21st October 2022
CONTENT WARNING: Highly graphic images of war injuries
Since March this year, I came to work as a frontline medical volunteer in Ukraine, because we as MSDN see it as very important from perspective of critical solidarity, to be able to put in practice alternative medical structures, and open possibilities to those who are unable to join Territorial Defense units for different reasons. Whether it is capacity or other reasons, we want to be able to show that anybody can join that work with the right training, time and effort being involved. I wanted to help build something like this through Medical Self-Defense Network through providing medical training, participating in support of Ukrainian people and volunteers who are already engaged in educating others.
My work differed depending on which region I have been working in. I did not stay the whole time since I came, and when I was in Ukraine I worked in Kharkiv region and in Bakhmut in Donetsk region. We work in solidarity with the Ukraine Armed Forces and Territorial Defense units, the medics and other volunteers who are in these structures. We supported them giving medical training or sometimes gave medical training to people on our own accord. We have been participating in the frontline defense efforts and learning from the perspectives from other medics involved in this work. Some of the daily routines involved:
- Preparing ambulances with equipment and necessary medical material.
- Organizing logistical needs for the group.
- Facilitating local medical groups getting the medications they need for the work.
- Supporting other structures and groups with medical logistical solutions in cases of need.
- Routines and culture of daily life is very important: living together with other people, we eat together every meal time and connect to each other on human level.
Areas of Work
We worked in the frame of critical solidarity with Territorial Defense forces, the army, other volunteers and doctors who engage in the work there. Of course, when you work with such wide coalition of forces in one field, there are all sorts of contradictions involved. But we worked together in solidarity to help protect the people from the invasion.
One place we worked in is Kharkiv region. Artillery shelling happened quite often in the place where we were stationed. Myself and other medical volunteers I was with would respond to these situations as medics. We would go to the areas that were hit and treat injured people. Sometimes we would go directly to different places that were being attacked and other times we would set up a triage point, where the wounded can be brought by armored vehicles or other type of transport available. At times it would be civilians bringing wounded people in their own cars as well. We were working at different points at the frontline – trenches, fields, but also joining operations and participate in this way as well. Sometimes were that we had to hide in between trees to receive patients while fighting is going on.
In times when nothing happens, we would not lose any time and prepare medical training for other volunteers who do not organize within MSDN frame but work with us. The goal of such trainings is to create more autonomy for volunteers in order to conduct medical work when we are not around.
Other times we also worked at the clinic and helped to distribute blood pressure medications, helping some of the elderly people who decided to not leave their homes. It is important to keep in mind that it’s not only soldiers who get wounded. Many civilians are getting wounded and killed. Many elderly people and families cannot leave and often don’t even want to, as they have nowhere else to go and want to stay in their home. Among the civilian population we encountered stroke patients, dealt with blood pressure issues, and some casual incidents as well – once we treated a woman who got burn from the gas stove.
Another place we have been working at is Bakhmut. Mostly at the hospital with others and helped when patients were brought, wounded in the fighting. We also went together with ambulances to different points at the immediate frontline, like trenches, streets and residential blocks in the city, treating patients which were brought to the triage points we had improvised.
Risk and Danger Involved
There are a lot of dangers involved in this work, like in any work in any armed conflict area. Whether it is a risk to be hit by artillery shell or shrapnel, being shot in result of an ambush, sustaining injuries while evacuating the patients.
Mortar and other artillery bombings were hitting very close to us often. Sometimes it would hit points further away, for example 500 meters. And sometimes it would hit the houses right behind us. Reality of our work also includes ambushes on the roads, including attacks on medical vehicles that are on their way to evacuate the wounded. It would also happen sometimes that after an a artillery strike would hit a point, medical team would come there to evacuate survivors and the Russian forces would target and hit the point again. They are doing this sort of a deadly trap for medics and rescue teams. It was very dangerous to evacuate patients in these areas. As the Russian army is closing in more on the city it becomes more dangerous to do evacuations.
Mental health is also an important part of the risk involved in this work. Especially for people who are participating in the defense for very long time and have to deal with a lot of injured people, and the sad and dark reality war brings, with the constant pressure and stress. Considering this, mental health awareness is crucial. It’s quite difficult for medics to work with the patients in such tough conditions. Many injured who come in are already dead or on the verge of dying. Many of them isn’t possible to save. This work involves dealing with massive amount of death for a prolonged period of time. It affects mental health of medical responders, and those responsible for the direct defense.
Other danger involved being worrisome of people around, sometimes not knowing who in the region is collaborating with Russians and who doesn’t. It is a risk. I have not seen these situations from my time working in Ukraine, as well as other volunteers who MSDN works with – although it exists.
At the time of my work, most days at the frontline me and other volunteers in our group and hospital staff would come to treat around 15 or more patients daily, not counting those we could not retrieve.
Many of the injuries are inflicted on people in result of long-distance warfare – the artillery. In Kharkiv region, we have treated civilians who was living there in their houses, and were hit by the artillery. These were mostly burns, shrapnel and blast injuries. One elderly woman we have treated lost a part of her jaw during the bombings. Another patient was wounded during the artillery shelling and lost her mother. These examples are basically shrapnel injuries and blunt force trauma injures. But it is also very important to acknowledge the mental strain people go through due to losing their relatives and homes.
Other injuries I came across are cut and puncture wounds, airway injuries, cranium injuries, internal bleeding, fractures of various types (which sometimes would seriously complicate evacuation), gunshot wounds, loss of extremities, concussions and injuries from the blast impact, shock either from the sustained injuries or the mental shock of seeing other people (including friends and relatives) getting injured. People being ambushed on the roads would often get gun shot and shrapnel wounds and concussion. People in the trenches would also often get burns in the the face down to their shoulders, as not everyone manages to take cover and get burns from the heat wave of explosions. That also often leads to airway, and eye injuries.
These includes green but also yellow and red patients, with all sorts of injuries that I have listed. There we some red patients who lost a lot of blood and had massive cranium concussion. It was because they had to stay at the frontline not being able to get evacuated within the Golden hour, and eventually they went into shock.
Needs and Necessities of the Coming Time
One thing that could really help our work is a vehicle. We need an ambulance. At the front you are running out of cars quite quickly. In Bakhmut armored vehicles and ambulances are especially targeted. At the time in Bakhmut several medical groups lost their vehicles and their medics were killed. Quite recently several medics lost their lives while performing their duty, some of them I have worked with as well. I would say that having more people, more vehicles and more medications would be quite a big aid for the situation there. Also, for example now in the winter there will be more instances of treating hypothermia, due to difficulties in evacuation. And as time goes on, resources are getting depleted and a lot of basic necessities will be needed.
Challenges and Inspiration
One challenge I can share is when there was a lot of injured people coming at the exact same time. We tried to organize triage in this situation and treat as many people as we could, and at the same time we knew that some of them will be considered “black” patients even though they are still breathing. Because we are trying to conduct treatment in the most effective way and save as many people as possible, it’s not possible to focus on such patients when there are so many others in somewhat better condition, which will worsen with each second. A lack of prioritization results in a situation where many who could have been saved to die if we put all our attention in the wrong directions, and we want to save as many as we can. Triage is one of the most difficult medical tasks. Especially in the hospital I saw surgeons doing a fantastic job. I really put my heart and my feelings for those surgeons who did this work. I can say it was one of the hardest things to see – these people who really put themselves out there and feeling really burned out from not being able to save everyone, but still doing their best.
I am very inspired by all the other groups, medics and volunteers, people who came together to do this work. All these people who did not earn any money to do this, but just wanted to be there and save lives in a very difficult and dangerous environment. I saw people taking genuine care of each other, and trying to keep the morale up, even though we are not under exact same name or structure, we still worked together and worked to build something together.
I also remember people connecting to each other through all the loss and pain, and comfort each other. There was this old man who was at the hospital, always trying to take care of people’s basic needs, take care of those who were injured, or people who came around after losing somebody. He put a lot of genuine and dedicated human care into these people. I think it was hard to do for many who are already struggling and this person had lost all of his unit, and he was still putting himself out there for emotional and practical care for those who were really struggling. It was hopeful to see somebody who had lost so much but cared and tried to be there for everyone because of his love for the people. Seeing that, bus also his sadness from people grieving and trying to cope… It was beautiful in its own way.
Evaluation of Work and Organizing
I believe that the impact of our work was not huge in the bigger picture. On the other hand, I think it really does mean something for the Ukrainian people to see volunteers from different places to come there and show solidarity and to support in different ways, while opening up political discussions whenever possible. I think such discussions should be more often and present, yet of course also in such difficult times people are showing their convictions through care that they give to others, and also through how they carry themselves. My lack of language skills was the reason it can be hard to carry on with many of these conversations and interactions. I think that it could have been more meaningful with speaking the language. I think having people willing to do the work at the frontline and not trying to go as saviors like “we gonna to do this” but actually helping and giving training, providing support with what is needed, showing solidarity for other people to do the work – is very impactful. It is also meaningful to try to train people who otherwise would not have the chance nor opportunity for that with all the war and stress. It is good to open up these possibilities and I hope in the future we will be able to more of this. It can be done in a more organized way. Preparing more people for this role is crucial. Many people get only 3-days quick education because of the pressure, and being places at the frontline to do this work. Some people get quickly taught the basics of MARCH algorithm and are sent on the frontline, because medics are desperately needed. It is important for people who are able to provide high quality medical training to come and do that. Overall, I believe that the frontline medicine will grow in quality and quantity as the war goes.
On the other hand, I worry that logistical and other material support, including finances, will decrease as the war continues. Support of the UN and other countries will change because of the agreements that were made on blocking Russian economy. But will this hold? because if not, more money will go to Russia and this will have a direct impact at the front – more pressure, more people injured and killed, less medical support, less quality equipment. There was a lot of support so far, but over a long time it can weaken. So it is important to continue to pay attention to the situation and donate. It is necessary to put infrastructures in place for this to make it sustainable, instead of providing one-time support. It is important to produce things like medical equipment, provide ambulances. There is a lot of humanitarian support happening, also in terms of healthcare professionals coming to engage, and local people learning and using these skills from previous educations or new ones. This will be important for all development that will take place in the regular but also low-intensity warfare in the future.
It is a very dangerous work for frontline medics. A lot of people who work in this capacity were injured and died. A lot of people who went through this come out with mental scars. But people are really working hard. The volunteers who are coming there are really nice. Language skills are pivotal and translation is also very important for this work to be accessible. It is also important to try to coordinate with other groups and volunteers before coming and when already in Ukraine, to make the work more organized. One day we in MSDN are hoping to build up a parallel infrastructure with the local people there and engage in many ways of organizing the health care, knowing that we are a small part of a much bigger picture, its nice to stay hopeful of building together.
There is a lot of work in front of us, and the prognosis of coming months has a lot to do with volunteers, medical aid, how the war goes on and what kind of support Ukraine will continue receiving, and what is the situation in the society in Russia. On the medical side, my personal analysis is that it’s quite heavy in different regions with losing a lot of medics. There is a lot of work being done to solidify and improve, make it more effective and sustainable. A lot of international and local volunteers are the big support for the resistance, and more need to come. We are still striving to pass all tools and knowledge we have to other volunteers who are willing to do this work as well.
Pictures are taken by both MSDN and other medical volunteers