It’s a bright sunny morning in a Ukrainian hospital near the front lines, with patients napping in their rooms. The night prior, the sound of explosions and Russian drones had made it difficult to sleep.
As patients with complications continue to arrive, Doctors Without Borders/Médecins Sans Frontières (MSF) teams are helping to alleviate the burden on the hospital by supporting its emergency department and operating theater. MSF also conducts ambulance referrals for patients who need to be examined by highly specialized surgeons in hospitals further away from the front line.
One patient, Volodymyr, is waiting for his second surgery. He is from the village of Komar in the Donetsk region, located less than 7 miles from the front line. He came to the hospital four days ago with Fournier’s gangrene—a type of flesh-eating disease that should have been treated much earlier, but ongoing hostilities made it difficult to seek care.
“I could no longer walk, so my neighbor had to bring me to the hospital,” says Volodymyr. “I should have come about a month ago, but I just couldn’t make it. It is hell in our village now. The entire street was destroyed, everyone is hiding in their basements. As soon as it seems to become quieter, the shelling starts again.”
Consequences of delayed treatment
Patients like Volodymyr who have neglected diseases are common in this hospital, which is the closest medical facility to the eastern front line that provides secondary care. It is located at the intersection of three regions with active fighting, and receives a high influx of people seeking medical help.
People come here from the frontline communities of Donetsk, Dnipropetrovsk, and Zaporizhzhia regions, where the shelling does not stop for even a day. The living conditions there are difficult. Patients often do not have access to medicines and medical care, or to food and hygiene items, spending most of their time hiding in the basements of their homes.
The most intense fighting continues in the Donetsk region, where the front line remains unstable and shifts rapidly, leaving behind devastated towns and villages with people trapped in them. The current hotspots are near Pokrovsk, Kurakhove, and Chasiv Yar. Hospitals in these areas have had to evacuate their medical staff and equipment, forcing residents to travel long distances to reach the nearest medical facility. Roads are often littered with remnants of weapons, some of which may still contain unexploded ordnance, making travel extremely dangerous. As a result, many people delay seeking medical help, and their conditions worsen.
“Once we had a patient with a three-day-old peritonitis [inflammation of the abdomen’s inner wall], so we had to take him to the operating theater immediately,” recalls MSF medical activity manager Dr. Khassan El-Kafarna. “People have limited access to health care, and we see how it affects them. There are lots of patients with exacerbated non-communicable diseases: hypertensive crisis, strokes, and neglected surgical diseases.”
Preparing for surgery amid possible power cuts
Attacks on energy infrastructure can cause unexpected power outages. The hospital has generators, but the surgeons cannot afford to have any interruptions in their work. That’s why Dr. Khassan, who is performing Volodymyr’s operation, wears a headlamp for the procedure.
Hospital staff are usually quick to switch on generators, as they’ve become used to the power cuts. However, delays and difficulties still occur. Hospitals must maintain sufficient fuel reserves, and while MSF supports some hospitals with fuel donations, it remains an additional challenge in providing health care. “At such times, elevators don’t work,” recalls Dr. Khassan. “We had to carry patients up the stairs to the operating room on stretchers.”
Treating patients with war-related injuries
Other patients MSF teams treat are those with war-related injuries, such as trauma from shelling, landmines, and bomb and shrapnel blasts. “These people often have multiple traumas to various parts of their bodies, including head trauma, penetrating abdominal and chest wounds, and soft tissue trauma,” says Dr. Khassan. “A lot of patients we receive have open fractures.”
People with war-related injuries also do not come to us immediately after they sustain their trauma, Dr. Khassan explains, “We are dealing with infected wounds. Patients could not get help for a long time and they come to us in advanced stages of sepsis. For the past month we treated seven patients with septic complications.”
MSF continues to support medical facilities in Ukraine near the front line. Our medical teams operate in the hospital in the Dnipropetrovsk region and in the city of Kherson. In 2024, MSF teams assisted and performed 1,149 surgeries and supported 435 patients in intensive care units. In the city of Kherson, an MSF medical team also provides surgical and trauma care, running triage and performing surgeries.
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Surgery is just the first step on a long road to recovery
Volodymyr’s operation lasted less than an hour. This was not the first surgery he had to undergo. “When he first came to us, he had septic shock and anemia,” Dr. Khassan says. “Now we got rid of the source of the infection, but he definitely needs tertiary care. We need to stabilize him before we can refer him to a higher-level facility, because he needs a plastic surgeon, a urologist, and admission to intensive care.”
The nurse finishes bandaging Volodymyr, and he is sent to the intensive care unit. There is a long road to recovery ahead of him. Despite his condition and the approach of the front line closer to his village, Volodymyr says that, most of all, he wants to return home.
