Hello everyone and welcome back to another episode of Hungry Shark Evolution and today it's a special episode because what is it? It is the 10 year anniversary of Hungry Shark Evolution being released. Damn, it's been 10 years since, well, almost 10 years since I played this game as well. Good God, that's a long time and in order to celebrate the occasion Hungry Shark have sent out codes to their creators and stuff to showcase something new. You know, because they're celebrating, of course, it's the 10 year this only happens once. Every 10 years, only the first 10 years anyway. And it is a new shark, the Finfinfinny. I guess it's like a... I suppose that's what they're going for. These sharks have the ultimate combined attack to never fail in their hunt. So I'm assuming these are based on the cookie cutter sharks because they're sort of spinning around and I think that's how cookie cutters are like, boring to their victims or their prey. So it is 200,000 coin or 300 gems and unfortunately we don't even have the coin so it's going to have to be the gems. So this is one of those special sharks of special power deadly world. Proof that sharks can make coordinated attacks and that they work. This beast will grow rapidly but growth is not saved. That's right. So this is one of the few special sharks in the game.  You can't put again with special sharks is oh my god what's this? I'm so small. Okay okay so when I boost oh I do a spinny spin. Oh look at that. See those hammerheads they thought they could take me. Oh oh oh I am terrible on the land. Okay so how do I do like a coordinated attack? Is that even possible? I don't seem to have any special. Oh god no. Can I even take on a submarine? Oh no. Oh my god where am I?  Whoops it is. I was about to go into a spiel about how that's how we found out about the cookie cutter shark is because we found holes in the holes of submarines way down in the depths and they were actually made from cookie cutters so they have a bite that's so strong it can penetrate and take chunks out of submarines so hey ho that's something that if you didn't know now you know so but with them I guess maybe getting into a size that's you know where we can't be killed very easily by submarines may take a while tuna there we go also I think they've taken chunks out of dolphins and other bigger sharks so they're a kind of almost like a parasitic shark where they don't actually kill the victims in order to feed off them it's nice it's nice not everything has to end in death and the cookie should cut the cookie cutter shark is a living testament to the sting rays oh wow so when I do my swirly swirls oh you know it is when we get into Gold Rush I bet that's when we are we do our amazing attacks isn't it I bet as well although these cookie sharks ah yeah they don't seem to mind about killing everything I love some junk food you got do little bursts can I oh okay okay I thought I could take our minds I was very wrong oh there it is okay so oh there it look at them go whoop whoop whoop okay apparently that doesn't work well maybe it does I'm really not sure we all level 3 though so that's not so go and eat this yes oh a lion fish even a lion fish isn't worth it no don't stand a chance against hold on hold on me yes nom nom nom nom eat them all glorious yes and you come on tunas yes yes yes I think they're one of the fish as well that have been subject to the cookie cutter sharks a bite okay why is the sky gone red I've completely forgot is this normal this is a normal thing this might be a normal thing oh there we go oh I got so big from that we so the thing is I can't put anything on this I can't get jet packs I can't do the roller blades or rockets or lasers or anything on these sharks so it's all about this skill of the player yes so I set off that mind to liberally and it killed all of those fish whoa oh we're almost there no no no no no the submarine's bad oh god thank you thank you took one for the team that guided oh yes me me oh sword fish okay that's fine we're level five would we're doing not so bad I don't think it oh look at this show yes flying fish I'll take them red world to Gold Rush here we go it's got to be somewhere we can go to get lots of food right oh my god even a barracuda can out swim me this is terrible and I even lost my boost when I was into God Rush no I mean I'm definitely a little bit bigger but I'm not like crazy I mean oh there we go yes oh this is brilliant okay go go go oh yes yes oh no no no no finally we're almost back and eat these guys oh okay can I destroy a boat apparently boats were always good let's eat a boat yeah yes level six oh that's right I forget yeah okay here we go here we go so in Gold Rush your boost doesn't go up but it doesn't go down either so you need to you need to step off the boost more turtles yes like a corkscrew yes level seven here we go this is the easy part yes I'll take that no no no no no no yeah I mean boosting and oh my god that was a huge came about time 96 yes let's go let's eat all of these electric shock seals all that was brilliant oh the pyro shock okay we're level eight I think well we're definitely getting somewhere new you is it level ten I max so we the biggest cookie could a shark you could ever see maybe not gonna go and land up enough skateboard I haven't learned that skill yet there we go times 96 oh we're doing good I think oh the swordfish keep the time say yeah that's how we get into the gold rush whoa oh is it captain ahab there oh no that's the cage oh my god yes oh my girl was level 10 come on still times eight that's great just just as long as we eat you know a tiny fish every now and again that's what'll keep the bonus going we got five million I'm pretty sure that's a world record it's definitely not but you know what oh the submarine swim away or now attack it now attack yes revenge sweet revenge okay this guy's no this is normal boat okay it's taking a while to get to level 10 oh there it is there's level 10 okay how far can we grow how much took a while to get there so if we can go further I like how we can eat them through the cage really even have to destroy the cage I guess that's because we're so small how about helping Chris's more level we get no no no no no oh no you little buggy you can't eat my tail I eat yours right gold seals there's gotta be something here gotta be some oh that's good yep we're gonna go to a higher level surely we can get it now I can't something something anything one of you something give me the points okay yeah I think level 10 must be the biggest cuz we're not going that way because all is that way is death as well as a good job I like it I like this oh there's oh yes oh this is great we got my one 40 million 16 million what's going on we got 26,000 corn oh I see 10 of those and I didn't even need to spend the gems for it sweet right come on in let's go the blood fish the blood love those avoid that you see I'm not small I can actually avoid stuff like that normally I can't I died by well this shocks actually it's really good because it seems like as long as I'm doing my little coax screw attack everything dies oh god I mean yep there you go I love how they they sort of come into it as well once I start doing the like oh oh my god I was a Godzilla attack that was like a flum and five nights at Freddy's job scare came out of nowhere okay we're doing good I think we can go deeper that's good I like how I don't do it I don't do any spins but my brothers and sisters do release the one with the hat I don't I don't know I'm just assuming oh mr.


So me and my buddy Johnny are about to get fishing. I lost my other tripods. I've been using my really like high-tech one This is for my big camera. This is for my Canon x8 30 I got this little camera on this huge tripod like what is going on? debating if I should Either use my chest camera. I should use the tripod But like if I'm gonna be going I don't know what pons I'm going to get I don't know if I'm gonna like I wasn't gonna go on linear today But the thing is this is Saturday it's an afternoon already already had it like I have a lot of stuff to do So I didn't really have time to go this morning so That didn't work out in like an afternoon. It's really bad. It's really windy So I'm not gonna go out right now Hopefully tomorrow I'll be able to go out or at least go to some other lake on my boat and be able to fish Get out here on the pond I'm out here with my buddy Johnny and also this kid named Luke I actually met him through watching my videos and he's been wanting to always fish with me So we're out here right now They're gonna be leaving here very soon and so Johnny brought his car because I'm gonna be out here So it's pretty windy right now. So I hope the audio is not bad if the audio is bad I might commentate but I highly doubt it's gonna happen. So let's go ahead and catch some fish So guys, I just set them up down there on them, too.  I'm gonna let them throw it and catch a few fish I'm gonna feel like a rabble trap, but um, this lighting is horrible. Okay. What do we got going? Okay, but I'm gonna let them throw that right now and hopefully they'll get a few fish I'm John Johnny's never casted Baycaster kind of just taught him real quick. Let's do this rattle trap out there But let's go ahead and get it started Sorry if the winds bad with first fish, that fish hit it literally right when I hooked so they jumped out of the water This wind's bad. I'm probably gonna have to commentate every bit. I apologize first fish rattled trap Let's get something. Oh, I told him he's about to catch one right now.  Oh Johnny's about to catch one caught one guys. He did it boy.  This is probably gonna help it out a lot There he is.  Oh He's tugging on that, huh? Don't yank on it if it's like that ruin it. Let me see. You gotta take out the knot I don't know how I got that out.  There you go. Yeah, I got some worms in my pocket. Do you have a Texas rig? Yeah, I don't have any weight. Oh, I do have some weights. Honestly, that's probably I'm was trying to find a shaky head That's probably what I'm gonna go back and look actually. All right guys I was actually fit fixing his his reel and my bait was out there. I just caught this one Just a little tiny one I'm gonna go with mr. Swim bait. I'm going bigger going home guys. I don't That's not a big swim bait, but Shouldn't ice says bigger fish to buy.  Oh my god Well, I lost this bait literally like a year ago Yeah, no, it's a $30 bait too. Oh my god. Oh my god guys. Look at this All right guys, I don't know if you're familiar with jackal baits or not But I literally just found this lure. I lost over a year ago Like this bait is like a $30 bait. They're very expensive and I was like really hurt when I lost it I guess the hooks just rusted out Can't see the wording on top anymore and I just hooked it with my bait and brought it in. That is crazy That's amazing.  I was running a little weird to me So I tie back on that rattle trap Another little guy nothing big. I want to get a big one out of here really bad. Is he a good one? There you go Johnny There you go, bro That's not bad There you go, boy.  Let me see it Only if you ate more is mouth big Fish there. That was a bass that time Small one just a small one boy There you guys got one on a Texas rig Decided to slow down. I have the awkwardest literally cheapest weights that I could have found So I don't have any good ones, but I mean that's not That's a pretty fish nothing big, but Still a fish. This one's fine hard. It's not even that big. Look at him run next cast He's on that grass line over there. I was talking about This is actually the cast after I caught the last one thing and I'm starting turning on There you go. This is a little fatty in that one You see that thing? There you go. Oh man Pretty good It's not a bad one dude. That's the best one yet.  There we go It's not a bad fish at all guys. This is Really healthy one. It's pretty thick too.  I apologize brother. You guys have bad lighting and really bad winds. So We'll go over a few setups So first rod proxmoon Bay rod spy kuma tcs, which is the term it concept series rod It's a Scott Martin signature series and this is a heavy-powered rod 7 3 The real is a helios tcs and I have this on 15 pound fluorocarbon as the first setup I used today. Oh My god, this wind. I don't know if you guys can hear that This is hard Second combo is an akuma helios and this is gonna be a 7 6 heavy-powered rod This is what I was using the Texas rig on You know, you can also use like a medium heavy if you want a little more accuracy and not too much tip on the rod You can go with the medium heavy, which is the Martin APC. That's the one I usually use by the kuma But there's a rod and reels I used Let's close out the video I'm over here closing out the video Luke's already already over here. He's catching another one That's not a bad one dude. You get it Look at that fish It just poked me. I was already closing out the video. There you go. That's a good one, dude There we go, that's what's up.  I'm got to take Luke out had a fun time, dude Got some fish. We caught some fish Johnny caught some fish. We all caught some fish The funny part is like right when Johnny left we just started catching them I was like, we're gonna be out here for a walk. So I got to catch a pretty good amount of fish for the video But I mean it was fun time I had fun If you guys want to see more videos like this hit the thumbs up button comment below something about the video because I'm Going to be doing those Answered the questions and other videos, but thank you guys so much for watching be sure to leave a thumbs up Subscribe if you haven't already


Daydreaming is a short-term detachment from one's immediate surroundings, during which a person's contact with reality is blurred and partially substituted by a visionary fantasy, especially one of happy, pleasant thoughts, hopes or ambitions, imagined as coming to pass, and experienced while awake. There are many types of daydreams, and there is no consistent definition amongst psychologists, however the characteristic that is common to all forms of daydreaming meets the criteria for mild dissociation. Negative aspects of daydreaming were stressed after human work became dictated by the motion of the tool. As craft production was largely replaced by assembly line that did not allow for any creativity, no place was left for positive aspects of daydreaming. It not only became associated with laziness, but also with danger. For example, in the late 19th century, Tony Nelson argued that some daydreams with grandiose fantasies are self-gradifying attempts at wish fulfillment. Still in the 1950s, some educational psychologists warn parents not to let their children daydream, or fear that the children may be sucked into neurosis and even psychosis.


Thank you very much for joining us such early morning. Usually in Ukraine in this moment, the alarm is finished and all the missile attack is finished because they are attacking us in the night, so we could speak. And I wanted to start today's meeting. It's right now all Ukraine is keeping the minute of silence for those who are killed in this brutal war. So I suggest for us to take the minute to reflect and to remember all the victims of this war. Thank you. I'm Hannah Dovbach, Eurasian Harm Reduction Association. I'm very, very happy to facilitate this meeting and happy for you to come. Thank you very much for this support and for all tremendous support your countries, your citizens, everybody providing to Ukraine and to Ukrainian refugees. Today we will speak about the response, response of Ministry of Health, response of a civil society community. And I have absolutely tremendous panel to present this response which we all gave during this year of the full scale war. So the first, from the very beginning, I will give a floor to our absolutely heroic Ministry of Health who developed the response from the first minutes of the full scale invasion of Russia in Ukraine. So I am presenting Anna Shemet, Ministry of Health of Ukraine, the representative of Ministry with her presentation. Good morning, colleague. And I want to start our presentation. Elisa, please, next slide. Before down of February 24th, 2022, Russia launched a full scale invasion across Ukraine using land, sea, and air. By sunset, Russian special forces and airborne soldiers had sighted the nuclear site of Chernobyl after a bloody battle. And we are advancing into our skirts of the Ukrainian capital, Kiev. Ukraine is standing and is successfully fighting against the enemy. Intense battles and happening in a lot of cities and regions of our country. We have now that are protecting our native land, our relatives, and the future of our children. Elisa, please, next slide. Ukraine has been resisting a full scale invasion by the Russia Federation for more than a year now.  Even if these are patients of healthcare facilities and hospitals themselves, more than 22 million of people were forced to leave their homes. There were 8 million of refugees from Ukraine across Europe as of 27 February 2023. Elisa, please, next slide. As of 7 June 2022, the Ministry of Health of Ukraine reported that after 24 February 2022, Russia destroyed 739 healthcare facilities of which more than 118 were completely destroyed and cannot be restored. Just a few problems of what trace an aggressive nature left behind. Occupation of certain regions and territories. Regions have mostly been affected. The total front line is around 1,300 kilometers. Difficulties in the logistics of drugs, medicine, and other supplies within the regions. An image of destroyed healthcare facilities, medical personnel draining and fling to other regions and countries. Medical works facing overwhelming amount of work, shortage of drugs. Elisa, next slide. And next slide, please. OST program has been implemented in Ukraine since 2004. And significant development has been achieved. Namely, scientific advice-based standards of treatment have been implemented. Since 2007, OST drugs have been procured with the state budget funds covering 100% of the needs of the regions. Since 2020, the Medical Guarantee Program provides free OST services. Since 2020, OST has been implemented in detention facilities. More than 95% of HIV-positive patients receive ART treatment, progressive policies regarding OST. Ambitions, studies, and procedure for OST implementation. Elisa, effective intersectoral cooperation on OST issues has been established. The list of service providers has been expanding. Treatment can be provided by any trained doctor. A number of training courses has been reasoned. Large-scale prescription of OST drugs for self-administration more than 90%. Next slide. Yes, the organization of OST service has always been a complex process due to a number of reasons. In particular, the fact that patients have to take drugs daily and the drugs fall under the category of strictly accountable, there are individual and complex regulations regarding their storage, dispending and transpiration. As a result of military aggression, some healthcare facilities were destroyed. Since February 24, data has been received that in the result of military action, 16 healthcare facilities providing OST services has been damaged. The total number of patients' public healthcare facilities who dropped out of the OST program in 2022 is 66666 which is 2363. More patients than is 221. Next slide. Difficulties with logistics of OST drugs due to the uncertainty of the situation regarding the temporary occupation is the terrorist risk on the roads and the need to pass checkpoints. The logistics companies that deliver the drugs refuse to make the plan to deliver the drugs. In turn, the regions having used to walk under normal conditions where deliveries were made according to the schedule did not inform about the planned execution of the drug stocks while waiting for the delivery of all these created significant risk of treatment interruption. Since 2017, the OST drugs were procured with the state budget funds. In turn, the specific procurement including the timelines of its performance was put at risk in the result of a budget deficit caused by the invasion of the aggression country. The situation was also complicated by the fact that in the first month after the invasion, the national manufacturers from whom the drugs were procured in the recent years actually terminated their activities. Destroyed roads, shelling, suspension of public transport lead to the fact that medical walks, walkers and patients often could not get to health care facilities. The specific situation significantly increased the risk of treatment interruption by patients and termination of OST services provisioned by health care facilities. National drug manufacturers stopped walking, occupation of territories and stopping of OST programs. As a result of hostilities, some patients were forced to leave their homes and seek safe shelter in safer regions bought within the country and abroad. The world forces the majority of patients on the OST program to move within the country. Termination of activities on the private health care facilities, the party of OST patients abroad considering the fact that most of the patients of the OST program are men, they do not go abroad frequently. At the same time for those persons who expressed their intention to go abroad, there was an acute problem of obtaining information about places of treatment in other countries. In order to solve the situation, the specialists of the public health center collected information about where they could get OST services abroad. Panic lack of confidence that the program can continue to walk miscommunication. Next slide. Decrease in the number of patients under treatment was observed in some regions. Next slide, please. Responses right now. Doctors and nurses are one of our most valuable resources. Medical walks are having equally critical fights for life and the health of soldiers and civilians. Every day health care system services countries request from those who want to give a helping hand to Ukrainian clinical and hospitals. Next slide. The Ministry of Health of Ukraine, the public center of Ukraine, the international charitable funds, non-governmental organizations and partners began a non-stop walk to solve the problem of the field support doctors, medical workers and what is the most important patients. Even in the conditions of bombing, air raids and constant risk to their own lives, specialists continued to be faithful to the mission and stood on guard of tension and protect the health of the population of Ukraine. Next slide. Action were taken. Organization measures were implemented. Relevant information was collected about the availability of drugs in health care facilities, about the movement of patients and medical personnel, as well as their needs. The health care system also found solutions to logistical problems, the registration of displaced persons inside the country and abroad, in order to provide support not only to doctors but to patients as well. The health care system promptly established cooperation with the international organizations, state institutions, donors, patients, organizations, volunteers and clinics from all around the world. In order to resolve the situation, the center implemented the following response measures, manual monitoring of the consumption of the OST drugs, taking into account the mentioned risk from the first day after the invasion. The monitoring of the availability of the OST drugs was switched to manual mode. Employees of the PHC collected weekly information on the availability of OST drugs from the health care facilities. Due to the promptly implemented new mechanism, it was possible to prevent the treatment interruption in a number of regions. After the invasion and maintenance of both supplies were suspended for a certain time, time and separate orders were issued to renew them, regulating the delivery of drugs to the final recipients. It was decided that the delivery would be made not only to a designated health care facility on a farm or a pharmacy, the house at the level of the region as well usually the care but also to specific health care facilities that had difficulties in picking up the drugs in the regions by themselves. It was possible to distribute drugs to all recipients on time and to prevent treatment interruption. A mechanism for the delivery of OST drugs was developed and applied to using the measures of the ICP for public health. During this time, the alliance was able to deliver to a number of regions the drugs pursued with the funds of the state budget as well as those procured funds of the GFIM. Taking into account the risk of temporary occupation of certain regions, the risk of disruption of transport connection, the refusal of logistic companies to deliver drugs. One of the mechanisms for providing treatment interruption was the arrangement of buffer stocks of drugs in the regions in order to enable this activity, the order of the Ministry of Health of Ukraine on the storage of narcotic drugs, hydrocarbon substances, and sprecosas under the Martial Law condition was issued allowing the storage of the three months supply of drugs in health care facilities during the Martial Law. Previously, only the month supply was allowed to be stored in the health care facilities. In order to provide for buffer stocks of drugs, the ICP public health alliance and the charity organization 100% Life procured drug resides from the national manufacturer ALC InterChem. Thanks to all the measures taken, it was possible to deliver drugs to all regions in need. Next slide. In order to enable the procurement of the drugs, the APHC provided for prompt procurement of drug residues from the national manufacturers and negotiation with the international agencies and agreed procurement of OST drugs with the funds of international projects. The city of manufacturers ready to supply the drug for Ukraine. Next drugs we hand dispensing of OST drugs to patients for self-administration for a certain days. Drugs handed over for a period of up to certain days in case of risk of treatment interruption in regions with active hostilities. Before the introduction of the Martial Law, it was allowed to hand over OST drugs for self-administration for a period of up to days. The center took the following measure and sent it to the new flexible mechanism regions to help care facilities can apply for the amount of drugs they need taking into account to needs of the internally disposed persons rather than begin being limited by the existing schedules. The following has been improved information in exchange between doctors verification of data and the provisions treatment of the patients in the center or database of the health checking data on provision treatment in the Syracs database sent to develop it in the identification mechanism. It was possible to prevent cases of drug abuse. Then patients tried to get drugs in several several places at the same time or cases without being able to identify the patients as the one who received treatment doctors start treatment home the induction stage. Information about OST sites is different countries was collected and the support was provided to patients traveling about in terms of insurance treatment continue. Payment among patients of health professional in consistently of efforts the following post carried out weekly meetings for patients and doctors from the first weeks of the war to inform them of the current situation weekly monthly status report of on the current situation which the OST program weekly meeting of state holders on OST issues as the operative decisions and activities a pilot project has been launched regarding video surveillance of the intake of OST drugs doses ensuring access to new OST drugs which had not been used in Ukraine before buprenorphine and the combined form of buprenorphine plus naloxon suboxone. A study has been launched to examine the effect of self-administration of OST drugs on them and herons to treatment and retention in regulation training of drug of doctors development of online courses to increase the leave of knowledge knowledge of doctors about OST. A number of studies were conducted assessment of change in the drug send assessment to the of the level of knowledge of provides of OST services prevalence of adverse reaction of OST drugs implementation of the medical information system the register of OST patients has been started. Implementation of pilot project on the treatment of HIV on the basic of OST sites in addition to ensure the transparency of decision making weekly meeting of the problem K stakeholders are held separately with the particular pacification of the World Health Organization CDC you know this is a global fund and I see here aliens for public health charity organization one person one hundred person live USAID at such meeting the current stage of provision of OST service and the fun functioning to the program it also discussed the transparency of decision-making communication partnership and the key principles to be currently follow when creating platform for decision-making as of one point one point 2023 the number of people with mental and behavioral disaster due to the use of opioids who were being treated of healthcare facilities was 20 28,523 of which 9,990 people receive service in public healthcare facilities eight thousand six hundred four people in private healthcare facilities in percentage terms in the increase in patients for 2020 2022 in public healthcare facilities was two thousand eight hundred seventy six patients in private five thousand eighty twenty two patients as one point one point twenty twenty three the total number of people who received OST drugs for self-administration outside the public healthcare facilities was 19 percent the number of patients who received drugs for self-administration through pharmacist decreases from 163 people at the beginning of the period to 114 it is difficult to describe all the pain experienced by the citizens of Ukraine we had the opportunity to talk with the doctors providing COST services ordinary people who is the face of a mortal to reach under daily air raids to enemy aircraft under artillery and missile attacks did not leave the city and continue to the resistance thank you for your attention thank you very much Anna and I need to say that that's absolutely unprecedented work which ministry of health and central public health and all our doctor nurses civil society organization together dead and I need I need to say that from the very first minutes of the war this commitment to support people who use drugs and their essential treatment OST treatment and you've heard about research innovations in this time so not only to fulfill the commitment to harm reduction to support civil society to support services but also to innovate to change the system to make it more efficient absolutely unprecedented response and thank you for this example and actually that was very good cooperation between communities who help support each other support their peers civil society who develop the flexible system of delivering drugs and delivering services uh evacuating widening the the range of services and actually I need to to give the floor to representative of people using drugs in the Ukrainian country coordination mechanism representing all Ukrainian Ukrainian network of people who use drugs volna and in the same time etg eights treatment group uh Anton basenka good afternoon so my name is Anton basenka and it's a great pleasure for me to speak after representative of ministry of health with such a detailed um presentation of issues of opioid substitution therapy because i'm one of the first opioid substitution therapy patients in ukraine since 2004 so for me it's really some kind of a personal honor let's say and of course thanks Anna for saving my time because she really presented well the majority of issues we as the community of people who use drugs at least those who are opioid substitution therapy patients were the problems which we faced with um due to this um war um issue so i will speak as Anna mentioned on behalf of two organizations um i will start from a Ukrainian network of people who use drugs next slide please um so it's a network of uh 1500 uh individual members and 28 organizations uh we are doing work on the national level and uh we have our a vaulting seat in in the cabinet of ministers national council on hava it's in tuberculosis which is also ccm country coordination mechanism for the global fund in in the country we have 24 representative offices in on the regional level supporting initiative groups we are doing certain advocacy capacity building we of course advocating and helping to open new service points new opioid substitution therapy sites um we're doing advocacy around legal changes to to have really progressive instead of a regressive or repressive drug policy next slide please um and as you can see we are united and it's a good entry point to the largest key population in Ukraine so estimate number of people who inject drugs it's only who inject drugs estimate number 350 000 people in Ukraine so nobody really tried uh to to calculate properly the the number of people who use drugs i think it's definitely a lot less than a million people um and yeah of course for us our life experience and it's it's the most motivation and of course the peer-to-peer support especially when we are let's say accustomed to live in the war mode let's say i mean the war on drugs mode but when the real war comes into your country and you kind of morally prepared you just of course you just mobilize yourself more and more and you try to find some resources to to you know maybe build some new networks of of help and that's why i want to to show you how how this help could look like in such a critical times next slide please so we were actually one of the first communities who organize and start this support of people who use drugs next slide of course so besides all those issues which which was presented by Anna from Ministry of Health of course people who use drugs as the citizens of Ukraine they faced with the same the same problems as as the common people i mean the houses were destroyed they were in the need of moving to other regions or being evacuated and that's where we as a network of course helped of course we we had certain resources from different organizations but more than two thousands of people who use drugs and their families it's not just people who drugs but their families and relatives they were evacuated with the help of our network next slide please we understand that when your house is destroyed after bombing on shelling and you just or you are moving to another regions of course the first the basic need is where where you live where where would you live so and of course the need of provisions certain temporary residents whether it's a certain shelter or kind of rental rented apartment so more than 400 people received this support from our network as well next slide please of course another basic need is the food and of course we provided we helped with the provision of food sets and more than almost seven thousands of people who use drugs received food assistance from our network thanks next slide please we also realize that it's not just about you know food and and and housing but also certain material aid and some small funds you know for some other needs people really need it as well and almost two thousands of people received certain material aid as well next slide please but what we also of course we are also involved in the we assisted in the delivery of enteroviral therapy and OST drugs because as Anna said when logistics chains were interrupted and of course we were trying to find alternative you know solutions to to to avoid interruptions of life-saving treatment for people in the regions we we we have some opportunity with transport and of course it's our personal commitment as well because it's not only people who use drugs and also personally with HIV and for me and for meaningful part of of people who use drugs let's say in Ukraine of course it's a matter of daily receiving of two medications it's not just opioid substitution therapy it's also ARV interruption of which is is really risky for your life next slide please and of course we support in the system organizing harm reduction programs and access to overdose prevention and here you can see the delivery of harm reduction supplies to one of the regions of Ukraine next slide of course we should always say thanks to organizations who supported us and it would it could be possible without funding and other resources support from the organizations you can see on this slide as well as we always thank you for all who you know who politically supports our community and helps us to to resolve the our issues next slide please yeah I will be really fast so but the first part was about the people in Ukraine so mostly internally displaced people but as representative of European AIDS treatment group it's an oldest network of people living with or affected by HIV and we are based in Brussels in Belgium we celebrated 30 years so of course once first people started to fleeing from Ukraine and the people whose drugs or other communities representatives appeared in EU countries of course it was our also organizational commitment next slide please to start helping them on this side as as as refugees or as the migrants and you can see on these slides what what work we are doing so we had a we organized a separate focal point to coordinate with the different stakeholders and our members and organizations on the local level in the EU member states we contributed to help now UA initiative which my other colleague will will tell more about direct financial support of partner organizations of course we were working with media to raise awareness about what's happening in Ukraine and of course we were collecting donations next slide some policy and advocacy you can also see these specials civil society forum on HIV viral hepatitis in tuberculosis but as a coordination platform for Ukraine and of course we were other events we use for raising the needs of Ukrainian key populations in this emergency context and we've been involved in you know development of certain you know technical documents for Ukrainian refugees and different publications so that's next slide I think that's it from my side thanks a lot for thank you Anton and actually that that's what that was important that how all the country supported and and we all were united and that that's very important to understand the needs and to respond immediately and now I will give a floor to Sergei Filipovich from Alliance for Public Health Ukraine and I hope that Sergei will be fast I will presenting one of the one one of several biggest organizations working in Ukraine how civil society responded Sergei so we described the period which start on February 24 2022 so already already colleagues mentioned that it's create a big challenges to all Ukraine the whole citizens for health care system also many buildings were destroyed the territory occupied and people I need to play or in science country or outside the country so it's about two weeks after was started and you see already near two millions of refugees in neighboring country and then it's up to eight thousand refugees and additional seven seven million so yeah internally displaced people and many health care facilities were destroyed or damaged so all these factors create many challenges for home reduction program for substitution therapy which works from public health center already described and how we manage these issues also many of innovation like transportation logistic of drugs using the alliance in vans mobile ambulance vans and other but starting from first of May 2022 we developed or started developed this service because we start help now I mean we start from chatbot and then date developed services which include chatbot and online case management online medical consultation also we create hubs in Poland and Germany where the biggest number of refugees were allocated very resources and don't mention I want to mention many international partners and national also which without their help it will be difficult to organize services in such short time we put together all information in neighboring country where it's possible to get IRT, OST, other services but I want to mention again that in the beginning first two weeks we mainly or 50% are ended on request in Ukraine because people in Kiev as in hierarchy also ask what shall they do what where they can obtain services or drugs which side function which side not function so and we provide also the information and contact our colleagues at public health center also to provide information navigate patient and organize the possibility for them to receive necessary treatment and services so we describe challenges which particularly in OST area our people face in countries German others I don't want to describe there in detail but it's different system and we use our colleagues our partners organization in these countries also colleagues who have been in these countries to help help our clients to to get this treatment and because only information on site was not enough so and sometimes they need social support they sometimes or frequently when they ask for translation so and we also support them with this uh in serious delivery for us in Ukraine also many uh since happened particularly new priorities for patients appears like humanitarian needs for food shelters uh and we also like our partner organization work on this so land supported city three shelters during one year in January just open a new one in the hostel format and we plan to open so I want to mention international support and international communication we share experience of civil society in Ukraine we describe how civil society react and face this crisis and also we have received support from regional drug policy commission this commission due media briefings also bring attention to the war in Ukraine and the challenges health system faced in this time so about OST we actually had from each presentation but again it was in March 2022 decrease of number of patients due to acupuncture due to some patient migrated or go to other sites but after all we even managed to increase during the year number of patients so it's public health sectors and also we need to add those who receive treatment from private so actually figures already presented in conclusion so it's clear that community-based services prove the effect effectiveness to sustainability response during the war managed to provide immediate response to urgent needs and challenges provide quick and life-saving services also civil society organization organized operations from the war zones fast need services provided and with this important important lessons with the story with the discontinuation of the life saving services like it was in Crimea occupied and passed as in Ukraine in 2014 repeat again the newly occupied territories so an immediate termination of home reduction services and life saving treatment for people who live with HIV and for people with drug dependency so history represents sanction thank you Sergei and thank you to your team of for this resilient and for this support actually what war is is showing that the true network and true support and true community in the pure meaning and that's what we saw in our Eurasian network Eurasian Association of Harm Reduction we saw how in the first days all around the Eastern Europe Central Asia all our community organizations stand up with Ukraine to support Ukraine and that was 24 seven support never paid by the by the local countries or municipalities never expected like this and we are grateful to Polish colleague Moldova Lithuania Estonia Latvia everybody were mobilized and from our partners Poland became the first stop and first location for millions of Ukrainian and I will give the floor to Magdalena Barknik from precursor foundation for social policy from Poland to share the story of the support and solidarity good morning so after the invasion started in February and March there were 2.4 million entries to Poland and what we saw was the mass solidarity movement of families neighbors local communities and non-governmental organization and enormous grassroots spontaneous mobilization not sorry next slide sorry yeah not counting on state and not waiting for the response private and institutional activists activities overlapped town mayors and community members were transporting those fleeing the war helping them materially and hosting them in the cities everyone helped state involvement was then criticized at that point for being too late insufficient interfering with much more effective spontaneous action next slide please March 12th the act on assistance to citizens of Ukraine was signed giving access to social benefits public health care education and labor market according to European Union agency for fundamental rights survey from published this year among very important data we need to underline that health conditions of refugees residing in Poland are alarming 20% assess it as bad 44% as average the most common barriers to getting medical care is lack of knowledge of language and not understanding the functioning of medical system as of March yes as of March 6th there were more than 1.5 million million people registered for temporary protection in Poland 85% women and children and 15% men next please according to MCDDA transporter breathing an estimated number of people who inject opioids from Ukraine in Poland is between two thousand and eight and a half thousand and OAT patients 120 to 500 before war there were the estimated number of Polish citizens using opioids in injection was between 15 and 70 thousand and there were 3000 OAT patients and that is since 1992 there were around 2500 clients of harm reduction services the current situation of Ukrainian people who inject drugs 120 around 120 OAT patients 380 contacts but that includes also HIV testing so harm reduction services and opioid agonist treatment programs had around 100 people sorry like without the patient so around 100 people of harm reduction services next please when you look at the pre-existing conditions the harm reduction and OST coverage is really low you see the map the blue points are opioid agonist treatment programs substitute a medication is not prescribed by doctor and these three red cities there are harm reduction programs being run there a couple of few needle and surgeries exchange programs in other parts of of Poland OAT and HIV clinics are in urban settings OST is a high high threshold programs with with sobriety regime low access to HIV and hepatitis C really low access to social help no access to self self to safe housing and shelters for people who use drugs and lack of gender sensitive programs next please so in the our project founded by AIDS funds and Mercy Corps supporting people who use drugs coming from Ukraine we're working through outreach online and in-person assistance in assistance in accessing and maintaining treatments emotional support and material aid since 2017 we've been running harm reduction mobile unit with the foundation for social education providing HIV hepatitis C and STI testing and middle syringe program and there were also many Ukraine clients reaching that service next slide please what are the barriers in accessing treatment language and communication providing information is not enough people need to be assisted every stage of the treatment entry process there are different working hours of OST programs and HIV clinics doctors who admit the treatment were for example for two two hours in a week so it's not just an information of address and contact but the people what we when needed really to arrange and schedule the meetings and find out all requirements needed like medical records sometimes translated medical records and so on logistics it's when you're a woman being hosted in the eastern part of Poland because people were taking refugees all around the country and the nearest OAT program is 200 kilometers away and our HIV clinic it is really difficult to reach these facilities if you have a child it's even more challenging and when you realize the situation of people being hosted small virgins and towns far away from urban settings and lack of ability to really communicate whereas harm reduction services can navigate system really well this is really important to to underline the assistance and being with someone at every stage there are also of course unmet needs child care and social help we also helped we also provided material aid of course stigma and fear so we try to ensure the sense of security and offering emotional support once again harm reduction was the place of of safe ground and safe environment there were people saying that we were the only ones they could display their drug use and health status and not talking about this with their host families or any other organization and this is crucial when you think of reaching to people and really getting the getting in touch with them and access and and helping them to get to treatment the barriers and challenging in providing access to treatment administrative issues it's a question of legal requirements in excessive treatment but also a question of ability of addiction facilities to ease treatment restrictions giving patients bigger doses one time for example in for two weeks and not to have patients to come to program every day national program capacity is also in issue as we know that there are already waiting lists for patients to want to enter the treatment lack of psychosocial support safe housing social assistance and employment within the programs and lack of female sensitive approach we we also have to take into account people and move and the continuity of care barriers in accessing harm reduction services not knowing about services not a new environment different needs and of course stigma but the challenge is connected with harsh drug law and a lack like lack of life-saving medications we do not have naloxone available in Poland and people do ask ask for it methodically in liquid form and and it's really I mean it it impacts people and increases risk when it's injected and people on the move and being contact with them this was also was also a challenge so building relationship with the community based on peer work and trying to meet the needs that was our main focus thank you thank you very much for this actually he wrote and what I need to say this war and this this disaster bring us to the real true meaning of harm reduction which is solidarity providing help support employment food place to shelter to stay mental health and unfortunately this would be the systematic problem and we are facing it as a systematic problem which catalyze problems in harm reduction in European country in hosting countries in Central Asia but I believe that in solidarity we really succeed to to do the better systems for Europeans for Ukrainians not together we will win thank you very much