36 hours aboard MSF's medical train in Ukraine

A glimpse inside MSF’s medical train as it evacuates patients from a hospital hit by shelling near the front lines of Kherson.

MSF teams treat patients aboard the medical evacuation train in Kherson, Ukraine

Ukraine 2023 © Yuliia Trofimova/MSF

“I always wear two rings when I am on the train. This jewelry is simple, almost invisible on my hand, but when I need to relax or calm down, I roll the rings around my finger. It's such a small thing, but it connects me to home and gives me a sense of peace. It gives me strength.”

Nataliia Pivovar works aboard the Doctors Without Borders/Médecins Sans Frontières (MSF) medical train in Ukraine, which is used to evacuate patients from frontline areas to safer regions within the country.  

Another journey begins today. Nataliia feels confident and resilient because there was no shelling that night, so she managed to sleep. This is necessary because the next night will be almost sleepless—she will spend 36 hours on the medical train caring for patients, most of whom are elderly people with dementia, cerebral palsy, and other neurological disorders. 

An MSF doctor aboard the medical evacuation train in Ukraine checks on a young patient.

Dr. Nataliia Pyvovar. Ukraine 2023 © Verity Kowal/MSF

"It's important for patients with psychiatric conditions to feel the floor under their feet. It makes them feel calmer and more at ease.”
— Dr. Nataliia Pivovar

“We are preparing the train for the journey to Kherson,” explains Nataliia. “We've placed fresh linen on the beds and provided a hot kettle and lunches for each carriage. Ukrainian trains have lower and upper benches. This time, we are using only the lower ones. It's important for patients with psychiatric conditions to feel the floor under their feet. It makes them feel calmer and more at ease.” 

Arrival in Kherson 

When the train arrives, the sun is shining in Kherson. Patients are settled into the carriages, covering their eyes from the bright rays with their elbows while sitting in wheelchairs or on stretchers. Many of them have limited mobility and rarely go outside while receiving treatment in special facilities. Nataliia notices that some people look confused. 

“The frontline is very close and during the boarding process, shelling starts nearby, and explosions are heard. Some elderly people have hearing impairment, so they aren’t sure what is going on. They ask us if everything is alright. I have to reassure them, saying, ‘Everything is calm. It's important to get on the train now, and we will soon take you to a safe place.’” 

An MSF team member checks the blood pressure of a patient on the MSF medical evacuation train in Ukraine
Halyna Milovus, a nurse with MSF, checks the blood pressure of a patient who is one of 150 people evacuated from a Kherson hospital after it was shelled. Ukraine 2023 © Verity Kowal/MSF

The journey brings challenges. Doctors and nurses explain to each patient where they are going and why. “People ask me if it will be safe at their new destination and if they will return. During these conversations, I think about my own grandmother and how difficult it is for the elderly to change their surroundings and living conditions.”  

Nataliia goes through one carriage with nine patients. Some need their blood pressure measured, some need medication, and others are connected to an oxygen station. 

She steps out into the vestibule between train cars, standing alone as she twirls her rings, takes a deep breath, and then enters the next carriage with a smile. And so it continues, carriage-by-carriage on the MSF medical train. 

View through the window of MSF's medical evacuation train in Ukraine
MSF teams assist an elderly patient in a wheelchair as they evacuate Kherson, Ukraine.

A view from the window (left); MSF teams transfer patients by ambulance to the medical train (right). Ukraine 2023 © Verity Kowal/MSF

Belongings saved and those left behind

Each patient carries only a small bag with them, containing some clothes and documents. Among the 150 patients being evacuated, only a few have photographs—for most, all they have left are their memories. This is the first journey Nataliia can recall where people have only their most precious possessions. For many onboard, their other belongings were either destroyed when their homes were attacked, or they didn't have time to take anything, as they left amidst shelling. 

It’s important to create a calm atmosphere throughout the carriage. If one patient becomes anxious, it can affect the others. Nataliia and her colleagues make tea and serve lunch, which comforts the patients. 

Ukraine: MSF evacuates 150 hospital patients due to attacks in Kherson region

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“After each evacuation, there are patients whose eyes I remember for a long time. I ponder their stories, their paths, and destinies.”  

Among them is a 17-year-old boy from Kherson with cerebral palsy, impaired vision, cannot speak. At first, he is anxious on the train, fidgeting on his bed and growing increasingly distressed. Nataliia approaches him and gently starts talking to him, holding his hand. 

“The boy touched my rings, and I told him that everyone should find their own amulet in life. It could be anything—a necklace, a favorite cup, a handkerchief, a small stone. This little thing could save you from anxiety and loneliness. The boy calmed down as I spoke to him.”  

Although he can't express it in words, Nataliia feels his gratitude.

Established in March 2022 in collaboration with Ukrainian Railways. the train transports patients away from overwhelmed hospitals in Ukraine’s east and south to other hospitals with more capacity, farther from the frontlines.

About Nataliia
Dr. Nataliia Pyvovar is from Kharkiv, which is located in the northeast of Ukraine. Before the full-scale invasion, she worked in an ambulance and in the pediatric intensive care unit of the Ministry of Health. She has been working as a doctor with SF since June 2022.