Ukraine: Fighting Declines, but Medical Situation Remains Dire

Though fighting in eastern Ukraine has declined since a ceasefire came into effect on February 15, shelling continues in some areas and medical needs remain urgent on both sides of the frontline. Residents and displaced people alike are living in extremely precarious conditions, many medical facilities have been damaged or destroyed, and there are critical shortages of basic and specialized medicines and medical supplies. In response to the surge in violence since January and the increasingly dire humanitarian situation after ten months of conflict, Doctors Without Borders/Médecins Sans Frontières (MSF) has rapidly expanded its medical activities on both sides of the frontline in the hardest-hit areas.  

MSF Reaches Shattered Debaltseve

On February 21 an MSF team was able to reach the heavily affected city of Debaltseve, after weeks of intense fighting made it impossible to provide humanitarian assistance there. MSF had been supporting the hospital in Debaltseve with supplies since September 2014, including sending medicines in January.

“The city has been destroyed,” says MSF emergency coordinator Olivier Antonin. “The windows of the houses have been blown to pieces, tree branches are strewn on the ground, and power lines are severed, hanging in the wind. The people who remain are living in shelters or in basements of buildings as it’s freezing inside the houses. There is no electricity, no heating, and no running water in town. When we arrived they were in shock, asking where they could find medications or other assistance. Many need drugs for chronic diseases.”

Both of the city’s hospitals have been damaged in the fighting; one has been rendered unusable. When MSF arrived only three doctors remained for the entire city: the head doctor of the Central Hospital and two others working in a clinic on the ground floor of a building on the main square. Debaltseve was home to some 25,000 people before the fighting began. While many residents have fled or been evacuated, at least 5,000 remained and many are in urgent need of medical care.

The MSF team provided medical supplies for treating war-wounded, medicines and supplies for basic health care, and essential materials like syringes, catheters, and gloves. An MSF doctor also began providing consultations in the city on February 24.

Teams are currently assessing the situation around the city of Gorlovka, where an MSF surgeon provided support to Hospital #2 during the most intense period of shelling in January. On February 25, a team also visited Uglegorsk, east of Gorlovka, where the hospital has been shelled. Two days later, they began mobile clinics and mental health activities, and this week will distribute essential relief items to 1,000 families in the city and surrounding villages.

A Huge Need for Basic Health Care

MSF has started running mobile clinics in 19 locations in Donetsk and Luhansk regions to provide basic health care to people living in rural areas or displaced by the conflict. In just the first three weeks, MSF doctors carried out more than 1,500 consultations, illustrating the huge need for health care and medicines in these areas.

"We see mostly respiratory infections, because many people have been living in damp, overcrowded, and unheated basements," says Zahir Muhammad Khan, MSF’s doctor in Svyatogorsk, a town 100 kilometers [about 62 miles] north of the frontline. Here, MSF is running mobile clinics in four  sanatoriums, where more than 3,000 people fleeing the conflict zone have taken refuge, many since the escalation in fighting in January.

With medical supply lines in the east of the country severely disrupted or cut entirely since summer 2014 and health facilities in rebel-held areas not included in the 2015 Ukrainian government health budget, people now face a critical shortage of medicines. Banks have been closed and pensions have not been paid for many months, so many have had no choice but to delay doctor’s visits simply because they cannot afford the cost of transport or medication.

The price of medicines has increased significantly, and even basic medications such as painkillers are out of reach for many. Patients with chronic diseases are particularly affected, with the majority of MSF’s patients in mobile clinics needing treatment for heart disease, hypertension, diabetes, or asthma.

The humanitarian situation is particularly alarming in Luhansk region where the shortage of medicines and essential supplies, including food, is even more acute. Most people who remained in Luhansk are among the most vulnerable members of the community—the elderly, disabled, and sick—who did not have the means to flee the conflict.

In addition to running mobile clinics in rural health centers, MSF is also supporting social services facilities, including hospices for the elderly, disabled, orphaned, and people with psychiatric disorders, with consultations, medicines, and hygiene materials.

Since May 2014, MSF teams have provided medical supplies to around 100 medical facilities on both sides of the frontline in Donetsk, Luhansk, and Dnepropetrovsk regions, enough to treat more than 15,000 wounded patients, 1,600 pregnant women, and 4,000 patients with chronic diseases.

In January 2015, MSF began providing basic health care through mobile clinics in rural and conflict-affected areas and to people displaced by the conflict. MSF psychologists are providing mental health support to those affected by the conflict, conducting 700 individual and 1,760 group counseling sessions so far, and running a training program for local psychologists, social workers, and medical staff working throughout the affected region.

MSF is also continuing its drug-resistant tuberculosis treatment program within the regional penitentiary system in Donetsk, which has been running since 2011.