Risk Communication and Community Engagement in Action During Ukraine's War

"Lessons learned from the response in Ukraine's surrounding countries clearly highlight that community engagement is at the core of greater acceptance and uptake of health protective measures and of social cohesion."

In emergency situations such as war, risk communication and community engagement (RCCE) entails working together with the community in order to co-design behavioural, social, and public health solutions that are tailored to their evolving needs and risk perceptions. Both in preparedness and response, trust is a central factor to RCCE, which involves, in part, providing actionable, timely, and credible health information online and offline. In the context of the war in Ukraine, the World Health Organization (WHO) Regional Office for Europe attributed a critical role to RCCE within the response plan in Ukraine and surrounding countries. This short paper describes the effort to roll out a strong RCCE response in refugee-receiving countries.

As detailed here, the Communication Pillar of the Ukraine's emergency Incident Management Support Team (IMST) prioritised strengthening RCCE capacities in the WHO country offices of the Czech Republic, Hungary, Poland, the Republic of Moldova, Romania, and Slovakia. They began by conducting an RCCE rapid needs assessment across the countries in the initial weeks of the war to understand the health needs, perceptions, and concerns reported by Ukrainian refugees, along with capacity of each country to respond to these needs while maintaining social cohesion. Interview guides were designed to support 15 focus groups discussions and 71 interviews with civil society organisations (CSOs), governmental figures, key leaders, refugees, and host communities. This situational analysis led to objectives prioritisation.

Although there were some discrepancies in the findings between different countries, this report highlights some common themes. For example, all the ministries of health in the host countries posted health information on their governmental websites. The refugees were not always aware of these efforts; thus, accessing health information is a challenge for many. Based on the findings, the goal across all the countries was to support Ministries' of Health RCCE efforts to encourage Ukrainian refugees to access health services, based on their needs and concerns. Four main objectives were identified: (i) strengthen trust between refugees, host population, and health authorities; (ii) support refugees to access health services; (iii) promote healthy behaviours among refugees and host population; and (iv) strengthen community readiness and resilience. Strategic plan pillars included:

The RCCE plan relied on three main success factors:

1. Drivers related to behaviour change: "In a situation of extreme confusion and anxiety as that of Ukrainian refugees fleeing the war, receiving clear information is vital. This will improve refugees' ability to navigate and access the new system for prevention and treatment, as well as give them a sense of orientation and belonging, thus increasing their well-being. Theoretical crisis models recommend that it is essential to comprehend public views; yet, little is understood about the intricate interactions between health seeking behaviour and the numerous elements that influence persons escaping war..."
2. Human interactions at the core of behavioural change: "While Information, Education, Communication (IEC) materials are a useful support tool, it is the direct engagement with affected communities and stakeholders that can make a difference in terms of behavioural change and perceived support. The role of local authorities, civil society organizations, and community workers is critical to this objective. They have the outreach, the trust, and the capacity to engage focus audiences based on their interest and concerns."
3. Balanced approach to the needs of both resident and refugee populations: "With the large influx of refugees, it is critical to act and communicate in a way that recognizes and addresses the needs of both residents and refugees. While the host community has been very open to welcoming refugees and caring for them, some negative sentiment is growing that refugees might take away resources from residents and hamper access to health and other services. Balanced interventions will contribute to social cohesion and will increase trust in the government and the Ministry of Health."

"RCCE interventions are only effective if they respond to the community needs and reflect its context and culture." In order to support the exchange of best practices and learnings such as this one, WHO created a platform to link CSOs to policymakers and engaged CSOs in message testing, co-designing of interventions, and monitoring and evaluation processes to enhance the participatory approach and leverage the structures, systems, and skills of local community organisations. Recommended interventions for others undertaking RCCE in emergency contexts include:

• Strengthening risk communications interventions: Coordination with non-state actors is crucial, as "[t]he partnership between health authorities and CSOs allows community voices, context, culture and concerns to be heard at the governmental level." As suggested here, a community listening system should be created to ensure regular two-way communication with both the host and the Ukrainian communities. Relatedly, behavioural and social insights research should be undertaken to inform action plans. Finally, a deployment strategy for health information produced by the government and non-state actors should be developed.
• Promoting healthy behaviours: For example, vaccination promotion campaigns that reach both residents and refugees should be conducted.
• Informing refugees about the continuity of care: A key strategy for decreasing burden of diseases at an early stage is engaging health workers, CSOs, and volunteers in efforts to communicate transparently to refugees about what health services the country offers.
• Anticipating mental health needs: Refugees, especially children, said they were open to psychosocial support. Due to a limited available number of licensed psychologists and psychotherapists, a pool of social workers should be trained and health workers engaged to detect and address signs of mental health impacts in refugees and colleagues.

It is hoped that the outcomes of the RCCE plans detailed in the paper will contribute to better access to health information and health services, an increase in vaccination rates (routine immunisation and COVID-19), better social cohesion, and enhanced mental health status among Ukrainian refugees. Looking ahead, research should be undertaken on the impact of such strategies on the health profile of the refugees.