1. Introduction Ukraine gradually moves to development firstly as an independent, sovereign, strong, respected by the world community state and as a competitive, prosperous, self-sufficient member of the Europe- an Community; and secondly as democratic with formed civil society, social and legal state, country of health and welfare. Complicated social transformations associated with preservation of the integrity and sovereignty of Ukraine, burdened by a number of today’s geopo- litical antagonism, internal and external challenges, such as opposition to separatism with the formation of the national unity resulting in “Anti-Terrorist Op- eration” (hereinafter – ATO). The transformation processes in Ukraine related to long, lasting and sporadic, multifaceted political and economic transformation of systems providing the country functioning and livelihoods of people today still relate to the need of drastic changes in organization, management, financing etc. It signifi- cantly negatively impacts, primarily the social sector, causing increased social differentiation of popula- tion and decline in quality of life, reduction in so- cial protection and confidence in the future of the Journal of Geography, Politics and Society 2016, 6(3), 18–24 DOI 10.4467/24512249JG.16.016.5803 SocIal ProtectIon of ato PartIcIPantS and memberS of theIr famIlIeS In modern condItIonS of develoPment rISkS of UkraIne Olena Korolchuk The National Academy of Public Administration under to the Office of President of Ukraine, Ezhena Pottier 20, 03-057 Kyiv, Ukraine, e-mail: terrasanitas@gmail.com citation Korolchuk O., 2016, Social protection of ATO participants and members of their families in modern conditions of development risks of Ukraine, Journal of Geography, Politics and Society, 6(3), 18–24. abstract In this article we analyze the unfavorable demographic, social, economic situation, which has been forming for 20 years in Ukraine and now is burdened with military actions. That’s provoking increasing a number of people, who having received disabilities and, as a result, need versatile rehabilitation. The state takes care of its defenders and their families. Defined at this article risks, unfortunately, impede rehabilitation, resettlement and reintegration of those who participated Anti-Terrorist Op- eration and members and their families. key words public health, socio-economic situation in Ukraine, Anti-Terrorist Operation, the participants of the Anti-Terrorist Operation, social protection. Social protection of ATO participants and members of their families in modern conditions of development risks of Ukraine 19 citizens, physically and mentally complicating their livelihoods. Thus, the priority tasks are building and improvement of medical and social support towards the establishment of such a system that would meet modern world standards and ensure promising fu- ture to the population of Ukraine. Thousands of Ukrainian mobilized soldiers and volunteers protecting the territorial integrity and in- dependence of the homeland, during the last year had to practice military skills, look into the eyes of war due to ATO in the east. Nowadays reality stipu- lated by increasing role and value of management factors, the need for new forms, methods and tech- niques of organization and management lead to formation of new scientific modern mechanisms of state control for regulation of social relations in this sphere: including ATO procedure, regulation of ATO participants status, creation of perfect and ef- ficient system directed to preventive medical and welfare improvement of health of the ATO partici- pants and members and their families. The absence of multifaceted, complex, interdisciplinary, scientific and analytical researches on the medical and social security of ATO participants and members of their families with option of effective ways, methods and procedure for solving certain scientific and practical problems that would show the feasibility and ways of implementing qualitative changes in public ad- ministration led to the topicality of this article. At the meeting of WHO Regional Office for Europe in 2009 “Health in times of global economic crisis: Implications for the WHO European Region” (1–2.04, Oslo, Norway) it was highlighted that the current global crisis is a serious global threat to health sys- tems, social security and public health in general, because in continues at the background of global environmental and energy issues and profound demographic changes that in modern Ukraine are complicated with hostilities of ATO. It is universally recognized that the socio-eco- nomic situation in a country determines the state of public health. Thus, lower incomes during the crisis lead to a feeling of uncertainty in the future, which inevitably causes negative changes in health status and increasing needs of the population in medical and social protection while the state is unable to sat- isfy it fully. On the other hand, it is common that deteriora- tion of public health is a prerequisite for deeper ir- reversible effects of socio-economic and spiritual development of the Ukrainian nation, the real threat to Ukraine’s national interests. Unhealthy nation cannot at full strength resist negative external and internal (social, economic, socio-political, environ- mental) factors to solve complex problems in order to overcome the crisis. Therefore, it is necessary to identify, evaluate ex- isting and potential risks and ways to minimize or eliminate their negative impact. Implementing anti- crisis measures, to adopt effective appropriate deci- sions to complete the transformation processes and future development. 2. Problems and risks of health care and social spheres For the last 15 years, unfortunately, in Ukraine the demographic situation, accumulating influence of a wide range of factors (transient and long term, related to the specific socio-historical development caused by modern social changes) is characterized by a decrease in the total population, reduction in life expectancy for both men and women; decrease in birth rate, increase of death rate, lack of natural growth; aging of population with increased “load” for working persons, deformation of gender and age structure by predominant death rate of men; in- crease sanitary-epidemiological problems at risk of outbreaks and dissemination of infectious diseases, worsening the situation of tuberculosis and HIV; sig- nificant deterioration in the health of the nation with increased premature mortality and so on (tab.  1.) (Лібанова, Курило, 2012; Рингач, 2014). The problems and risks of health care also include reducing the availability, quality and effectiveness of Tab. 1. Demographic indicators in Ukraine for the last 5 years 2010 2011 2012 2013 2014 Total population [millions of persons] 45,778.5 45,633.6 45,533.0 45,426.2 42,928.9 Rate of natural increase, population decline [thousands of persons] -200.5 -162.0 -142.4 -158.7 -144.2 Number of births [thousands of persons] 497.7 502.6 520.7 503.7 465.9 Number of deaths [thousands of persons] 698.2 664.6 663.1 662.4 632.7 Migration increase, population decline [‰] 16.1 17.1 61.8 31.9 22.5 Source: Data of the official website of the State Statistics Service of Ukraine (Дані офіційного сайту Державної служби ста- тистики України). 20 Olena Korolchuk medical care (prevention, treatment, supervision) at all levels and medications support, medicines, which come amid a surge of quantity, change of need for medical and social care and growth in the number of contingent in need for state care; difficulty of healthy lifestyle. Decreasing the number and reducing health state of Ukrainians, migration outflow of young, ac- tive and rich segments of the population automati- cally lead to deterioration of the country’s labor po- tential competitiveness. Among worsening economic risks in Ukraine are chronic budget deficit, devaluation of the hryvnia, reduce of real value of the allocated funds, respec- tively, the country’s inability to ensure implementa- tion of the adopted social programs and activities during growth and modernization of social needs, corruption; loss of income by the most people etc. The economic risks were enlarged by necessity of warfare in eastern Ukraine, going beyond the de- stroyed region, formed a chain of economic losses of the country: numerous enterprises, commodity markets and jobs which, in turn, increase unemploy- ment, decrease budget revenues and social insur- ance funds, thus the capacity of the state to provide social programs and activities of medical and social sphere. Repeated increase in funding the military sphere and restore of destroyed infrastructure also turn into increase of budget expenditures. Risks and effects of social issues are related to the loss of housing, livelihood due to large-scale displacement of people from temporarily occu- pied (so called „gray zone”) and located close to the boundary territories, which remain industrial desert and reduce the chances of reintegration of the local population. Fall in living standards combined with fear for life (own, children`s, relatives`) increase migration, par- ticularly people are fleeing with intention to change the country forever – this is the risk-effect that will influence the development prospects of the country for many years - massive exodus of active employ- able people produces direct loss of labor and repro- ductive, intellectual potential – Ukrainians will work in other countries, spend their money, and have chil- dren there. The spread of unemployment, growth of tradi- tional risk groups and the emergence of new risk groups – victims of social conflicts and refugees – provoke increasing of social tension in Ukrainian society, large scale of social exclusion, marginaliza- tion and polarization of the population. The issue of increasing the number of children who receive no education requires special attention – it is a poten- tial threat for rising crime. In Ukraine there is a high degree of deterioration in the quality and accessibility of different popula- tion groups to social activities (including education and health care), social and economic inequality, in- cluding gender and territorial. Socio-legal problems, which Ukrainians fre- quently face, are related to the protection of so- cial and economic rights, including receiving the state financial assistance, because today Ukraine is a country of privileges, subsidies and grants: from social protection for poor families, pensions, aid to unemployment subsidies for utilities; child benefits (childbirth assistance, child care, single mothers) to the important issues related to the participation of the citizens in ATO (guarantees during mobilization, the status of combat veteran, compensation in case of injury or death, treatment of wounded, prosthet- ics). Also matters about housing of families of the soldiers who died in ATO are important for the ATO participants and their families. The most important thing today in different re- gions of Ukraine is the problem of social protection of migrants (status of migrant, restore of lost docu- ments, registration, targeted assistance for employa- ble and disabled family members, dismissal and em- ployment). As of February 1, 2016, according to the data of social protection structural units there were registered almost 1,705,000 persons or 1,346,276 families from Donbass and the Crimea. Also, social risk-effects include uncontrollable territories of Ukraine, full of weapons complicated criminal situation, increasing manifestations of sep- aratism, banditry and threats of terrorist acts that inevitably spread to remote territory from warfare areas. Sharp political confrontation, bloodshed increase aggression in society; set up illegitimate methods for disputes and conflicts resolution; lead to usage of force and weapons. There appears a need for fast and simple solutions – the threat of criminalization and dehumanization of society in general, when emotions, accusations and revenge come to the fore; intolerance, values split, atomization of society are catalyzed. Events in the east, ATO caused except economic and social very important psychological impact on Ukrainian society – the war has generated a num- ber of challenges and threats to socio-psychological nature. Prolonged existence of the population in state of acute and chronic stress is provoked and/or en- hanced by common socio-economic problems of life in Ukraine and ATO. This will have social Social protection of ATO participants and members of their families in modern conditions of development risks of Ukraine 21 risks-effects – increase in number of patients with mental disorders (post-traumatic syndrome, psycho- somatic disorders) and behavior (socially dangerous and suicidal). It has been dozens of suicides of ATO participants returning home, including healthcare workers. According to the Ministry of Defense 171 Ukrainian soldiers committed a suicide in 2014, but it is believed that the real number is much higher. Alcoholism and drug addiction are major problems today among Ukrainian demobilized soldiers. Continuous military operations and constant in- crease in a number of their participants (currently there are more than 124,000 soldiers, who has com- bat veteran status) create implications, risks-effects of post-war syndrome, resocialization of demobi- lized soldiers and their families. Socio-psychological risks-effects are complicated with inadequate per- sonnel support from state managers to sociologists, physicians, psychologists. However, there have been positive changes of socio-psychological situation in Ukraine, manifested in the acceleration of integration of Ukrainian politi- cal nation, society has united for the idea of building an independent sovereign state; enhanced social connections - social capital is gradually increasing, particularly through the establishment of a new sys- tem of contacts between total strangers. The awareness and the desire to avoid public danger led to the formation of active mass volunteer movement – a bright manifestation of strengthen- ing civil society, growth of its social role and new alternative informational system, formation and use of which involves Ukrainians, especially young and middle aged – as a sign of democracy. 3. Some aspects of the social protection for ato participants Today Ukraine has a system of social protection at three levels: national (Presidential Administration of Ukraine, the Cabinet of Ministers of Ukraine, Verk- hovna Rada (Supreme Council) of Ukraine, ministries and departments, courts), regional (regional admin- istrations, regional councils, departmental territorial bodies), local (district administrations, district coun- cils, departmental territorial authorities, enterprises, institutions and organizations). The bodies and institutions that provide social protection for ATO participants coordinated by the Ministry of Social Policy, are: • State Services of Ukraine for war veterans and members of the Antiterrorist Operation, services on Labour, Employment and Pension Fund of Ukraine; • Territorial social security agencies (total of 696 – structural subdivisions: 25 regional departments, one city department in Kyiv, 670 district offices); • The network of social services for families, chil- dren and youth (total of 692 centers, 25 regional, 464 district and 138 local, 31 district-city, 34 vil- lage); • Services for Children (total of 695 services, 24 regional, 464 district and 143 local, 60 district in towns, 3 city); • Centers of Vocational Rehabilitation for Disabled (total of 10 centers, with the ability to provide re- habilitation services to about 1.6 thousand peo- ple with disabilities); • Specialized resort facilities (total of 4 sanatori- ums: “Peremoga” (Kyiv), “Batkivshchyna” (Truska- vets), “Slava” (Myrgorod), “Salut” (Odessa)); • Children’s Center State Enterprise “Moloda Hvard- iya”; • Fund of Social Protection for Disabled; • State experimental prosthetic and orthopedic enterprises (12 state enterprises and 70 - private); • Ukrainian Scientific-Research Institute of Pros- thetics and Rehabilitation. As indicated above, more than 124 000 of Ukrainian citizens – ATO participants have received combat veteran status, so state social protection system now conducts 6 programs for social protection of ATO participants and members of their families: With regard to obtaining combat veteran status. At first the Interdepartmental Commission on grant- ing combat veteran status was established. Today, combat veteran status is given under simplified pro- cedure by departmental committees dealing with these issues. With regard to resort treatment. 3,700 tickets for ATO participants were purchased; more than 200 people were made healthier under this program in summer. With regard to housing of ATO participants. Close fruitful cooperation of social security bodies and local authorities is being conducted. More than 10 million UAH were transferred for housing of 25 ATO participants; another 10 million UAH are planned for purchase of housing for 19 ATO participants. 64 mil- lion UAH were allocated from budget for housing to those who lost functionality of the lower extremities during ATO. With regard to prosthesis. 120 ATO victims got prostheses, four injured soldiers received biological and myoelectric prostheses abroad (cost from 30 to 45 thousand euros). Each ATO participant who needs high-tech prosthetics, not available in Ukraine, by the decision of departmental commission can count on aid (over 2 million UAH). People who need 22 Olena Korolchuk prosthetics or provision of technical means of re- habilitation are monitored. Currently, nine soldiers prepare for prosthesis under this program. It is im- portant that professionals work abroad to open in Ukraine service center for imported prostheses. With regard to psychological assistance. Psycho- logical support is provided to ATO participants by experts of both small and large medical institutions (there are 20 hospitals, 29 hospital departments - in total, more than 6.5 thousand beds) and private enti- ties. 50 million UAH were allocated for the program of psychological rehabilitation of ATO participants from the state budget. As of August 1, 2015 psycho- logical support and rehabilitation were provided to about 20 thousand families of ATO participants. With regard to social and professional adaptation of ATO participants. The state provides 27 million UAH for social security program. Retrain and second specialty groups are being formed with the help of NGOs and volunteers. It will help ATO participants to adapt to new conditions. Of course, all the problems of people who until recently were carrying out military service in east- ern Ukraine these six programs cannot solve. There is a lot of questions, a lot of conflicts, sometimes they require innovative solutions. For this purpose new modern mechanisms of public influence are in process. This issue is under ongoing debate among ex- perts, managers and scientists. Personnel is taught, qualification of specialists such as management spe- cialists, social and medical workers military psychol- ogists is increased. Social protection for ATO participants and mem- bers of their families is carried out by State Employ- ment Service. Pursuant to Presidential Decree No 150/2015 of 18.03.2015 “On additional measures for social protection of Anti-Terrorist Operation partici- pants” [Про додаткові заходи щодо соціального захисту учасників антитерористичної операції], Order of the Cabinet of Ministers of Ukraine of 31.03.2015 No 359-p “On Approval of action plan for medical, psychological, vocational rehabilitation and social adaptation of Anti-terrorist Operation participants” [Про затвердження плану заходів щодо медичної, психологічної, професійної реабілітації та соціальної адаптації учасників антитерористичної операції] and Order of the Cab- inet of Ministers of Ukraine of 13.01.2016 No 10-p “On approval of Interagency Action Plan for Adapta- tion to Civilian Life of Anti-Terrorist Operation par- ticipants” [Про затвердження плану міжвідомчих заходів з адаптації до мирного життя учасників антитерористичної операції] in order to promote employment and social integration of Anti-Terrorist Operation participants, State Employment Service Fig. 1. The number of people receiving assistance from State Employment among ATO participants in different regions of Ukraine as 31.12.2015 Source: Data of the official website of the Ministry of Social Policy of Ukraine (Дані офіційного сайту Міністерства соціальної політики України) Social protection of ATO participants and members of their families in modern conditions of development risks of Ukraine 23 ensures full range of social services, including em- ployment, vocational guidance and training, etc. Since 2015, 21,100 unemployed among ATO participants took advantage of State Employment Service, more than 700 of them have disabilities. 20 200 persons received unemployment benefits. 4 000 persons, including 78 people from among the disa- bled got work. The age structure of the unemployed among the soldiers who took part in ATO is as fol- lows: every tenth person is 15–24 years old, over 19% are from 25 to 29, one in five is 30–34, 38% are per- sons of 35–44, 12% are persons of over 45, including 1% of over 55. Division of unemployed by education among the soldiers who took part in ATO is as fol- lows: people with vocational education represent al- most 50%; people with higher education – 27%, pri- mary and secondary education – 26% (http://www. dcz.gov.ua/statdatacatalog/document?id=393494). In 2015, half of the unemployed soldiers among ATO participants were employed at positions of leg- islators, senior civil servants and managers, each one of six at worker position, 7.4% at elementary occu- pations and 6.6% at positions in trade and services. 1,500 ATO participants started their own business at the expense of one-time payment of unemployment benefit since 2015 (Офіційний сайт Міністерства соціальної політики України). Since early 2015, more than 2  200 ATO demobi- lized participants were trained at the advice of State Employment Service. Thus, at the end of 2015, 14 700 persons had unemployed status (decrease of 6,400 people – 30% for a year); unemployed among ATO participants, of which 14,000 received unemploy- ment benefit (30% less than at the beginning of the year). In January-February 2016, 16,500 unemployed ATO participants took advantage of State Employ- ment Service. 15,900 people received unemploy- ment benefit. 1 000 persons got a job, including 968 persons, who were employed at the advice of State Employment Service. 325 of them received one-time payment of unemployment benefit for organization of own business. 870 unemployed among ATO par- ticipants underwent vocational training. 359 such persons were involved in public and other tempo- rary works (Кондратенко, 2015). Figure 1 shows the number of people receiving assistance from State Employment Service, among ATO participants as of 31.12.2015 in different regions of Ukraine. 4. Summary Ukraine faced with resolving the issues of further development with the formation of national unity, preserving the integrity and sovereignty, which is burdened with a number of today’s geopolitical an- tagonism, external and internal risks, including op- position to separatism and conduction of ATO. Negative demographic dynamic described herein above, burdened by deterioration of health, economic and social welfare as a result of long-term sporadic maintenance, chaotic changing vectors of implementation and incompleteness of reform pro- cesses in country`s functioning. Unfavorable demographic, social, economic situation, which has been forming for 20 years is burdened with military actions in the area of ATO, provoking increasing a number of people, who need versatile rehabilitation, having received disabilities, especially considering the fact that 70% of them are people of working age. An important fact is increas- ing a number of family members of ATO participants, those who doomed to limited opportunities for quality development over the next decades. Solving the issue of adequate medical and social security for ATO participants and members of their families is an important duty of the state. In 2016 systems of medical, social and psychological care for this category of people are being developed and started to work efficiently in Ukraine. But only a few areas of theory and practice are developed to- day, rehabilitation activities and institutions are be- ing elaborated, but a proper level has not yet been reached which is determined firstly by lack of experi- ence, and secondly by lack of relevant capabilities. Thus, the state takes care of its defenders and their families, but there is still a need for optimal variant of complex multi-stage rehabilitation and competent scientific approach to the governance of medical and socio-psychological support of ATO participants and members of their families. Despite general awareness of the importance of integrated rehabilitation, recovery and return to normal life of soldiers; support to their families, there are still no clearly defined common methodo- logical approaches to medical, vocational and social rehabilitation, no complete national system for com- prehensive medical and social rehabilitation for this group of people. Therefore, further researches and development are very important for the theory and practice of public administration in particular and development in general. Solution to these complex risk issues described herein is an important task of government and now- adays, in our opinion, lie in securement of adequate living conditions and productive life of society as a whole and each individual in particular. 24 Olena Korolchuk references Health in times of global economic crisis: implications for the WHO European Region. Overview of the situation in the WHO European Region: reference and analytical document, 2009, WHO Regional Office for Europe, Copenhagen. 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