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„Many fail to react till war arrives at their doorstep“

The war in Ukraine continues to disrupt the country's unstable healthcare system. How the situation in hospitals is heating up and what this means for the population. A closer look. 

Claudia Tschabuschnig

Hasty steps in the darkness. Nothing but a glaring light illuminates the approaching porter from between heavy curtains of the field hospital. Hurry is needed. The wounded soldier is lifted onto a bed. His pain-distorted face covered by a mask and anesthetic pumped into his lungs.

Eastern Ukraine, just a few meters away from the front line. Up to 70 soldiers are treated in the military hospital on some nights. Today, 55-year-old Lubomir* is one of them, meanwhile, his facial features got more relaxed. The sedative is working. A few breaths later, a cartridge is pulled out of his arm. One of the most common treatments here. Most of the soldiers who arrive here have had shell fragments or ammunition bored into their bodies or severed limbs. In addition to the physical wounds, many are severely traumatized. Weary and apathetic, they sit and lie on their beds, staring blankly into the camera of the "Al Jazeera" reporter as pain medication flows into their veins.

"We don't need medication, we need weapons"

Behind the garishly lit beds at the end of the room, it gets darker again. Multicolored sleeping bags line the wall here. This is where the medical staff of the military hospital spend the night. Many of them have worked for years in war zones in other countries, but did not expect to have to do the same at home, says one surgeon. On the wooden table in front of him are piles of ampoules, syringes, cans, and packs of medicine. "We don't need medicine, we need weapons," he says, laughing.

Further up-country, about three hours by car from Kyiv, the Russian tanks have left. After more than a month of occupation, residents of the village of Bykiw are returning to their homes. They are climbing up from the cold cellars where they had made makeshift provisions of pickled vegetables and candles. Even there, despite thick walls, they could feel the bombs. "Everything was shaking," one resident described the situation to a reporter from "Deutsche Welle." Some held out for days without water or bread. Upon their return, many of the houses were emptied. Electrical appliances were taken away, often nothing was left behind except for heavy furniture.

An old man with gray hair is riding his broken bicycle through the mud, passing ruined walls and wooden struts that look like houses and metal garden fences with children's toys arranged on them: teddy bears and a baby carriage. These are all signs of the Russian soldiers. The plea to spare the families who live there.

Bags full of tranquilizers

A gray SUV crosses the cyclist. A priest gets out of the car. Under his black robe and green winter jacket dangles a long prayer chain with a plate-sized cross. He arrives from the neighboring village. He carries two bulging black sacks in his hands. Inside is what most people here ask for: Neither money nor food, just tranquilizers.

Some of the residents were surprised by the attack, taken hostage, or are still missing. Despite numerous warnings from the West, many Ukrainians are unaware of the danger. Even in places close to the Russian border, there are many who do not think there is a war, consider everything a "bluff", the reporter recounts his observations. Most people were worried about their business or job until the very last moment, reacting only when shells fell or tanks showed up at the door.

In Mariupol, the harbor city where intense battles are raging, some see it the same way. "We're not leaving Mariupol, we're staying here until the end," says a senior woman in a pink coat with fur and a leopard-print scarf. "We'll stay here," she points demonstratively to the ground. "No matter what happens, we will not give up Mariupol". Her blue eyes sparkle, and her lips curl into a smile.

Somewhere else in Mariupol. Roaring rumble. Grenades detonate. In front of a maternity clinic surrounded by soldiers, a woman screams, and gasps for breath. With one hand she covers her mouth, with the other she presses her child tightly to her chest and rocks it for calm. A few steps away, a young woman with a bloodstained face stands alone, emotionless, wrapped in a thick bedspread. Behind them, one can see the ruins of the hospital that was hit by the bomb.

Attacks on hospitals poorly investigated

More than 90 health facilities have been attacked since the Russian invasion, according to the World Health Organization (WHO). A high number of attacks frequently leads observers to compare the situation to the war in Syria, which has raged for a decade. There, too, health facilities have been increasingly targeted, and Russia has been involved as well.

However, what is new is that the attacks are now being monitored more closely, such as by the U.S.-based Johns Hopkins University. "Until now, no one has captured these attacks the way we do now. That's why we don't have reference values," said Leonard Rubenstein, director of the U.S. university's human rights program. "The issue has not been on the global health agenda or the human rights agenda, except for a small number of NGOs."

Former Ukrainian Deputy Health Minister Pavlo Kovtuniuk also tries to assess the damage to Ukrainian health facilities. Ukraine counts about 2,500 hospitals. And according to Kovtuniuk, there are cities where the entire health infrastructure has been shattered.

Not all withstand the trauma of war

Some hospitals were also hit several times, within a few days. Such as a hospital an hour's drive from Mariupol. The head of the trauma center and his children directly experienced a shelling. While they had sought shelter in the hospital, he is still haunted by what they experienced. "The shelling lasted almost half an hour. My children and I (...)," he breaks off for a moment, struggling for words, then continues, "We didn't make it to the basement. We were in the main building the whole time and witnessed the bombing firsthand."

Not all medics can withstand the trauma of war. In one hospital in eastern Ukraine, there were at least 30 doctors who left their jobs in the first days of the Russian invasion. They could not bear the sight of war wounds. Many of the soldiers that lie in the hospital are severely wounded, some with bodies disfigured by the war, swollen stumps, bone debris screwed to sticks.

Corrupt, inaccessible, and underfunded

Being a doctor in Ukraine is hard in general. Doctors employed by the state receive around 100 euros per month. A salary that is not enough to survive and causes many to demand bribes from patients. Despite the integration into the state system, patients pay 50 percent of the treatment costs out of their own pockets. More than 90 percent of Ukrainians cannot afford treatment because of the high prices, according to recent surveys. As a result, many stay away from hospitals.

On paper, however, the image is good: with 4.4 doctors and 7.8 hospital beds per 1,000 inhabitants, the country has more than most European countries. However, Ukraine's health care system has hardly been reformed since its independence in 1991. Twenty-five health ministers have held office since then, since 2009 some of them have promised reforms but never followed through. Compared to other Eastern European countries, a large portion of the population also struggles with tuberculosis and HIV. In addition, wars generally lead to the spread of infectious diseases because people are crowded into small spaces.

Many hotspots urgently require the help of international NGOs. Yet the aid often doesn't arrive. "It's a challenging environment. There are many areas where humanitarian aid is needed. But people often have a hard time fleeing from there, and aid organizations have a tough job reaching these areas to get resources to hospitals," describes Avril Benoit of Lviv-based Doctors Without Borders. Roads are frequently mined, and checkpoints stop aid workers. The organization also receives many requests for the transport of patients. Much more than they could handle.

Back at the field hospital. Lubomir is one of the patients who will soon be transferred. Away from the front line to a safer place. After surgery, he is stable again and feasts on a plate of sliced sausage and bread. "The guys with the mortars are hard to see, they approached our trenches and threw grenades. Just yesterday morning they hit our camp with 50 shells," he says, shaking his head. Later, a grin rolls over his face. The shell was only millimeters away from ending his life. He knows he was very lucky.

Medical personnel and their facilities are often not further identified or located in news reports. Reason for this is the belief that they could be targeted by Russian attackers because of the treatment they provide to Ukrainian soldiers or because they provide shelter to civilians. 

Recently, allegations have also been made that civilians and especially medical personnel are being forcibly recruited in occupied territories. Ukrainian military intelligence spoke on social networks of doctors in the Kharkiv region being forced to treat Russian soldiers on the front lines under threat of execution.

The Doctors' chamber supports with donations and as a coordinator for Ukrainian aid.

The Doctors' Chamber of Vienna has donated almost 69,070 Euros to support international organizations in the Ukraine crisis. The sum was raised in the course of the Medical Chamber election, in which ten euros were collected for each vote cast. The money went to: Doctors Without Borders with € 30,000, Pharmacists Without Borders with € 15,000, the Greek Orthodox Church with € 10,000 and € 7,035.00 each to Neighbors in Need and Caritas. Their donation pages are linked in each case.

Other organizations involved in Ukraine aid: Red Cross, Diakonie, Hilfswerk International, SOS Children's Village and Malteser International.

Doctors can also volunteer for Ukraine Aid with aid organizations that are registered in the doctors' list. More details can be found in the weekly doctors' newsletter.

If you would like to provide short-term housing for people who have fled Ukraine, you can register with the Federal Agency for Care and Support Services (BBU) at https://forms.office.com/r/GdWUeGJ2C7. For more information, visit www.bbu.gv.at/ukraine-krise-wir-organisieren-Nachbarschaftsquartiere .