Magnitude and duration of emergency department shock following the Ukrainian refugee surge in Poland

Background

Large-scale forced migration can create sudden pressure on emergency departments (EDs), yet the magnitude and duration of these shocks are rarely quantified. Following the 2022 Russian invasion of Ukraine, Poland hosted millions of Ukrainian refugees, with 1 million settling temporarily. Evidence is limited on the duration of refugee-related acute care demand and its return to baseline. This study quantified the size and duration of the refugee-related ED surge in a major Polish city, a key transit-reception hub in Poland.

Methods

We conducted a retrospective time-series study using ED visit data from a large hospital in Kraków, Poland. Bayesian Structural Time Series analysis estimated the effect of the Russian invasion on ED visits by Ukrainian nationals. The pre-period was March 9, 2020–February 20, 2022, and the post-period was February 21, 2022–December 31, 2023. The control series included ED visits by patients of other nationalities. ED visits excluded suspected COVID-19 (modeled separately as a covariate).

Results

During the full post-invasion period, mean weekly Ukrainian ED visits were 11.4 vs. 5.0 predicted, corresponding to a 131% relative increase and 619 excess visits (95% CI 500–743). During the acute crisis phase (February–October 2022), mean weekly visits were 24.1 vs. 6.1 predicted, corresponding to a 308% increase and 595 excess visits (95% CI 525–652). ED demand peaked at ∼40 excess visits/week. Utilization returned to the modeled baseline on October 9, 2022, indicating a 7.5-month acute ED shock.

Conclusions

Ukrainian refugee-related ED demand rose substantially, but excess use was time-limited, concentrated in the first 7.5 months after displacement. Findings support rapid ED surge planning during humanitarian crises, including temporary staffing, interpreters, and flexible bed capacity. Real-time monitoring of nationality-linked utilization may strengthen preparedness and resource allocation during future migration emergencies.

Key messages

• Ukrainian refugee ED visits surged sharply after the Russian invasion of Ukraine, increasing by over 300% during the acute phase.

• The surge was temporary and returned to baseline after 7.5 months, highlighting the need for rapid, flexible ED capacity and real-time monitoring during migration crises.