Winter's Toll: Assessing the Public Health Impact of Cold-Related Illnesses and Energy Damage in Ukraine During the Invasion.

During the Russian invasion of Ukraine, targeted attacks on energy infrastructure exposed civilians to heightened cold-related health risks. This study aimed to: (1) characterize respiratory infections and cold-related injuries during the conflict; (2) identify vulnerable sociodemographic groups; (3) assess household adaptations; and (4) evaluate how winter preparation influenced health outcomes. We surveyed 2,311 households across 24 Ukrainian oblasts during the 2022-2023 winter. One adult per household provided data on demographics, winter preparations, housing, heating, and access to services. Machine learning models were used to predict respiratory infections, symptoms, and cold injuries, based on sociodemographic and household factors. Respiratory infections affected 75.2% of participants, and 3.76% reported cold injuries-rising to 10% among older adults. Larger households experienced more respiratory infections, while Russian-controlled areas reported higher cold injury rates. Key predictors of respiratory infections included age, household size, financial stability, and heating practices; cold injuries were predicted by age, region, anxiety, and household size. This is the first study to apply machine learning to examine cold-related health impacts following energy infrastructure attacks in an active conflict zone. Our findings underscore the vulnerability of older adults and the widespread burden of respiratory infections, highlighting the need for targeted cold injury prevention in conflict-affected and cold-climate regions.