Since the beginning of the war in Ukraine, Kharkiv, the country’s second-largest city, has been severely affected by the Russian offensive. While many of the 1.8 million people who lived in Kharkiv before the war broke out have fled, some 350,000 who were unwilling or unable to leave remain in the city, according to local authorities.
Many have taken refuge in underground subway stations to escape the incessant bombing. Trapped underground, they are cut off from essential services, including health care. From children who are too afraid to fall asleep to people who feel like they can’t breathe to patients with high blood pressure at risk of stroke, Doctors Without Borders/Médecins Sans Frontières (MSF) mobile clinics working in several stations on three of Kharkiv’s subway lines are treating a wide range of health conditions, both pre-existing and related to or exacerbated by the conflict.
Here, MSF doctor Lisa Searle describes her experiences caring for patients sheltering below the city.
The public transport system has completely collapsed here, and the network of underground subway stations have become refuges for people whose homes have been destroyed by airstrikes and shelling, or who are too scared to stay at home above the surface. Being on the surface now feels so strange, eerie. A few people hurrying down the streets in ones or twos clutching bags of supplies. Trying to get to safety before the next air raid alarm sounds, which is often, at least four or five times a day. And after only a few days here, the sound of outgoing and incoming shelling has become background noise. It's just too exhausting to spend too much time thinking about what it means whenever we hear that sound. Another building destroyed, more lives lost and homes destroyed. Today during one of my too-brief visits to the surface, I could see smoke rising from a building that had just been hit, in a part of the city that is already destroyed and suffering more damage every day. The hits from above force the buildings' contents to spew out onto the streets. Books, clothes, shredded insulation, bricks, curtains, and cooking pots trailing out of the buildings and down to the ground, like intestines hanging out of a disemboweled body.
The whole country is in a state of emergency. The few remaining inhabitants of this city are huddled underground, crammed into the subways or makeshift basement shelters. Trying to survive. Most people who had the means have left, leaving behind the elderly, the disabled, those with chronic mental health conditions. The most vulnerable. During the day some people venture out, squinting against the bright lights and shuffling down the streets, terrified and waiting for the next impact. Some people are too scared to surface at all and have been underground for weeks.
We are working underground, running mobile clinics for the displaced population and sleeping in the underground Metro stations on whatever we can find. With the sudden flood of displaced people from Ukraine, over 6 million now in the whole country, there is no camping gear left anywhere. The nights are cold, so people wrap up in coats and blankets, trying to stay warm. As we finished our clinic tonight and packed up, picking our way through the crowded platform, a woman I had treated called out to me, "Doctor!", and handed me a shiny red apple with a grin. I took it gratefully, holding her hand for a second, touched that she was willing to share what little she had with me. She looked me in the eyes, thanking me profusely for being here. She lost her home in the shelling and has nowhere else to go. She is suffering panic attacks and insomnia, as well as being unable to access her regular medication for high blood pressure.
Tonight I spoke to an elderly woman whose home was hit and destroyed yesterday. She and her husband were at home, her inside the apartment and him on the stairs. They heard the first explosion and had no time to react before their block was hit. They were pulled from the rubble by emergency services and, through some miracle, the only injury between them was a ruptured eardrum. She was distraught. She has nowhere else to go, so she has joined the thousands like her now living a subterranean life, with no privacy or washing facilities. Stories like this are everywhere. So many of the patients we see present to us for a problem which initially seems fairly simple, like a top-up of their blood pressure medication, or a check-up for a sore throat. But once we start talking to them, they often break down, words spilling out of them about the horrors they have endured.
I treated an 11-year old boy two nights ago whose father brought him to see me. Initially, he was complaining of difficulty breathing, and when I asked some more questions it became clear that this only happens when he has to go up to the surface. Panic attacks are common among the people living here underground. They are terrified of surfacing and many of them experience severe panic attacks at even the prospect of going up.
Something inspiring and positive here amongst all this suffering is the appearance of local volunteer networks throughout the city: people organizing themselves and working together to help those most in need. Local people who have decided to stay here are taking requests from people stuck in their homes, and coordinating donations of food, hygiene items, and medications. Local drivers travel around the city, taking huge risks to get these much-need items to the most vulnerable. I meet people every day whose compassion and determination to help the most vulnerable brings tears to my eyes and forces me to see the hope that lives on in this devastated place.