On February 24, 2022, after years of simmering conflict in eastern Ukraine, Russia launched a large-scale military operation that rapidly escalated into a war across most of the country. One year later, eight million people have fled Ukraine as refugees and approximately five million remain internally displaced. People who still live in areas under attack face incredible hardships, often living without electricity, medicine, food, or clean water. Hospitals are in constant danger of running out of supplies, especially those required for surgical, trauma, emergency room, and intensive care units. Other key medical needs include insulin for diabetes patients, as well as medicines for people with other chronic diseases.
Doctors Without Borders/Médecins Sans Frontières (MSF) has been working in Ukraine since 1999, providing treatment for tuberculosis (TB), HIV/AIDS, and hepatitis C, as well as supporting the national response to the COVID-19 pandemic. It is crucial to remember that people on the frontlines have been suffering from physical and psychological wounds since the war started in 2014. When the war escalated in 2022, MSF quickly mobilized a response and now has approximately 124 international and 686 Ukrainian staff caring for people affected by the conflict. They work as medical staff; psychologists; in logistics and administration; and management.
MSF also runs mobile teams and a medical train to transport the sick and injured to safety. Our teams are responding to people’s health needs in Apostolove, Dnipro, Ivano-Frankivsk, Kharkiv, Kyiv, Lyman, Lviv, Mykolaiv, Odesa, Poltava, Pokrovsk, Kherson, Kochubeivka, Kostiantynivka, Kryvyi Rih, Uzhhorod, Kropyvnytskyi, Vinnytsia, Zaporizhzhia, and Zhytomyr. We are in contact with hospitals across the country, providing supplies and training as needed.
A home destroyed by shelling in the besieged city of Mariupol, southeastern Ukraine, where MSF has been providing care for eight years. Thousands of people there, including MSF staff and their families, are cut off from the world when the city is besieged.
Heavy attacks continue through early March and food supplies run dangerously low. There is no water, electricity, and heating. Internet and phone services have been cut off. Hospitals, supermarkets, and residential buildings suffer heavy damage.
In response, MSF teams distributed kits to treat war-wounded people in Mariupol and provided training for trauma care via a live video link for 30 surgeons from eastern Ukraine. More staff is on the way and logistics teams are working to deliver urgently needed medical supplies.
Ukrainian refugees wait to board buses in Palanca, Moldova, to head to other destinations in Europe. By February 28, the head of the United Nations refugee agency says more than a half a million people fled Ukraine since the conflict escalated. Our emergency teams set up begin providing care at various borders. At the Ukraine-Poland border checkpoints, MSF staff witness people cross over on foot, in cars, and on buses, many tired and exhausted, and some with children as young as 25 days old.
Many people tell us that they spent long hours waiting in freezing temperatures. Some are dehydrated and others suffer from hypothermia. Meanwhile, MSF is working to support the Ukrainian ministry of health to ensure that patients can access treatment for drug-resistant TB, including those previously supported by MSF in Ukraine.
In Moldova, MSF community health workers Adelina Ciumac and Olena Starovoitova help people with general information and emotional support at the Palanca border crossing in Moldova. Thousands of Ukrainians are arriving here every day, mainly from Mykolayiv—a target of intense bombing. Entire families, mainly women, children, and the elderly, often wait several hours in sub-zero temperatures and wind before being allowed to cross the border.
Volunteers have been welcoming them with tea, food, and tents to shelter them from the wind. Dozens of people a day—many of them living with untreated chronic diseases like hypertension—are treated at the medical post located at the Moldovan border post. MSF sets up a medical center in Palanca to support the Moldovan teams already on site, providing psychological first aid.
As hospitals in eastern Ukraine become overwhelmed with growing numbers of war trauma patients, their supplies are also dwindling. With front lines shifting rapidly, MSF teams know they could have limited time to get essential supplies to the facilities and communities that need them most.
“Our primary efforts for now are on getting the right medical supplies to where they are needed, in large volumes and as rapidly as humanly possible,” says MSF emergency coordinator Anja Wolz.
On March 5, the first three MSF supply trucks gain entry to Ukraine. Between them they are carrying 4,200 cubic feet of emergency medical supplies. One-third of these essentials—mostly medicines and surgical and trauma supplies—are immediately sent on to Kyiv by train, where they are distributed by the ministry of health to hospitals caring for war-wounded people in both the capital city and hospitals in war zones further east.
At the 750-bed Okhmatdyt pediatric hospital, one of the largest in central Kyiv, an MSF surgical team trains and advises staff on how to handle large influxes of trauma patients. Among them is Martial Ledecq, an MSF vascular surgeon with war surgery experience who also assisted in the operating theater. He provides training to hone skills in rapid lifesaving trauma stabilization and surgery. These include removal of bullets or shrapnel, preventing internal bleeding, effective wound cleaning, and more.
Edward Chu, MSF advisor for emergency medicine, trains Joachim Gruber, a doctor in a hospital in Lviv, on how to manage the mass influx of war-wounded patients. In other parts of western Ukraine, MSF carries out similar training sessions that also address decontamination, care for survivors of sexual and gender-based violence, and mental health with local health professionals, psychologists, and first responders.
From March to August 2022, MSF provides 36 training sessions attended by 707 people in Zakarpattia oblast and 62 sessions in Ivano-Frankivsk oblast, with the participation of 1,069 people. By the start of 2023, our mental health teams in the region have seen 330 patients in individual sessions and 4,557 patients in 488 group psychoeducation sessions.
Many of the 1.8 million people who once lived in Kharkiv, Ukraine’s second-largest city have fled. Some 350,000 people who were unwilling or unable to leave remain in the city. To escape the bombing, many take refuge in subway stations. 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, MSF mobile clinics working in several stations on three of Kharkiv’s subway lines treat a wide range of health conditions, both pre-existing and related to or exacerbated by the conflict. We also set up a hotline to respond to ongoing needs for medications and online medical and psychological consultations. Volunteers deliver the medication to people’s homes.
On the morning of April 1, MSF finalizes the first of many transfers of patients using a medical train. Nine war-wounded patients in serious but stable condition are transferred from a hospital in Zaporizhzhia, in the southeast of the country, to major referral hospitals in Lviv. The journey to safety can take anywhere from 20 to 30 hours.
By the end of 2022, the train evacuated 2,607 patients, over 40 percent of whom are wounded elderly people and children, including 78 orphans. Blast injuries caused 73 percent of the war-related trauma cases, with 20 percent caused by shrapnel or gunshots and the rest by other violent incidents. More than 10 percent of war trauma patients had lost one or more limbs, the youngest just six years old.
MSF psychologist Marina Popova provides psychological first aid to an internally displaced Ukrainian woman who just arrived by bus at the reception center in Zaporizhzhia. Many people in Ukraine are seeking mental health for the first time.
MSF runs mobile clinics at the center and 30 shelters for people who fled Mariupol and other areas providing medical consultations; medicines for people with chronic illnesses such as hypertension, asthma, diabetes, heart disease, and epilepsy; referrals to hospitals for severely unwell patients; psychological first aid and mental health consultations; and basic relief items. Since May 2022, MSF teams in the region have visited 82 temporary shelters for elderly people and families with children.
A patient, who was left with a broken wrist and an amputated right finger, looks away as MSF physiotherapist Ahmad Alrosan stretches his hand muscles during a session at the physiotherapy department of the main medical center of the Ministry of Internal Affairs of Ukraine in Kyiv. The brutality of the war has left many people with major injuries. Without proper care, the high number of trauma patients are at risk of developing long-term mobility issues.
To address this need, MSF begins providing physiotherapy services in July in a hospital managed by the ministry of interior in Kyiv, where 70 beds (out of a total of 200 trauma beds) are dedicated to physiotherapy for war-wounded people. In Vinnytsia and Kyiv, MSF also offers the use of assistive devices as well as individual psychological or psychiatric treatment to support patients in overcoming both physical and mental health issues associated with the war.
Patients from the Hetmanivka village in the Kharkiv region wait for their primary health care and mental health consultation provided by the MSF mobile clinic team. Most patients we meet are women over the age of 60 presenting with chronic illnesses like hypertension and diabetes that have gone uncontrolled for months due to the war. In October, after the Ukrainian army retook control of this area, people’s medical and mental health needs are still high.
Many communities have been left with damaged health facilities, while many residents have been left with psychological wounds caused by months of fear, loss, isolation and proximity to violence. MSF mobile clinic teams are working in the area to provide people with general medical care and mental health support.
On January 17, 2023, a missile strike on a residential building in central Dnipro kills at least 40 people. In addition to those who died in the blast, at least 75 people were injured and around 30 people remain missing. MSF is one of the first international organizations on the scene, providing on-the-spot treatment to people with minor injuries and transporting those with more serious injuries to the hospital.
Intense airstrikes severely damaged Ukraine’s infrastructure, leaving nearly half of the power grid in need of repair. The consequences are recurring emergency blackouts as well as rolling power cuts in most parts of the country.
Many of the larger hospitals have been able to run on generators and back-up power systems, but ongoing military strikes hitting energy infrastructure make this less and less secure. In rural areas and smaller health facilities this is an even greater challenge as working conditions for health care staff have become increasingly difficult. Many households close to the front line have been left without electricity, gas, or heating for months.
In a situation of intense, rapidly evolving conflict, MSF teams are working to remain agile and responsive, to ensure that we can contribute to providing health care to patients in the best way possible. The medical needs are changing as the war takes new directions. It is not always possible to be sure where or when new medical needs will emerge, but we will continue to adjust our response accordingly.
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