real problem in that funding may run out before the research question is actually answered, said the Wellcome Trust’s Whitworth. “Frankly, very often clinical trials don’t look great value for money.”

    HIV research has tended to carry out trials in the most expensive way, Witty said, noting that researchers often make poor correlations between cost and the potential impact of a study.

    Donors and researchers are looking at partnerships and other ways to bring down costs, including “adaptive testing”, which uses real-time data to modify an ongoing trial.

    New funding

    In 2010, the Bill & Melinda Gates Foundation pledged $10 billion to research and develop vaccines for some of the world’s poorest countries and its grants database shows more than $70 million going to clinical trials since 2004.

    In the UK, the Wellcome Trust, the Medical Research Council (MRC) and DFID have committed $57 million to fund late-stage trials of interventions in cash-strapped countries.

    “Give us the evidence,” said Wendy Ewart, deputy chief executive and director of strategy at MRC. “Make the case for future funding.”

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    Cost of clinical trials worries donors

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