How people are rescued from the east and why the wounded from Azovstal were not evacuated. Interview with the coordinator of Médecins Sans Frontières

Ukrainska Pravda, 24.06.2022

Two months ago, a special train began to run in Ukraine, with the help of which doctors managed to evacuate from active combat zones hundreds of injured Ukrainians, more than 40% of whom are elderly people and children.
“Hospital on rails” is a joint initiative of the Ministry of Health of Ukraine, “Ukrzaliznytsia” and the international humanitarian organisation Médecins Sans Frontières, which has been working in Ukraine since 1999. After the beginning of a full-scale war, the organisation adjusted and expanded its activities on the territory of Ukraine.
Now hundreds of doctors are helping the victims of the war to survive by evacuating them by a medical train. Passengers are people who have been seriously injured as a result of bombing, shelling or other crimes of occupiers. 11% of patients are children under 18, and 30% of the wounded are over 60.
“Ukrainska Pravda. Life” talked to Christopher Stokes, Emergency Coordinator of Médecins Sans Frontières in Ukraine.

 – An evacuation medical train has been running in Ukraine for more than two months. How many wounded can be evacuated at a time and how many patients in serious condition are among them?
– The idea of transporting patients appeared in March this year, when I met with Alexander Kamyshin, the head of Ukrzaliznytsia. Hospitals in the east were overcrowded, and we decided to take patients to free up beds for new victims.
The new, more complex train was launched over a month ago. It can transport about 50 patients. 46, to be precise. The number of patients on board may vary, but the main question is not how many people we pick up, but how many patients in serious condition we can pick up.
We have 5 beds in the carriage where intensive care can be provided. There are 16 beds in 2 carriages with 8 beds in each for patients who need inpatient care. But these patients are not in such a serious condition that they need care 24 hours a day. It is still possible to pick up about 20 patients with mild injuries. Most of the evacuated patients are people injured as a result of hostilities. A large number of victims are elderly people, as well as, unfortunately, a very large number of wounded children.
According to the latest estimates of Médecins Sans Frontières, 73% of war-related injuries were caused by explosions, 20% – by fragments or shots, the rest were caused by other violent incidents. More than 10% of patients have lost one or more limbs. The youngest of them is only six years old.

–  What kind of help can the wounded get on a medical train?
–  In order for our patients to survive the transportation and for doctors to maintain their stable state of health, complex medical care is necessary. Therefore, before each departure of the train, we clarify the data on the injured in the Ministry of Health. In more detail, the train provides assistance to patients who need intubation or oxygen support. Patients in the most serious condition are in a carriage with 5 beds. Intensive therapy is provided there. A doctor or nurse should be next to patients 24 hours a day. Medical staff works in rotations, that is, in shifts. They control all patients’ key indicators.
– How many doctors are usually on shifts during one transportation by train?
– The number is changing. When we first started transporting the wounded by train, there were 12 medical workers. Now the number changes – may be 16, 17, 18.

 –How old was the smallest patient who was evacuated? What were the injuries?
– We talk about hundreds of patients. It is difficult to talk about everyone, but, for example, after the attack on the train station in Kramatorsk, when we picked up the wounded, the child was about 7 years old. We also had a separate evacuation of orphans from the orphanage. There were 78 children and all at an absolutely tender age – a year, a year and a half. We evacuated them not because of injuries, but for security reasons, based on the fact that the orphanage was very close to the frontline.
You asked about the types of injuries. Many patients have polytrauma, i.e. multiple injuries as a result of shelling or missile strikes. One child evacuated from Mariupol had all 4 limbs injured. Some patients have multiple wounds from missile fragments throughout the body, including the head.

 – Do you remember a journey during which the largest number of wounded were transported? Were there any patients who did not survive the journey?
–  Yes, there was one such case. We took one elderly woman from eastern Ukraine, she was in a very serious condition. And we were forced to leave her halfway, in Kyiv. She died a few days after arriving in the capital.

–  How are the wounded evacuated, how are they taken to the hospital on wheels? Are Médecins Sans Frontières directly involved or do the military and volunteers help?
–  Transportation is carried out in two stages. The first is when patients are sent to the railway station. Different people and institutions are involved here. In particular, ambulances of the Ministry of Health. We also have our own transport. When patients arrive in Lviv (second stage), they are also taken away by ambulances of the Ministry of Health.

–  What challenges do evacuation teams face? In particular, how do foreign doctors communicate with the wounded?
–  Regarding the language barrier, there are nurses who work 24/7 with patients, including night shifts. These are Ukrainian workers, so there is no language barrier here. When it comes to doctors, it’s a mix of Ukrainian and international. They communicate with each other in the language of medical terms, so there are no problems either.

 – Is it now possible to track the trend towards an increase or decrease in the number of wounded who are being evacuated?
–  It’s hard to track. There was more work when there was a tense situation in Kharkiv, because we needed to focus on both the Kharkiv region and the eastern region. Now that the situation has more or less stabilised in Kharkiv, we can coordinate efforts in the east. Now the evacuation train runs 2-3 times a week.

–  In early May, Irina Vereshchuk , the head of the Ministry of regional integration called on Médecins Sans Frontières  to evacuate the wounded from Azovstal. There was an official response on your part. However, there was no news that you succeeded in organising the evacuation, at least to some extent. Why?
– Then there was a very difficult situation at Azovstal, and at that time the International Committee of the Red Cross played a key role in evacuations. As an organisation, they have a more developed network of contacts to organise such evacuations. Because such events require security guarantees on both sides (Ukrainian and Russian). For our part, we offered medical care during the evacuation. That is, we would provide medical care to patients, and the International Committee of the Red Cross had to provide the issue of logistics and negotiations between the parties.

–  Why, in your opinion, did the evacuation fail?
–  This is, in fact, not a key area of activity of Médecins Sans Frontières, because we mainly provide medical assistance. We are ready to provide it for our part, but we do not have the same experience as the International Committee of the Red Cross and the United Nations in the evacuation processes.

–  Is it possible to compare the level of complexity of MSF’s work during the war in Ukraine with the conditions that were in other warring countries in which you worked?
–  I have worked for 25 years in countries where active hostilities have been conducted, but a distinctive feature of Ukraine is that medical care is provided here at a very high level. The only thing is that now, in eastern Ukraine, there are certain problems with the supply (of drugs) and with the provision of medical care. Medical facilities were bombed, people were evacuated, medical workers were evacuated. But our medical teams also work there and provide medical assistance, including surgical interventions.