Abstract
Although the devastation of war is well recognized, no previous study has systematically integrated the interplay of conflict intensity, access to humanitarian aid, environmental conditions, and infrastructure to understand how these factors collectively shape health vulnerability across war-affected regions. Using spatial and suitability modeling, we assessed multidimensional vulnerabilities in Ukraine during the Russian invasion, including mental health risks, environmental stressors, and infrastructure disruptions. We developed a multi-source conflict-related health impact database (February 2022-December 2023). Sleep, mental health, and casualty data were collected through national online surveys (n > 2,312). Data was cleaned, geolocated across 461 cities, and analyzed using Inverse Distance Weighting interpolation. Logistic and spatial regression were used to assess relationships between conflict exposure, living conditions, mental health, sleep deprivation, and cold injury risks. A composite vulnerability index was created using weighted Principal Component Analysis-based methods. Regions with intense conflict, poor housing, frequent power outages, food shortages, and limited access to healthcare and aid faced the highest vulnerability. Cold and damp conditions, housing damage, and resource scarcity exacerbated household living conditions, especially in eastern and northern Ukraine. Not all high-conflict areas had poor mental health outcomes; cold, damp, crowded housing, food insecurity, and power outages were equally critical drivers. Mental health issues (PTSD, depression, and insomnia) were highest in regions with harsh winters, poor infrastructure, and limited aid. War-related health issues extend beyond direct conflict exposure and involve the interplay of conflict, environmental stressors, and infrastructure damage in shaping casualties, sleep, and mental health outcomes.