Reclaimed territories in Ukraine reveal a health care system in ruins

Voices from MSF patients and staff on the devastating effects of war

As Ukraine takes back territories in Kherson and Mykolaiv oblasts that have been devastated by war, Doctors Without Borders/Médecins Sans Frontières (MSF) are witnessing the grave medical and humanitarian needs. People have gone without health care and medicines for over nine months and health care structures and pharmacies remain badly damaged. ​Elderly people are especially impacted by this, as well as people in need of medicines for non-communicable diseases and chronic conditions. Many people have endured months of extremely difficult conditions and fear for their lives and now suffer from stress, anxiety, and other mental health problems. ​

MSF teams have been working in areas of Kherson oblast since June. We are operating mobile clinics focused on basic health care, treatment for non-communicable diseases, and mental health. MSF ambulances also transfer patients to hospitals and between medical facilities around Kryvyi Rih and in the areas of the Kherson oblast that are under Ukrainian control. Apart from Ukrainian state actors and volunteers, there remain very few international organizations on the ground in recently re-taken areas of Kherson and Mykolaiv. ​

Below are stories from MSF patients and staff who have endured tremendous challenges to continue living and working through many months of fighting.

Nadia Pedchenko, a woman from the town of Vysokopillia in Kherson oblast

“My husband and I lived under occupation for two months. When the Russians started letting people out, we left the town on foot. More than 600 people left Vysokopillia on Easter.

When we tried to leave the town for the first time, there was horrible shelling. We had to drop to the ground a hundred times. I hurt my arm. Houses were exploding all around us.”

When we learned that Vysokopillia had been liberated on October 4, we decided to go back home. On October 15, my husband became paralyzed, probably because of stress.

I worry a lot. We have no one to ask for help. There is no light in the town, and every evening my husband needs an injection of magnesium. I’m in despair, I’m crying, I can’t do anything.

We called a hospital in the city of Kryvyi Rih. The doctors say it is very far away for my husband to be transported there, since he is in a severe condition.

I put an IV in him and give him medicine at home. I came [to MSF’s mobile clinic] to get him medicine. I spoke with your psychologist last time. It helped me so much!”

Ivan Khokhlov, MSF emergency room doctor

“I have lived in the city of Lyman for the past two years. That city had everything I needed: nature, parks, a river, blue lakes, a forest full of mushrooms and berries. I bought a house there. On February 22, I made the last payment. I lived on the outskirts of Lyman. In March, when they started shelling about 50 meters away from my house, I told my family that we had to leave. I never returned to Lyman again.

We moved to Dnipro and in September I started working with MSF as an emergency room doctor and also support the MSF mobile clinics. Several people who approached us had previously had surgical operations and were constantly in pain. They have no paramedic, no doctor, no pharmacy nearby.

We met one man who needed dressing for his wound, but he didn’t have anything. He had no disinfectant solutions, no antiseptics, no dressing materials. He just washed and reused the dressing.

I recently met a doctor who was a pediatrician all her life. Because of the war, she had to become a cardiologist, a therapist, a traumatologist, a resuscitator… this is very scary.”

Svitlana, a woman from the village of Ivanivka in Kherson oblast

“On May 5, at three in the morning, we ran for safety to the village of Mykolaivka, where volunteers found housing for us. My children are still living there but my husband and I decided to go back home. It took us years to acquire what we have. If we leave our house, everything that’s left will be gone.

We don’t have our animals anymore.This spring we planted vegetables under fire. We hoped for the best, but we have nothing. The roof and windows of our house are damaged; we have had to cover them. There is no electricity or gas in the village. We have stoves, so we heat the house with firewood.

We want our children to come back. But they study online now and there is no electricity in the village. I have five children. One of my sons lives in the village of Korobky, in Kakhovka district [controlled by Russian military]. We are very worried about him and his family. We don’t know what’s going on there and we can’t get in touch with them.”

Liudmyla, a woman from the village of Ivanivka in Khersonoblast

“My husband and I stayed in Ivanivka for three months. Our children who live in the city of Kryvyi Rih kept asking us to leave the village. I don’t sleep well; my hands are shaking. They shelled us so badly every day that it became a usual thing for us. During one shelling I realized that my husband could make it to the basement, and I couldn’t. The shelling was so close, that it felt as if hail was hitting the roof. One of our cows was killed and another one was injured.

It took us 35 years to build our house, and now it is destroyed. A shell hit between the hall and the veranda, and the ceiling fell on the freezer. We have only two bedrooms now. We swept a little and covered the windows with plastic sheeting. When you go outside and look around, you can only see a pile of garbage and nothing else.

There was a Russian doctor in the village. People with serious conditions had to turn to him. There were people with cancer here, and there was no way for them to get their medicine. People were scared but they asked that doctor for help.”

Serhiy Nikolenko, MSF driver

“I have been seeing this [conflict] since 2014, although back then they didn’t use such heavy weapons. I had to move twice due to the situation. In 2020, I was living in Kramatorsk with my family but the front line came very close, so my wife and I decided to leave the city with our two children.

I was one of the first to join MSF’s project in the city of Kryvyi Rih in April. During our trips, I see terrible things that should never have happened. We meet a lot of people whose houses were hit by a missile, as well as those who lived under occupation for five or six months. People told us that they lived without food, water, or medicine.”

Volodymyr Todosenko, a medical director and a urologist in a hospital in the town of Snihurivka, Mykolaiv oblast

“Russian troops entered Snihurivka on March 19. I stayed in the town until August 15. In the end, there were just a few doctors in the hospital: me, an obstetrician-gynecologist intern, an ultrasound doctor, a trauma specialist, a therapist, an addiction physician, a psychiatrist, and a dentist. We had no surgeons at all. People with shrapnel injuries were brought to the hospital every day. We helped them.

We ran out of medical supplies. I had to go to the Russians and tell them that we had nothing to treat people with. For example, we did not have urethral catheters which, are needed for people with serious injuries who are being treated in intensive care and cannot get up. We had to soak these catheters in special solutions and then reuse them. We didn’t even have urine collection bags and used bottles instead.

There was also a pressing need for medicines for people with diabetes and high blood pressure. Most of the people who stayed behind were elderly and had chronic diseases. Pharmacies were destroyed.

Once the Russians told us, ‘Write down the list of medicines, we will give you everything.’ I must have given them those lists 10 times. The list consisted of 86 items, and they gave us only 16 things— bandages, gauze, plastic bedcovers, cannulas, syringes, and a few medications such as painkillers and anti-inflammatory pills. I asked them, ‘How can I treat hypertension or diabetes with these?’”

Vasyl Kukhar, a man from the village of Novovoznesenske in Kherson oblast

“Some 400 people previously lived in the village. During the occupation, only about 50 stayed here. We haven’t had light or gas since March. Many people have nowhere to come back to because a lot of houses burned down.

Our village was often shelled. I had to put out the fire in my house two or three times. The fields that we had sowed burned. All the wheat burned. Many animals were killed. My cow, a sheep, and a pig were badly hurt and I had to put them down. I’m a veterinarian. I knew that they were suffering.”

Natalia, a nurse at the hospital in the town of Snihurivka in Mykolaiv oblast

“A few of us kept working in the hospital, but we became very close; we were united. We knew that no matter how scary it was, we had to help people. I have been living in the hospital since March 21.

Nurses worked in shifts. Shrapnel injuries, fractures, cuts—this is what we had to deal with. There were a lot of hungry dogs left behind in the town. They attacked people, so we also had patients with bites.”

“On February 24, I was at work. A lot of wounded people came in. At the same time, many doctors were leaving the city, so there was not enough staff. In Novodruzhivka [a town near Lysychansk], people were lining up for water when there was an attack. I had to send three or four ambulance teams to Novodruzhivka that day. Lysychansk was occupied in June. Two weeks earlier, I left it through Russia. Then I immediately travelled to Latvia, Lithuania, and Poland—and then back to Ukraine, all over three days.

In August, I started working for MSF—first in the east of Ukraine, and now in the south. We go to hospitals in Kherson to pick up the wounded and take them to the hospital in Kryvyi Rih. A few weeks ago, the city of Zelenodolsk was shelled. Many people were wounded waiting for a bus when the shelling began.”

Oksana Khodorkovska, MSF psychologist

“We work in hospitals, outpatient clinics or just on the streets. Most often, people suffer from anxiety, tension, poor sleep, and nervousness. We take a standardized approach. First, we talk to people about mental health and how to maintain it; we explain coping mechanisms to them and how to restore them. We use different methods from different areas of psychology.

Oksana Khodorkovska is a psychologist working with MSF in Kherson.

One man had a concussion. He came to me and said, ‘I don’t believe in your psychology! But I feel bad. Maybe you can help me.’

We drew together, did breathing exercises and many other things. After the first time he felt better. I thought that was it, but he came one more time and said, “It made me feel better. I want more.”

Reclaimed territories in Ukraine reveal a health care system in ruins
Source: Philippines Legacy PH