Disruptions in basic health services such as vaccination programs and treatment of diseases like AIDS were reported in 92% of 129 countries, a World Health Organization survey on the impact of the COVID-19 pandemic showed on Monday.

The survey, conducted in November-December 2021, showed services were “severely impacted” with “little or no improvement” from the previous survey in early 2021, the WHO said in a statement sent to journalists.

Emergency care, which includes ambulance and ER services, actually worsened with 36% of countries reporting disruptions versus 29% in early 2021 and 21% in the first survey in 2020.

Elective operations such as hip and knee replacements were disrupted in 59% of the countries and gaps to rehabilitative and palliative care were reported in about half of them.

The survey’s timing coincided with surging COVID-19 cases in many countries in late 2021 due to the highly transmissible Omicron variant, piling additional strain on hospitals.

The WHO statement attributed the scale of disruptions to ”pre-existing health systems issues” as well as decreased demand for care, without elaborating.