In late September Doctors Without Borders/Médecins Sans Frontières (MSF) transferred more than 200 patients with neurological and psychiatric conditions by medical train from an overcrowded hospital in Ukraine's Kharkiv city to facilities with more capacity in Kyiv.
These people were part of a larger group that had been evacuated from a hospital in Kharkiv oblast [province] that was located on a front line of the war with Russia. An evacuation process had been underway when the facility was reportedly shelled, killing four medical staff and two patients. Survivors were then transferred to the Kharkiv city hospital.
When they arrived in Kharkiv city, their numbers filled the facility beyond capacity—from 400 to more than 1,000 patients. The influx overwhelmed hospital staff and forced some patients to sleep on the floor.
“After receiving so many patients, despite the best efforts of the staff, the conditions in the hospital became really difficult,” said MSF doctor Borys Potapov, who accompanied the patients during the transfer from Kharkiv city to Kyiv. “They didn't have enough beds, medication, or staff to take care of everyone.”
"They looked like they had been malnourished for a long time"
MSF was asked by the Ministry of Health to help ease pressure on the hospital by transferring around 200 of the evacuated patients to facilities in Kyiv. The Ministry of Health selected which patients were to be relocated and informed MSF of their medical conditions. MSF donated hygiene items such as soap, shampoo, and toiletries to the hospital before arranging the evacuation.
Buses and a Ministry of Health ambulance transported the patients to the Kharkiv train station, where they boarded the MSF medical train. The first train departed on September 23, staffed by an MSF medical team supported by nurses and a psychiatrist from the Ministry of Health to assist patients during the journey.
"I worked in a carriage where we had nine bedridden patients,” said MSF nurse Denys Babiy. “When I fed them, they asked for [another helping]. People were hungry, we could see their bones and ribs. They looked like they had been malnourished for a long time. It was hard to see."
In addition to the risks to people’s lives from bombing and shelling, health care facilities and other care institutions on the front lines in Ukraine face serious challenges to providing adequate services for their patients. Many have experienced cuts to water and electricity, difficulties meeting basic needs including food, and obstacles to accessing the medication their patients need.
Alleviating pressure on health facilities
MSF’s medical train made two trips from Kharkiv city to Kyiv in 36 hours, transporting people with a range of pathologies. “Some were elderly people with neurological diseases such as Parkinson’s or Alzheimer’s,” said MSF project coordinator Emilie Fourrey, speaking from the train platform in Kyiv. “We also had a lot of patients with acute psychotic disorders, especially today on the final journey. Some of the patients were understandably quite agitated, but it went smoothly during the journey to Kyiv. The patients will be transferred to two different facilities here, where MSF will follow up to check on their condition.”
MSF operates an ambulance referral service from 11 hospitals near the front lines in the east and southeast of Ukraine. In the first three weeks of September, we transferred 277 patients to facilities away from the fighting. The majority of these patients had suffered trauma and were able to receive a good standard of care.
However, as the experience in Kharkiv city shows, being transferred from hospitals on front lines is not a guarantee of receiving adequate health care if the receiving hospitals are overcrowded, particularly if patients have complex, chronic health needs. Evacuating patients to hospitals in the west of Ukraine, far from front lines, can alleviate pressure on health care facilities.
On September 27, MSF visited some of the evacuated patients at a psychiatric hospital in Kyiv oblast. A Ministry of Health worker explained that some patients had thanked them, grateful to be in conditions far better than on the frontlines. Despite these improvements, the patients still have significant health needs, with one nurse remarking that in their many years of caring for patients in psychiatric facilities, they had never seen patients in such poor mental and physical condition.