Wars may vary in terms of tactics, warring states, weapons and the like, but one thing remains universal in all of them: human suffering. In a recent article published in this journal, the authors rightfully called that “infectious diseases and war are maleficent comrades.” ^{Reference Vuorio, Sajantila, Kovanen and Budowle1} This reality applies to the ongoing war in Ukraine and the current coronavirus disease (COVID-19) pandemic. The author agrees that COVID-19 is a significant contributor to mortality in the setting of the conflict in Ukraine and population displacement but proposes differing priorities for humanitarian interventions, moving away from an emphasis on the effects of the COVID-19 pandemic. The world is indeed facing a huge humanitarian and refugee crisis coupled with the COVID-19 pandemic. A year after Russia’s full-scale invasion of Ukraine on February 24, 2022, to February 27, 2023, the Office of the United Nations High Commissioner for Human Rights (OHCHR) recorded 21 580 civilian casualties in the country: 8101 killed and 13 479 injured. This included a total of 8101 killed (3584 men, 2127 women, 256 boys, and 201 girls, as well as 31 children and 1902 adults whose sex is not yet known) and a total of 13 479 injured (3536 men, 2421 women, 398 boys, and 293 girls, as well as 271 children and 6560 adults whose sex is not yet known). ² Russian deaths in the first year of its war on Ukraine have now exceeded the combined death toll of all its wars since World War II (WWII), according to new research from the Center for Strategic and International Studies (CSIS). CSIS tallies the number of Russians killed or missing in Ukraine since last February at between 60 000 and 70 000, a figure that tracks with recent United Kingdom intelligence. ^{Reference Jones, McCabe and Palmer3} Overall, Russia has suffered roughly 200 000 to 250 000 total casualties—personnel wounded, killed, and missing—during the first year of the war. ^{Reference Jones, McCabe and Palmer3}

The human suffering that has been caused by war in Ukraine is beyond human comprehension. First, one must revisit the most urgent need of the people in need of humanitarian assistance and disaster medicine in war-torn areas. For humanitarian aid organizations and multilateral agencies, the situation requires a similarly unprecedented speed and magnitude of response. The United Nations (UN) states that the humanitarian situation in Ukraine deteriorated drastically and rapidly in 2022, after Russia’s invasion dramatically escalated 8 years of conflict into a full-scale war. ⁴ The main impediments preventing refugees from returning are safety and security concerns in their areas of origin. Other concerns cited are about access to and availability of basic services, including electricity, water and health care, work opportunities, and adequate housing, all of which have been hugely impacted by the war. ⁴

Second, we must think about the long-term global impact of this humanitarian crisis. The humanitarian crisis in Ukraine is a global problem. According to the UN refugee agency, more than 13 million people, or nearly a third of Ukraine’s prewar population, have been displaced since the invasion. Of those, more than 5 million are internally displaced, whereas over 8 million are refugees living in neighboring countries. ⁵ The war in Ukraine is an ongoing humanitarian crisis given the unimaginable destructions of infrastructures and services that directly impact the well-being of human lives. While the world hopes for a peaceful resolution of this attack against the dignity of the human person, it has been heartening to see the responses of the international community to the humanitarian crisis and the desire to help those in need. A special emphasis on the protection of the vulnerable population should be in place.

Lastly, the mental, physical, and emotional well-being of people must be at the top of our humanitarian interventions in the context of disaster medicine. The long-term impacts of war are both physical and emotional. Death, injury, sexual violence, malnutrition, and disability are the most life-threatening effects of war, whereas posttraumatic disorder, anxiety, and depression are some of the emotional effects of war. ^{Reference Corpuz6} The availability of mental health and psychosocial support for victims of war is crucial in humanitarian interventions. For frontline mental health workers, there are 2 crucial phases of early support. The first is the most directly comparable to conventional, physical first aid. It is a triage of people who need to speak to someone just to clam down. Second is the immediate psychosocial first aid to treat the emotional trauma caused by war. However, many war victims have no access to both medical and psychosocial interventions and are caught beyond functional supply lines, and some of the surrounding countries that are hosting Ukrainian refugees have already depleted their medical supplies. ^{Reference Corpuz6}

In conclusion, this letter highlights the myriad of effects that the conflict in Ukraine has had on the world population, ranging from mortality to medical and psychological problems. The humanitarian catastrophe is the worst refugee crisis since WWII. The psychosocial and mental health needs of Ukrainians should be among the most urgent concerns in the context of humanitarian intervention. One needs to take a proactive measure to prevent a psychosocial crisis caused by war.