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Journal Article

Citation

McKee M, Nagyova I. Eur. J. Public Health 2022; 32(4): 517-518.

Copyright

(Copyright © 2022, Oxford University Press)

DOI

10.1093/eurpub/ckac090

PMID

35913795

Abstract

The Ukrainian people have suffered enormously from illegal aggression by Russia, whose forces have devastated large parts of the country and committed numerous war crimes.1 We may never know how many have been killed but it is certainly in the tens of thousands. Many more will be left with life-changing injuries, both physical and mental. Even larger numbers have left Ukraine, moving westwards to seek sanctuary or, worryingly, in forced deportations to Russia. Colossal damage has been caused by Russian targeting of essential infrastructure, including hundreds of health facilities, and by indiscriminate shelling of urban areas. But some day, hopefully soon, the war will be over and the task of reconstruction will begin.

The cost will be enormous. In early May 2022, President Zelensky suggested a figure of $600 billion. By now, we can assume it will be much higher. And it will take years. There will be many demands on the Ukrainian authorities so it will be necessary to prioritize. While the decisions about what to prioritize will, rightly, be a matter for the Ukrainian government, we can identify several lessons from other conflicts in recent decades.

The first is the need for a robust system of governance. Unfortunately, as a recent systematic review revealed, this is an issue that has received far too little attention in recent conflicts.2 Yet there are lessons from the research that exists, including the crucial importance of coordination (often complicated by competition among donors and recipients), the recognition of power imbalances and the importance of understanding context. The need for robust governance systems was apparent in post-invasion Iraq. As was the case there, the recovery effort in Ukraine will act as a magnet for unscrupulous companies and individuals. Ukraine has made considerable progress since 2014 in tackling what was pervasive corruption. However, the vast sums of money involved and the imperative to move quickly will place the safeguards that have been created under pressure, just as was seen with the scandals when some western countries purchased often useless supplies at vastly inflated prices during the coronavirus disease 2019 pandemic.3 The principles of public procurement are clear, including transparency and value for money. Urgency is not an excuse to set them aside...


Language: en

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