The Paradox of Preparedness - Cold-Related Health Risks in Ukraine's War-Torn Winter

Abstract Older adults in conflict zones face heightened health risks, exacerbated by damaged housing and limited healthcare. In Ukraine, cold injuries and respiratory infections are significant but understudied threats. A survey of 2,311 Ukrainian households (April–May 2023) revealed widespread respiratory infections (86%) and cold injuries (8.6%) among 1,045 older adults. Using chi-squared tests, frequency analysis, and machine learning (Random Forest, XGBoost, AdaBoost, KNN), key predictors were identified with strong model performance (AUC > 0.9). SHAP and Explainable Boosting Machine analyses enhanced interpretability. Not performing home repairs was the strongest predictor of cold injuries (p = 0.004, η² = 0.54). Other key factors included insulation, window installation, and heating methods. For respiratory infections, seven predictors, including internal displacement, marital status, and food/water storage, were significant (q < 0.05). Interaction effects (η² = 0.38–0.58) highlighted compounded socio-economic and housing vulnerabilities. Machine learning consistently prioritized home repairs, insulation, and socioeconomic factors. This hybrid approach balanced statistical rigor with predictive accuracy. Findings underscore the critical role of housing infrastructure in protecting vulnerable populations. Targeted housing interventions and improved resilience are essential to mitigate cold-related health risks and cascading health threats during crises in conflict-affected regions.