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Lviv, Ukraine – It’s 10 a.m. on a Tuesday morning in July, and a train has just taken off for a station in the western Ukrainian city of Lviv. With the door of one of the carriages open, paramedics on the platform cautiously lifted two young men down the stairs and onto stretchers. The two men were wounded the day before, when an explosive device exploded in the city of Bakhmut in the eastern Donbass region, where Russian forces have been subjected to merciless bombardment for months. One of them is in a mood, making jokes with the medical staff as they gently drive him to a waiting ambulance. But his pale face betrayed the severe injury to his femur.
35-year-old Natalia Keneev got off the train for a quick vacation. She’s been on the job for 17 hours since the men, along with other patients, were flown out of the frontline cities. A doctor with the international humanitarian aid organization Doctors Without Borders or Doctors Without Borders (MSF), Kyniv has been caring for the sick and injured on these weekly rail medical evacuations since March 23.
MSF currently operates the only known specialized medical train in Ukraine, transporting patients from hospitals in the besieged east to hospitals in the west that are considered safer. The train seats were removed and refitted with beds, oxygen generators, medical equipment and an intensive care unit.
“Today, we had to drop off a woman in Dnipro before we came here. She was losing a lot of blood,” he said, referring to the city in eastern Ukraine that is 240 kilometers (149 miles) from the nearest front line. The decision was made on the way, when doctors realized that surgery on a deformed woman’s foot could not wait until they arrived in Lviv.
Kenev vividly remembers the many patients she met on the train recently, all of them from Donbass. “There was a woman from Mariupol who was badly injured in the face, she lost an eye. Some of the children of Kramatorsk lost limbs due to a missile strike near them. Every time I see people moving from east to west, they lose something – their homes, their families. For me, this is It doesn’t just feel like a job. “It’s emotional, too,” she says.
But it has also seen many tender moments, such as when patients worried about not being able to take their pets are thrilled to learn that animals are allowed on board. “Yes, we take everyone,” she laughs.
MSF is working on the information from the Ministry of Health to find out how best to relieve the pressure on the medical system. By making successive flights, it has so far evacuated more than 1,000 people in dire need of treatment. Apart from referrals for patients with war injuries, MSF has received many chronically ill people, a large part of whom are elderly.
But since the Russian invasion began on February 24, thousands more are likely to have fought their bravery on similar journeys by other means, escaping overcrowded or badly damaged hospitals in Donbass and other areas where the fighting has been particularly intense.
Throughout Ukraine, the situation in hospitals is precarious. In July, the government reported that 123 medical facilities had been completely destroyed, while another 746 were in need of repair. Since the start of the war, WHO reports have described how hospitals have been struggling with the collapse of essential health services – a problem exacerbated by severe shortages of medical supplies, from life-saving medicines to oxygen tanks.
In relatively calm Lviv, some doctors told Al Jazeera that the initial influx of patients from the east had subsided somewhat, as many patients chose to travel abroad for further treatment. But as Russia continues attacks on civilian infrastructure, many medical workers fear that hospitals in Lviv may see patient numbers rise again.
Like the other patients who have come before them, the two men who got off the MSF train will be taken to any hospital that has the capacity to receive and treat them. One of them is the Lviv Regional Clinical Hospital. Hundreds of internally displaced patients have passed through his doors since February. In one ward, which focuses on acute or emergency general surgery, 80 percent of his current patients are not Lviv residents. They came here because they could not seek treatment in their hometown.
“Not all of us can be moved’
“This hospital does not specialize in treating military trauma or injuries, so other doctors come to help when we receive cases like this,” says Yuri Mikhel, 64, a nice, fat man and one of the surgeons supervising this ward. “But these days, we’re seeing more and more patients now who have chronic conditions like diabetes, gallbladder and liver disease.”
Ivan Vasilovich, 72 years old, is one of those patients. For several months, he was unable to leave his hometown of Sloviansk, one of the last Ukrainian-controlled cities in the Donbass. Weak and hard of hearing, Vasylovych cannot sit in bed without help. He suffers from arterial calcification, which puts him at risk of a heart attack. Mobility is also an issue, as he lost his left leg years ago in a car accident. Since February, he has been in a hospital in Sloviansk, hoping to be evacuated. During that time, he needed to have one of his fingers amputated due to circulatory problems.
The war started so suddenly that not all of us could be moved, so we had to wait. The fighting was not so intense in the part of Sloviansk where I was at first.” But as time passed, he began to believe that it would be safer elsewhere. In June, Vasilovich, accompanied by a team of volunteers and doctors from the Red Cross, was finally transferred to Lviv, where his wife accompanies him.
“I don’t know when that might happen, but I still hope to go home,” he adds. But recent reports indicate that Sloviansk is now being bombarded with missiles on a daily basis, and that only a fifth of its population has chosen to stay.
“It was very, very terrifying.”
A few doors down is 73-year-old Halina Sergeevna from Kramatorsk, a city less than 16 kilometers (9.9 miles) from where Vasilovich used to live. She is receiving treatment for ovarian cancer, having left Kramatorsk after only one course of chemotherapy on the same day the war began.
“It was so terrifying,” she says, remembering the distant explosions that shook the hospital walls. As she was leaving, the staff quickly put sandbags near the windows for protection in the event of an explosion.
Amid fears that the hospital might be attacked, Sergeevna and her family decided to leave as soon as possible. Because of her poor health, Sergeevna found the train journey to Lviv very uncomfortable. She was first evaluated and treated at another oncology facility, prior to her transfer to this hospital.
Sergeevna was moderately behaved, cheerful and alone in Lviv for a month after surgery on the ovaries. Her entrepreneurial daughter and grandchildren left for Bulgaria.
“But it’s not bad at all. I’m staying with a friend, and I’ve met a lot of wonderful people here. I talk to other patients all the time, and their numbers are on my phone,” When she’s feeling lonely, she knows her family is just a phone call. Her face lights up with a smile when asked if she’s ready to take a picture. She says, “Of course.” “Let me wear a wig.”
temporary safe house
Some IDPs recover from more serious injuries. One of the rooms has been a temporary home for the past two months for 37-year-old Irina Vetrova from Bakhmut.
She is just preparing to go for a walk outside the hospital building, but her calm demeanor belies a horrific, near-death experience. Vetrova, as a pathologist, lost her job during the war and was forced to seek alternative work, eventually obtaining a position in the security services in the city of Pokrovsk, 77 kilometers (48 miles) from Bakhmut.
“I didn’t want to leave because my mom was in Bakhmut, and I’d rather be closer to her now that I’m older, but there was no other choice, there was no work in Bakhmut,” she says.
On May 10, during a week-long visit at home, Vetrova was waiting with her stepfather at a bus stop when she saw a bright flash from the corner of her eye. “It happened so quickly. I felt a ripple of power through me, and the next thing I knew I was on the floor,” she recalls. “I felt like my chest was completely compressed. I looked at my right thumb and it was hanging off my hand. I was bleeding all over the place. I thought: This is for me.”
Vitrova later learned that she was only 12 meters (39 ft) from the explosion of a bomb. Soldiers nearby immediately took her and her stepfather – who had a dislocated shoulder and some cuts and wounds – to a nearby hospital. There, doctors first tried to stabilize her case and sew up her thumb.
“Doctors were angels”
When the medical staff realized that they did not have the resources to perform the complex surgeries necessary for all the injuries that Vitrova had suffered, they decided to transfer her to Lviv. She, too, came on the MSF train. I felt at the time as if the doctors were angels sent to help me. “Everything was very professional,” she said.
Arriving at the hospital in Lviv after three days of bombing, Vetrova was immediately taken to the operating room, where Mikhail quickly worked to save her life.
“There were shrapnel in different places on her body, in her liver, and there was necrosis [tissue death] around her chest area. We had to work quickly,” he recalls. He goes to his office to retrieve a piece of shrapnel that he and other surgeons had removed from her body.
Although it is about three inches (7.6 cm) long, it looks surprisingly heavy. Unfortunately, despite their best efforts, they were unable to reattach her thumb. It had to be amputated. However, Vetrova is optimistic and says she is not particularly upset. “Without him I wouldn’t be here,” she said, looking at Mikhel.
Much to her dismay, however, is the safety of her 18-year-old daughter, who is trying to complete her online studies in Dnipro as Russian forces head towards the city. “I worry about her a lot,” she says. As well as her mother, most of her family chose to stay in Bakhmut.
She has also been counting down to the end of her hospital stay and is pleased to be discharged in two days. “It’s been 68 days. I know everyone here now, and many other people from Donbass. It feels like family. ” When she leaves, she will temporarily stay with one of her new friends, who lives about 50 kilometers (31 miles) from Lviv. But she, like other patients, does not know what the future holds for her.
In the corridor outside the rooms, Mikhel is in a meditative mood. The hospital was fortunate that it did not experience the kind of shortages that are widely reported across Ukraine. “We have a lot of good people helping us,” he says. “On that day, some volunteers came from Norway and brought a lot of medical supplies with them. I think we will be fine.”
However, the possibility of the hospital being attacked weighs heavily. His expression becomes serious, as he says, “I love my job very much. I will continue to work hard, no matter whether the war comes here or not.”