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Lviv, Ukraine – It is 10am on a Tuesday morning in July, and a train has just pulled into a station in the western Ukrainian city of Lviv. As the door to one of the carriages creaks open, paramedics on the platform gingerly lift two young men down the stairs and onto stretchers. The day before, both men had been wounded by a bomb blast in the city of Bakhmut in the eastern Donbas region, where Russian forces have been mercilessly shelling for months. One of them is in a jocular mood, cracking jokes with the medical personnel as they gently wheel him to a waiting ambulance. But his pallid face betrays the severe femur injury he has sustained.
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Descending the train for a quick break is 35-year-old Nataliia Kyniv. She has been working for the last 17 hours since the men, along with other patients, were transferred from front-line cities. A doctor with the international humanitarian aid organisation Doctors Without Borders or Médecins Sans Frontières (MSF), Kyniv has been caring for the sick and injured on these weekly medical evacuations by rail since March 23.
MSF currently runs Ukraine’s only known specialised medical train, carrying patients from hospitals in the embattled east to hospitals in the west that are considered safer. The train’s carriages have had the seats removed and been refitted with beds, generators for oxygen and medical devices and an intensive care unit.
“Today, we had to drop off a woman in Dnipro before we came here. She was losing too much blood,” Kyniv says, referring to the city in eastern Ukraine located about 240 kilometres (149 miles) from the nearest front line. The decision was made en route, when doctors realised that surgery on the woman’s mangled foot could not wait until they arrived in Lviv.
Kyniv vividly remembers several patients she had met on board the train recently, all from Donbas. “There was a woman from Mariupol with a heavy injury to her face, she had lost her eye. And some children from Kramatorsk who had lost their limbs because of a missile raid near them. Each time I see people moving east to west, they’ve lost something – their homes, their families. For me, this doesn’t feel like just a job. It’s emotional too,” she says.
But she has also witnessed many tender moments, such as when patients who worry that they cannot take their pets with them are overjoyed to find out that the animals are allowed on board. “Yes, we take everyone,” she laughs.
Relieving the strain
MSF acts on information from the Ministry of Health to figure out how to best relieve strain on the medical system. Running back-to-back trips, so far it has evacuated more than 1,000 people in critical need of treatment. Aside from referrals for patients with war-related injuries, MSF has received many people with chronic diseases, a large portion of whom are elderly.
But since the Russian invasion began on February 24, thousands more are likely to have braved similar journeys by other means, fleeing overcrowded or heavily damaged hospitals in Donbas and other regions where the fighting has been particularly intense.
Across Ukraine, the situation in hospitals is precarious. In July, the government stated that 123 medical facilities had been completely destroyed, while another 746 needed to be repaired. From the start of the war, reports by the World Health Organization described how hospitals were grappling with the collapse of essential health services – a problem exacerbated by drastic shortages of medical supplies, from live-saving drugs to oxygen tanks.
In relatively peaceful Lviv, some doctors told Al Jazeera that the initial influx of patients from the east has somewhat subsided, with many patients choosing to go 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 other patients who came before them, the two men who disembarked from the MSF train will be taken to any hospital that has the capacity to admit and treat them. One of them is the Lviv Regional Clinical Hospital. Hundreds of internally displaced patients have passed through its doors since February. In one ward, which focuses on acute or emergency general surgery, 80 percent of its current patients are not Lviv residents. They have come here because they were unable to seek treatment in their hometowns.
‘We couldn’t all be transported’
“This hospital isn’t specialised in treating military trauma or injuries, so other doctors come to help out when we receive such cases,” says Yuriy Mikhel, 64, a portly and genial man who is one of the surgeons supervising this ward. “But these days, we’re seeing more and more patients now who have chronic conditions like diabetes and gall bladder and liver diseases.”
Ivan Vasylovych, 72, is one such patient. For months, he was unable to leave his hometown of Sloviansk one of the last Ukrainian-held cities in Donbas. Frail and hard of hearing, Vasylovych cannot sit up in bed without assistance. He suffers from calcification of the arteries which puts him at high risk of a heart attack. Mobility is also a problem, as he lost his left leg years ago in a car accident. Since February, he had been at a hospital in Sloviansk, hoping to be evacuated. During that time, he needed to have one of his fingers amputated because of his circulation issues.
“The war started so suddenly that we couldn’t all be transported, so we had to wait. The fighting wasn’t so intense in the part of Sloviansk where I was at the beginning,” he says. But as time went on, he started to think that he would be safer elsewhere. In June, accompanied by a team of volunteers and doctors from the Red Cross, Vasylovych was finally transferred to Lviv, where he is accompanied by his wife.
“I don’t know when it can happen, but I still hope to go home,” he adds. But latest reports suggest that Sloviansk is now being hit by rockets on a daily basis, and only one-fifth of its population has chosen to stay on.
‘It was very, very terrifying’
A few doors down is 73-year-old Halyna Sergeyevna from Kramatorsk, a city less than 16km (9.9 miles) away from where Vasylovych was living. She is receiving treatment for ovarian cancer, having left Kramatorsk after just one course of chemotherapy on the same day that the war started.
“It was very, very terrifying,” she says, remembering the distant explosions that rattled the walls of the hospital. As she departed, staff hurried to place sandbags near the windows for protection in the event of a blast.
Amid fears that the hospital might be attacked, Sergeyevna and her family decided to leave as soon as they could. Because of her poor health, Sergeyevna found the train ride to Lviv very uncomfortable. She was first assessed and treated at another facility specialising in oncology, before being transferred to this hospital.
Mild-mannered and cheerful, Sergeyevna has been all alone in Lviv for a month following surgery on her ovaries. Her entrepreneur daughter and grandchildren have left for Bulgaria.
“But it’s not bad at all. I’m staying with a friend, and I’ve met lots of great people here. I talk to other patients all the time, and have their numbers on my phone,” she says. When loneliness gets to her, she knows her family is only a call away. Her face brightens with a smile when asked if she would be willing to have a photo taken. “Of course,” she says. “Let me put my wig on.”
Temporary safe home
Some of the internally displaced patients are recovering from more grievous injuries. One of the rooms has been a temporary home for the last two months for 37-year-old Iryna Vetrova from Bakhmut.
She is just getting ready to go for a walk outside the hospital building, but her placid demeanour belies a horrific near-death experience. A pathologist by training, Vetrova lost her job during the war and was forced to seek alternative employment, eventually securing herself a position in security services in the city of Pokrovsk, 77km (48 miles) from Bakhmut.
“I didn’t want to leave because my mum was in Bakhmut and I prefer to be closer to her now that she’s old, but there was no choice, there was no work in Bakhmut,” she says.
On May 10, during a week-long visit back home, Vetrova was waiting with her stepfather at a bus station when she saw a bright flash out of the corner of her eye. “It happened so fast. I felt a force ripple through me, and the next thing I knew I was on the ground,” she recalls. “It felt like my chest was totally compressed. I looked at my right thumb and it was just dangling from my hand. I was bleeding everywhere. I thought: this is it for me.”
Vetrova would later learn that she had only been 12 metres (39 feet) away from a bomb blast. Soldiers nearby immediately whisked her and her stepfather – who had suffered merely a dislocated shoulder and some cuts and grazes – to a hospital nearby. There, doctors first tried to stabilise her condition and stitch her thumb back.
‘The doctors were angels’
When the medical staff realised that they did not have the resources to perform the complex surgeries needed for all the injuries Vetrova had sustained, they decided to evacuate her to Lviv. She, too, came by the MSF train. “I felt at the time like the doctors were angels who had been sent to help me. It was all very professional,” she says.
Arriving at the hospital in Lviv three days after the bombing, Vetrova was immediately taken to the operating theatre, where Mikhel worked quickly to save her life.
“There was shrapnel in different places in her body, in her liver, and there was necrosis [tissue death] around her chest area. We had to work fast,” he remembers. He goes to his office to retrieve a piece of shrapnel that he and other surgeons had removed from her body.
Though only about three inches (7.6 cm) long, it feels surprisingly heavy. Unfortunately, despite their best efforts, they were unable to re-attach her thumb. It had to be amputated. Still, Vetrova is upbeat and says that she isn’t particularly upset. “Without him,” she says, looking at Mikhel, “I would not be here.”
What causes her great consternation, however, is the safety of her 18-year-old daughter, who is trying to complete her studies online in Dnipro as Russian forces edge towards the city. “I worry a lot about her,” she says. Aside from her and her mother, most of her family has chosen to remain in Bakhmut.
She has also been counting down to the end of her stay at the hospital and is delighted that she will be discharged in two days. “It’s been 68 days. I know everyone here now, and so many other people are from Donbas. It feels like a family,” she says. When she leaves, she will stay temporarily with one of her new friends, who lives about 50km (31 miles) from Lviv. But like other patients, she does not know what the future holds for her.
In the corridor outside the rooms, Mikhel is in a contemplative mood. The hospital has been lucky not to experience the sort of shortages reported widely across Ukraine. “We have so many kind people helping us,” he says. “The other day some volunteers from Norway came and brought plenty of medical supplies with them. I think we will be OK.”
The possibility that the hospital may be attacked, however, weighs on his mind. His expression turning earnest, he says, “I love my job a lot. I’ll continue to work hard, regardless of whether the war comes here or not.”