A convoy of five vans traveled from the battered Ukrainian capital, Kyiv, to the northeast of the country. generators, clothes, fuel, and medications were on board.
With a main bridge decimated by shelling, the drivers crept along back roads, hoping to reach Chernihiv on Saturday and begin distributing the drugs to some of the 3,000 residents in desperate need of treatment.
The war in Ukraine is threatening to become a public health disaster. The conflict threatens to upend decades of progress against infectious diseases throughout the region, sparking new epidemics that will be nearly impossible to control.
There are alarmingly high numbers of people living with H.I.V. and hepatitis C in Ukraine. Refugee living conditions are breeding grounds for a number of diseases, not to mention respiratory plagues.
There is a high risk that they will die if they don't get the medicines.
Mr. Sherembei found out he had H.I.V. 24 years ago. He is one of hundreds of thousands of people in Ukraine who are living with the virus, which is caused by the sharing of contaminated needles among drug users.
Multi-drug-resistant Tuberculosis is a form of the disease that is impervious to the most powerful medications.
Since 2010, the Ukrainian health ministry has made progress in bringing these epidemics under control, including a 21 percent drop in new H.I.V. infections and a 36 percent d ecline in Tuberculosis diagnoses.
Delays in diagnosis and treatment during the war may allow these pathogens to flourish again, with consequences that will last for years.
Iana Terleeva, who heads tuberculosis programs for Ukraine's Ministry of Health, said in a statement that they were working to differentiate between different Tuberculosis genes.
Thousands of people with chronic conditions like diabetes and cancer are at risk because of the fighting, and health facilities throughout the country have been damaged.
The former U.N. secretary general envoy for Eastern Europe said that everything is at very high risk.
He said that he expected major health crises with regard to infectious diseases and chronic diseases across the region.
The war will have a huge impact on health systems.
More than three million Ukrainians have fled to neighboring countries, most of them to Poland. The refugees are arriving in countries that are not prepared for the large number of patients with medical needs.
One of the most impoverished nations in Europe isMoldova, which is ill equipped to care for refugees or stem infectious disease outbreaks. Russia's economy is heavily dependent on the drugs and vaccines it produces.
Russia has more people with H.I.V. than any country in Eastern Europe, and Western sanctions are likely to interrupt the already low levels of funding for services in the country.
There are nearly 1,000 health care facilities in Ukraine that are close to conflict zones. At least 64 attacks have been recorded by the World Health Organization on such facilities.
The hospitals that are still operational struggle to care for the sick and wounded, and are crippled by a shortage of medical supplies, including oxygen and insulin.
The World Health Organization says hundreds of children with cancer have left their homes. Routine childhood vaccinations have been derailed by the armed conflict.
Only about 80 percent of Ukrainian children were immunized against the disease in 2021, and the country had detected a few cases before the war began. Measles vaccine coverage in Ukraine is too low.
Many experts fear that these are the ingredients of a public health calamity. The W.H.O. and other organizations are sending medical teams and supplies to Ukraine. The aid may never reach areas of active conflict.
The Ukrainian government disbursed three months of supplies of medication for H.I.V. and Tuberculosis. Many Ukrainians who were forced to abandon their destroyed cities were only able to take limited supplies of medication.
Four days after the bombing began, the Grib family fled their home. They packed what they could in suitcases and made their way by train to Mykolaiv, a city that came under heavy bombardment by Russian forces.
Ms. Grib took some of her medicines with her when she was diagnosed with Tuberculosis, but now is unsure how she will get the drugs long-term. Her disease could become resistant to all available therapies if she didn't receive treatment.
She said it was very scary.
1,200 people with Tuberculosis are thought to have fled Ukraine. The Alliance for Public Health helps more than 400 patients in countries like Poland and Moldova. The W.H.O. has a stock of drugs in Poland for refugees from Ukraine.
Most of the refugees are women and children, while the majority of Ukrainians with drug-resistant Tuberculosis are men who must stay in the country to fight.
In cities where it's still possible to travel, staff members are delivering medicines to the sickest people, and mailing drugs to communities that still have post offices.
Dr. Klepikov had to leave the suburb of Kyiv to go to Lviv. He was devastated by the destruction of apartment complexes, kindergartens and shopping malls in a few minutes when he returned to Kyiv.
He wrote in a text message that there was a smell of heavy smoke, sound of bombing, and sirens.
In a city that has become a refuge for Ukrainians, the alliance's staff members are delivering condoms, needles and tests. There is little the organization can do in other cities.
Only the alliance's mobile team was able to confirm that she was alive after staff members lost contact with colleagues in Mariupol. Staff members have lost touch with 60 percent of their clients in the suburbs of Kyiv, which has been under attack for weeks.
The gains that have been made over the last 20 years can be destroyed in a few days.
More than one in four new H.I.V. infections occur among injecting drug users. More than 17,000 Ukrainians received so-called opioid substitution therapy because of the country's policies on harm reduction.
As access to street drugs has decreased during the conflict, the demand for treatment has increased. Experts said that stocks of the drugs are unlikely to last more than a couple of weeks.
The W.H.O. is requesting drug donations from the Czech Republic, Austria and other countries. Over the next year, the Global Fund will make more than $3 million available to purchase these treatments.
Drug users in Ukraine would be at risk if Russian forces prevailed. Opioid substitution therapy is against the law in Russia. Russia shut down all of the delivery centers for the drug in 10 days after annexing the peninsula.
You can't stop the treatments from one day to the next.
The Ukrainian Network of Women Who Use Drugs says that women who use drugs face stigma and discrimination.
The organization helped 50 to 70 women a month before the war, but now they help more.
Ms. Koshova was diagnosed with H.I.V. at the age of 27. She said that the situation can change in a moment because rockets fly everywhere and destroy everything.
She spent most of Tuesday in the basement because of the threat of rocket attacks.
There are bombs constantly heard and there are problems with electricity.
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