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Refugees from Ukraine, which has a high rate of tuberculosis, are often screened for the disease. Above: Dr. Natalie Whrle analyzes the X-ray images of the lungs from a screening in Gauting, Germany, on March 12. Matthias Balk/picture alliance via Getty Images hide caption

Refugees from Ukraine, which has a high rate of tuberculosis, are often screened for the disease. Above: Dr. Natalie Whrle analyzes the X-ray images of the lungs from a screening in Gauting, Germany, on March 12.

"We have 20 patients we can't find, so we don't know if they are alive or not," says Dr. Olha Konstantynovska.

She's referring to the tuberculosis patients under her care in Kharkiv, where, as in much of Ukraine, the Russian war has disrupted lives including her own. She and her three daughters evacuated to her father's home about 20 miles away after a bomb hit a building down the street from their apartment.

Before she evacuated from Kharkiv because of Russian attacks on the city, Dr. Olha Konstantynovska treated tuberculosis patients at local hospitals. Olha Konstantynovska hide caption

Before she evacuated from Kharkiv because of Russian attacks on the city, Dr. Olha Konstantynovska treated tuberculosis patients at local hospitals.

TB a serious bacterial infection of the lungs is a big problem in Ukraine. According to the World Health Organization, the country has the fourth highest incidence of the disease in Europe. And it has one of the highest rates of multidrug resistant TB anywhere in the world.

In the tuberculosis hospital in Kharkiv, where Konstantynovska treats TB patients, about 70 of the 200 residential beds are filled. That's because at the beginning of the war, her team discharged as many people as possible to allow them to evacuate.

"I called to the hospital to speak with one doctor and she said that hospital has no potato and bread," says Konstantynovska. "We have drugs, but we have no food."

She says that before the war, "people from the whole city of Kharkiv two and a half million citizens [went] to this dispensary to be checked for tuberculosis." It's also where those with TB could receive medication, treatment and even surgery if necessary. Konstantynovska is a member of the small army of people in Ukraine who've mounted a stiff resistance against the disease, one that's been supported by the government.

But now, Konstantynovska says doctors are having a hard time getting to the hospital in Kharkiv. It's too dangerous to move about outside, and the roads are ravaged. One of the physicians walks a total of three hours each day to get to and from work. The head of a local dispensary is living in her office because her apartment was destroyed.

The view from inside the apartment of Dr. Tetiana Synenko, a TB specialist in Kharkiv, and a glimpse of the wreckage on her way to work. She's now living with 12 others in a nearby cellar. Tetiana Synenko hide caption

The view from inside the apartment of Dr. Tetiana Synenko, a TB specialist in Kharkiv, and a glimpse of the wreckage on her way to work. She's now living with 12 others in a nearby cellar.

Without intervention, people can live with tuberculosis and spread it, through the air for years. At some point, however, usually due to the stresses of hunger and injury; or a weakened immune system, it can turn fatal. Treatment consists of an antibiotics regimen that takes anywhere from six months to two years.

The contagiousness of TB is why Konstantynovska is especially worried about those missing patients. If they're on the move, she says, they're taking their TB with them, giving the disease more opportunities to spread through the air. "Eleven patients right now are in other regions of Ukraine," she adds. "They are trying to find the drugs because they stop[ped] treatment two weeks ago."

Interrupting an antibiotic regimen aimed at TB is worrisome for two reasons. First, drugs prevent someone from infecting others. So without meds, the disease has more opportunities to spread. And second, TB can become insensitive to the drugs if they're not taken regularly because insufficient dosing gives the tuberculosis bacteria time to mutate, selecting for populations of the bug that can dodge the meds. This is called multidrug resistant tuberculosis.

There's even extensively drug-resistant TB when the bacteria don't respond to the first or second lines of drugs. And once that form of resistant TB emerges, it can be passed from person to person, transmitted through the air just like regular TB. In 2020, a third of Ukraine's TB cases were drug-resistant, one of the highest rates in the world. And that number is likely to grow.

That's why Loyce Pace, the assistant secretary for global affairs at the U.S. Department of Health and Human Services, says her office is coordinating with the CDC and USAID "to track patients [within and beyond Ukraine] to understand where they are, what they need in terms of their meds and ensure that there's no gap."

To understand why Ukraine has so many TB cases, we need to rewind a hundred years.

For much of the twentieth century, when Ukraine was a republic of the former Soviet Union, tuberculosis was managed rather well, according to Tom Nicholson, executive director of the non-profit Advanced Access and Delivery. "The medical care system was quite comprehensive and was based on community medicine," he says. "It had a system of rural health posts, even in the most far-flung areas." There may not have been doctors on-site, but there were often nurses and medical technicians who could do a chest X-ray to screen for TB and dispense drugs to treat it.

The situation deteriorated with the collapse of the former Soviet Union in 1991. The economy in its republics tanked. Unemployment soared. Crime escalated, which sent a lot of people to prison. And that created a kind of "epidemiological pump," says Dr. Salmaan Keshavjee, director of the Center for Global Health Delivery at Harvard Medical School.

"Some people had TB," he explains. "It spread in the jails and in the prisons. And then they went back to their community, of course, when they were released. So the TB also went back to the communities." Tuberculosis rates soared, he says, including in some parts of Ukraine, which regained independence that same year.

During his work at a prison in Tomsk, Russia, Dr. Salmaan Keshavjee received this honey pot carved out of wood by a few of the prisoners. "It has a lot of meaning because this is where we showed that it was possible to bring [TB] mortality down close to zero if you got people the right treatment," he says. Salmaan Keshavjee hide caption

During his work at a prison in Tomsk, Russia, Dr. Salmaan Keshavjee received this honey pot carved out of wood by a few of the prisoners. "It has a lot of meaning because this is where we showed that it was possible to bring [TB] mortality down close to zero if you got people the right treatment," he says.

With government resources, Ukraine has since worked hard to build back its infrastructure for treating TB, registering a decade of declines between 2010 and 2020. But then COVID hit. Lockdowns early on in the pandemic shuttered hospitals where routine screening would take place.

Olha Konstantynovska's three daughters, afraid of an air attack, sleep in their apartment bathroom in Kharkiv. After an explosion down the street, the TB doctor and her family fled. Olha Konstantynovska hide caption

Olha Konstantynovska's three daughters, afraid of an air attack, sleep in their apartment bathroom in Kharkiv. After an explosion down the street, the TB doctor and her family fled.

"Sometimes it was impossible to check patients for TB," says Dr. Olha Konstantynovska, the physician currently living with her extended family outside of Kharkiv.

Without proper screenings and treatment, when tuberculosis did manifest and people came to the hospital, they'd be in bad shape severely underweight, a wracking cough, bleeding in the lungs.

In 2020, the percent of people receiving treatment fell dramatically from 75% the year prior to just over half. And now, in many parts of the country, the war's upended everything further.

In the chaos of battle, diseases find opportunity, disproportionately affecting people at the margins of society. Dr. Salmaan Keshavjee says, "In these moments of deprivation as a result of war, as a result of being refugees, as a result of being crowded in, not having enough food, et cetera, your TB rates go up." This isn't just true of Ukraine.

"I've spent many years working [with TB] with prison and other populations in Russia," says Keshavjee. "I have grave concerns that many of them are going to be dying. My guess is that they're trying to maintain their TB treatment programs. But Russia's under sanction. As funds and things get diverted to other efforts, you will see that the drug supply is going to drop."

Dr. Vasyl Petrenko visits a tuberculosis clinic in Kyiv before the war. Tatiana Butkivska. hide caption

Dr. Vasyl Petrenko visits a tuberculosis clinic in Kyiv before the war.

For now, Ukraine's stockpile of tuberculosis drugs is sufficient, provided they can be distributed. For instance, in Kyiv, Dr. Vasyl Petrenko, head of the physiatry and pulmonology department at Bogomolets National Medical University, says that Russian assaults on the city are limiting treatment options for patients.

When he's able to do his rounds, he tells his patients not to worry. "We are going to win," he reassures them. "The victory will be ours." He says it's crucial for morale. "It gives a lot of power, energy to every single person here."

The question is, how long will his optimism last?

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Russia's war with Ukraine is devastating for Ukraine's war on TB - NPR

LONDON Three European leaders staged a defiant show of support for Ukraine on Tuesday, traveling to its besieged capital, Kyiv, even as a relentless Russian artillery bombardment left apartment towers in the city ablaze, forcing terrified residents to flee into the street with only the clothes on their backs.

The dramatic visit by the prime ministers of Poland, the Czech Republic and Slovenia, which unfolded in tight secrecy as they crossed the Ukrainian border by train after dawn, was a strikingly personal gesture. But it caught other European leaders off guard, angering some and baring uncomfortable divisions in how best to demonstrate Western solidarity with Ukraine.

It also came as President Vladimir V. Putin of Russia disparaged the second consecutive day of negotiations with Ukraine, undercutting the faint glimmers of hope raised from talks the day before that both sides were looking for a way to halt the war.

The Kremlin slapped retaliatory sanctions on President Biden and other senior American officials. Mr. Biden announced his own plans to travel to Europe next week to showcase the unity of the NATO alliance in the face of Russian aggression.

A spokesman for Polands prime minister, Mateusz Morawiecki, said the three visitors were de facto representing the European Union in Ukraine. In Brussels, however, officials said the trio did not have the E.U.s blessing, and some European diplomats complained that the trip was too risky, given the Russian forces encircling Kyiv.

Others said they admired the audacity of the group, which also included Prime Minister Petr Fiala of the Czech Republic and Prime Minister Janez Jansa of Slovenia, casting it as a powerful symbol of the backing for Ukraine among countries on Europes eastern flank, where the specter of Russian aggression looms larger than in Paris or London.

Still, for all the symbolism of standing shoulder-to-shoulder with Ukraines leaders under the threat of Russias rockets, Ukraine was facing the devastating barrage largely on its own. The mayor of Kyiv, Vitali Klitschko, imposed a 35-hour curfew, starting on Tuesday evening, which suggested the capital was entering an even more difficult phase of its grinding struggle to hold off Russian troops and tanks.

This is their attempt to annihilate the Ukrainian people, President Volodymyr Zelensky of Ukraine said in an emotional video address to the Canadian Parliament, repeating his plea for NATO to enforce a no-fly zone over the country. It is an attempt to destroy our future, our nation, our character.

Mr. Zelensky asked the lawmakers to imagine if the CN Tower in Toronto were shelled like the towers in Kyiv. His language has become more pointed, even scolding, with each speech to a Western audience, revealing his frustration with leaders who have resisted more direct military involvement out of fear that it would entangle them in a wider conflict with Russia.

The Ukrainian leader, who has become a hero to many in the West, is scheduled to speak via video to Congress on Wednesday, where he is expected to amplify his pleas for more help and increase the pressure on the United States and its allies.

Mr. Biden is planning to announce $800 million in new security assistance to Ukraine on Wednesday, according to White House officials. The administration last week announced $200 million in security assistance for Ukraine and has made available a total of $2 billion in such funding.

On Tuesday evening, the Polish state broadcaster carried video of the Czech, Slovene and Polish leaders meeting Mr. Zelensky and other officials across a long table, with Ukraines blue-and-yellow flag behind them.

They are here to support us, Mr. Zelensky said at a news briefing after the meeting, which also was shown on Ukrainian television. It is a great, courageous, right, friendly step. I am confident that with such friends, such countries and neighbors and partners, we can really win.

A photograph posted earlier on Mr. Morawieckis Twitter account showed the three men poring over a map, seated in what appeared to be a train carriage en route to the Ukrainian capital.

It is here, in war-torn Kyiv, that history is being made, Mr. Morawiecki said in the Twitter post. It is here, that freedom fights against the world of tyranny. It is here that the future of us all hangs in the balance.

The White House announced that Mr. Biden would fly to Brussels for an extraordinary summit meeting of NATO on March 24. That may result in further economic and military aid for Ukraine but will likely fall short of Mr. Zelenskys request for a no-fly zone. Administration officials declined to say whether Mr. Biden planned to meet with the Ukrainian president, whom he has called a hero. But they said Mr. Biden may go on to somewhere in Eastern Europe to meet with refugees streaming out of Ukraine.

The river of people fleeing the war continued unabated on Tuesday, as Russia claimed to have seized control of the strategic Kherson region in the south. Russian forces kept up their pounding of civilian targets in Kyiv, where Ukrainian troops were fortifying intersections with sandbags, tires, and iron spikes.

A pre-dawn rain of rockets on Kyiv shattered windows, left craters in buildings, and turned a 16-floor apartment house into a towering inferno. The fire spread quickly after a missile struck the building, blowing a jagged hole at its entrance. Firefighters rescued residents from windows by ladder through billowing smoke. By midafternoon, they had carried out two bodies encased in black bags.

I came out with nothing, said Mykola Fedkiv, 85, a retired geologist. I left everything, my telephone, my medicines, everything.

When the missile struck, Mr. Fedkiv fled his 12th-floor apartment and made his way down the stairs. He climbed through the blasted entrance hall and found himself in the bomb crater. People pulled him out by his arms. He stood outside for hours, hoping to re-enter his apartment to collect personal documents. Asked where he planned to stay the night, he responded, God knows.

Conditions were even more desperate in the coastal city of Mariupol, which has been pummeled by Russian forces in a two-week siege that has left some residents crushed in the rubble and many others dying in a winter freeze with no heat, food, or clean water. Officials can no longer account for the number of dead and missing.

Officially, 2,400 civilians killed in Mariupol have been identified, but Pyotr Andryushchenko, an adviser to the city government, said he believed the toll was far higher, possibly as many as 20,000. Ukrainian estimates of the number of people trapped have ranged from 200,000 to 400,000.

Mr. Andryushchenko said 2,000 vehicles had managed to escape Mariupol on Tuesday and that another 2,000 were packed and ready to leave. Officials told civilians to delete all messages and photos from phones in case Russian soldiers searched them for signs of support for Ukrainian forces.

The perils of reporting accurate information from Ukraines combat zones were further underscored Tuesday with news that a Fox News cameraman and a Ukrainian colleague had been killed in an attack on Monday outside Kyiv raising to at least three the number of journalist fatalities in Ukraine in the past few days.

In Kherson, a southern city under Russian occupation, the mayor said that members of Russias national guard were rounding up activists who opposed Russias presence, possibly trying to recruit them through coercion.

Theyre all in the city, in the jail, the mayor, Igor Kolykhaev, wrote in several text messages, referring to the activists. Russian troops, he said, collect them, hold them, work them over and release them.

Kherson was the first major city to fall to Russian forces after the Feb. 24 start of the invasion. Although Kremlin officials had predicted that the Ukrainian people would welcome their liberation by Russian troops, residents of Kherson have been defiant, regularly gathering in the central square to protest the Russian presence, even when Russian troops fire into the air to disperse them.

Russia claimed to have captured the entire Kherson region, potentially strengthening its ability to push west toward the strategic port cities of Mykolaiv and Odessa. A senior Ukrainian military official, speaking on the condition of anonymity, confirmed that Russian forces were in control of much of the Kherson region, but said Ukrainian forces were attacking their positions and inflicting losses.

Negotiations via video link between Russia and Ukraine continued for a second day on Tuesday, though Mr. Putin doused prospects of any imminent breakthrough. In a phone call with the president of the European Council, Charles Michel, Mr. Putin complained that Kyiv is not demonstrating a serious attitude toward finding mutually acceptable solutions, according to the Kremlin.

Mr. Putin also continued to struggle in the information battle with Ukraine. On Tuesday, President Emmanuel Macron of France said his country could offer diplomatic protection to a Russian state television employee who was detained and fined over an on-air antiwar protest on Monday.

The employee, Marina Ovsyannikova, burst onto the live broadcast of Russias most-watched news program on Monday evening, yelling, Stop the war! and holding a sign that read, Theyre lying to you here.

Russia also faced further isolation from Britain, which imposed sanctions on more than 370 people it labeled oligarchs, political allies of, or propagandists for Mr. Putin. Among those blacklisted: Dmitri A. Medvedev, the former president of Russia; Mikhail Mishustin, the current prime minister; and Mikhail Fridman, the billionaire founder of Alfa Bank, one of the countrys largest private banks.

Russia, for its part, said it had sanctioned 13 Americans including Mr. Biden, Secretary of State Antony J. Blinken and Defense Secretary Lloyd J. Austin III in response to American sanctions against Mr. Putin and other officials. Also on its list was Hillary Rodham Clinton, the former secretary of state, and Mr. Bidens son, Hunter Biden.

Mr. Bidens press secretary, Jen Psaki, shrugged off the news, suggesting in jest that the Kremlins announcement might have missed its intended mark. The president, Ms. Psaki said, is a junior, so they might have sanctioned his dad by mistake.

Mark Landler reported from London, and Matina Stevis-Gridneff from Brussels. Reporting was contributed by Carlotta Gall and Lynsey Addario from Kyiv, Ukraine; Michael Schwirtz from Odessa, Ukraine; Anton Troianovski from Istanbul; Andrew Higgins from Warsaw; Ian Austen from Ottawa; Steven Erlanger from Brussels; David E. Sanger, Zolan Kanno-Youngs and Glenn Thrush from Washington; and Michael M. Grynbaum from New York.

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What Happened on Day 20 of Russias Invasion of Ukraine - The New York Times

A Ukrainian service member unpacks Javelin anti-tank missiles, delivered by plane as part of the U.S. military support package for Ukraine, at the Boryspil International Airport outside Kyiv, Ukraine February 10, 2022. REUTERS/Valentyn Ogirenko

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Ukraine, March 19 (Reuters) - Ukraine will receive a new shipment of U.S. weapons within days, including Javelin and Stinger missiles, Ukraines National Security and Defence Council Secretary Oleksiy Danilov said in a televised interview on Saturday.

The (weapons) will be on the territory of our country in the nearest future. We are talking about days, Danilov said.

Ukraine's allies have delivered planeloads of weapons shipments to bolster its military against the Russian invasion. Russia has criticised such deliveries from NATO member states.

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Reporting by Max Hunder; editing by Matthias Williams

Our Standards: The Thomson Reuters Trust Principles.

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Ukraine to receive more U.S. Javelin and Stinger missiles within days, Ukraine official says - Reuters UK

LVIV, Ukraine Russian forces are pressing their assault on Ukrainian cities, striking on the outskirts of the capital Kyiv and the western city of Lviv, as world leaders push for an investigation of the Kremlin's repeated attacks on civilian targets.

Lviv Mayor Andriy Sadovyi said Friday on Telegram that several missiles hit a facility used to repair military aircraft and damaged a bus repair facility, though no casualties were immediately reported.

The plant had suspended work ahead of the attack, the mayor said.

The missiles that hit Lviv were launched from the Black Sea, but two of the six that were launched were shot down, the Ukrainian air force's western command said on Facebook.

Lviv is located just a few dozen miles from Ukraine's western border with NATO ally Poland.

Elsewhere in Ukraine, rescue workers are still searching for survivors in the ruins of a theater that was serving as a shelter in the besieged southern city of Mariupol.

While officials have not yet announced the number of casualties from the theater attack, CNN reports that more than a thousand people were sheltering in the facility at the time of the bombing. Prior to the attack, Ukrainians had spelled out the word "children" in Russian in large letters outside of the building.

In Merefa, near the northeast city of Kharkiv, at least 21 people were killed when Russian artillery destroyed a school and a community center Thursday.

The World Health Organization has verified 43 attacks on hospitals and health facilities in Ukraine.

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Russia targets Lviv with airstrikes

A demonstrator, holding a Ukrainian flag, participates in a demonstration called by 70 associations in support of Ukraine on the square of Paris' town hall on Thursday. It has been three weeks since Russia began its assault on Ukraine. Julien De Rosa/AFP via Getty Images hide caption

A demonstrator, holding a Ukrainian flag, participates in a demonstration called by 70 associations in support of Ukraine on the square of Paris' town hall on Thursday. It has been three weeks since Russia began its assault on Ukraine.

When the invasion of Ukraine began three weeks ago, many thought it would end quickly because of Russia's military strength. But as the war drags on and Ukraine digs in, two questions are increasingly being asked: Can Ukraine win this war, and what will it take?

While Russia has occupied the southern city of Kherson, Ukraine's military and civilians have prevented the Russian army from taking control of other major cities. Russia has also suffered significant casualties, with conservative estimates putting it at more than 7,000 troop deaths, according to The New York Times.

The reason for Russia's lack of battlefield success started before the invasion began and can be attributed to systemic issues, including corruption and poor training, and bad assumptions, said Steven Horrell, a senior fellow at the Center for European Policy Analysis (CEPA).

Horrell, also a former U.S. naval intelligence officer, thinks Russian President Vladimir Putin saw the attack on Ukraine unfolding in a vastly different way.

"I think Putin truly believed the things that he said about the Ukrainian people welcoming them," Horrell told NPR. "They just failed to understand that the Ukrainian armed forces of 2022 are far different from the Ukrainian armed forces of 2014 when they annexed Crimea and began their adventures in eastern Ukraine."

A member of a Territorial Defense unit practices putting on a tourniquet at a defensive position on the outskirts of Kyiv on Thursday. Chris McGrath/Getty Images hide caption

A member of a Territorial Defense unit practices putting on a tourniquet at a defensive position on the outskirts of Kyiv on Thursday.

Those previous incursions by Russia provided Ukrainians with training by fire and allowed them to identify and adjust to shortfalls quickly, Horrell said, adding that Russia was also struggling with logistical problems this time around.

With all these factors in mind, Horrell said Russia could "certainly fail," either in terms of strategic objectives, defeat on the battlefield, or both.

Russia wants to control Ukraine and have it be a non-Western leaning state, but Horrell said the Ukrainian people had shown that the invasion alone would not eliminate their Western ideals. And, he said, they would not accept a president who was chosen by Russia.

"That is almost zero chance of occurring now," Horrell said. "And for Ukraine ... you would define victory as the complete expulsion of the Russian invaders, not just this recent invasion, but to get the borders back to 2014 before Crimea was illegally annexed."

Retired Lt. Gen. Ben Hodges serves as the Pershing Chair in Strategic Studies at CEPA and said that based on his experience and the reports of Russian ammunition and manpower shortages, the war may culminate in the next week.

"The time challenge for Russia is not just military," Hodges wrote in his analysis on Tuesday. "The effects of sanctions are growing Russia may soon default on $150 billion of foreign currency debt and Russian domestic resentment is also growing."

Hodges said the U.S. and other Western powers needed to move with "urgency" to offer more support against Russia.

Ukrainian President Volodymyr Zelenskyy speaks to the U.S. Congress by video to plead for support as his country continues to defend itself from an ongoing Russian invasion. J. Scott Applewhite/Pool/Getty Images hide caption

Ukrainian President Volodymyr Zelenskyy speaks to the U.S. Congress by video to plead for support as his country continues to defend itself from an ongoing Russian invasion.

Secretary of State Antony Blinken announced an additional $800 million worth of security assistance for Ukraine on Tuesday bringing the total amount of aid in the past week alone to $1 billion.

Blinken said the additional funding would be used for things like "anti-aircraft, anti-tank, and anti-armor systems as well as small arms and munitions used by Ukrainian security forces on the ground right now in the fight to defend their country."

But what the U.S. and NATO remain opposed to is instituting a no-fly zone over Ukraine. That is something that former U.S. Ambassador to Ukraine Marie Yovanovitch believes should remain an option.

"I think that has to be on the table. But I also think there are other ways of doing a no-fly zone," Yovanovitch told NPR. "I think we have lots of smart people at the Pentagon that can figure out ways to do this in a way that is less risky."

Russia may prevail militarily, but there will be a resistance, and it will be an ugly one for any Russians that are attempting to impose their will on Ukraine.

Marie Yovanovitch, former U.S. ambassador to Ukraine

Ultimately though, Yovanovitch said she believed Ukraine would win the war.

"Russia may prevail militarily, but there will be a resistance, and it will be an ugly one for any Russians that are attempting to impose their will on Ukraine," Yovanovitch said.

"I think that there's going to be not only a guerrilla war, but there's going to be civil resistance where, you know, people get poisoned when they go to the restaurant, sharpshooters are on roofs picking off Russian soldiers. It's going to be long and ugly, but this is a people that fights back."

But an incomplete victory for Ukraine is another potential outcome of this war. Horrell said this is a scenario that would end in a "frozen conflict" if Russia still held Crimea and the Russian-led separatist areas of eastern Ukraine.

"In one sense, that's a success for Russia in that it gets an anchor dragging Ukraine down, both in terms of economic advancement and full realization of their national potential," he said. "But also, that's the sort of thing that keeps a country out of the E.U. and out of NATO."

"At this point, though, with the success we've seen in three weeks [of Ukraine defending itself], is that even acceptable terms for Ukraine? I think it may not be."

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Could Ukraine win and Russia lose the war? Here's how it might unfold - NPR