Finding the most useful role – Doctors Without Borders' response in and around Ukraine

The first shipment of @MSF emergency medical supplies is now going to #Ukraine. This shipment departed from Brussels with 3 trucks and 120m3 of medical kits, including:
➡️surgical kits
➡️trauma kits
➡️chronic disease medications
➡️mass casualty supplies pic.twitter.com/yypkX92gqD

— MSF in Southeast Asia (@MSF_seAsia) March 3, 2022

To date, Doctors Without Borders has brought more than 225 metric tonnes of medical and relief supplies into Ukraine, much of it already dispatched to hospitals and health centres, or to the Ministry of Health for onward transport to the places where it is most needed. Moving supplies around a country at war is not easy, but our teams have found the Ukrainian Railways to be invaluable.

We have also brought in five shipping containers filled with thermal fleece blankets, sleeping bags, warm clothes and hygiene items (such as toothpaste, toothbrushes, soap and towels) and given them to local civil society organisations in Lviv to distribute to people arriving in the city from elsewhere in Ukraine or making their way towards the country’s borders. We have done further distributions of relief essentials in Kyiv, Kharkiv and other locations.

Medical train referrals

On 1 April Doctors Without Borders completed its first medical train referral, taking nine patients who had been wounded in or near Mariupol from hospitals in Zaporizhzhia to hospitals in Lviv, transporting them on a two-carriage train kitted out as a basic hospital ward, with a team of nine Doctors Without Borders medics on board.
Three further referrals by this train were from hospitals close to frontlines of the war in Donetsk and Luhansk regions. A total of 114 patients have been medically evacuated to date, with their family members. Further medical referrals by train are planned as the urgent requests from hospitals in the east continue to grow, while a larger and more highly medicalised train is being got ready for use.

Mass casualty training and trauma care

“When a hospital receives many patients at one time, we call it a mass casualty situation – when you don’t have enough resources and the patients have too many needs,” says Barbara Maccagno, Emergency Medical Coordinator in Ukraine. “One of the most effective ways to save as many lives as possible is to have systems to help you quickly triage the most severe patients who need to be treated right away, and the patients who are less severe and who can wait a bit longer. It can be learned quite easily, but it does have to be practised, as it is different from the usual way that hospital admissions work.”

We have conducted these mass casualty trainings in hospitals in Berehove, Bila Tserkva, Dnipro, Kharkiv, Kyiv, Lviv, Mukachevo, Odesa, Orikhiv, Vinnytsia, Zaporizhzhia, and in hospitals in and around Zhytomyr.

Some of the Doctors Without Borders training teams have included experienced war-trauma surgeons who have given additional hands-on practical training in surgical techniques for extraction of bullets and shrapnel and wound cleaning.

Less visible needs

Before the war started, we were treating tuberculosis patients in Zhytomyr; we will continue to seek ways to support them in their treatment, although this is challenging when people are on the move. In Kyiv, Doctors Without Borders has established a telephone hotline for people with non-communicable diseases, which can be used by elderly and vulnerable individuals to get their medication delivered at home. In Kharkiv we are running mobile clinics for people sheltering in metro stations, many of whom are suffering stress and psychological trauma due to the war.

In Chernihiv, we provided a substantial donation of medical supplies to one of the hospital in the city. We have also set up mobile clinics in neighbouring villages and in the city to respond to health needs.

Our teams are also starting to provide mental health support to people who have fled areas of more active fighting and have gathered in Kyiv, Vinnytsia and Berehove or are transiting through Zaporizhzhia. In and around Dnipro, we are providing essential relief items for people who have managed to escape Mariupol and the Donetsk region.

Areas with active warfare

The greatest needs are undoubtedly in places with active warfare that our teams cannot reach.  Civilians trapped in besieged cities need safe passage to locations of their choice.

Humanitarian supplies must be allowed to reach areas where civilians are in dire need. Civilians must be protected under the rules of war and international humanitarian law, in all places and at all times.

Around Ukraine’s borders

More than four million refugees have fled Ukraine for neighbouring countries, according to UNHCR. In most of these countries, there is massive solidarity to welcome and provide assistance for Ukrainians, and we do not intend to duplicate these activities. In countries bordering Ukraine, our teams are running clinics providing medical care and mental health support at border crossings and sometimes on both sides of the border; we have made donations of medical supplies; and we are supporting local civil society groups, for example by training them in psychological first aid.

While it is heart-warming to witness the solidarity shown to Ukrainian refugees by individuals, we note with distress that the governments of EU member states continue to demonstrate strongly repressive approaches to safe passage for refugees of other nationalities arriving in Europe.

We urge safe passage and dignified reception to be extended to all people arriving in Europe as migrants, asylum seekers or refugees, wherever they arrive and by whatever means.