Eastern Ukraine - Conflict

KAR_3666[1] - Kielpak, a 76 year old, talks with doctor, Irina and nurse, Svetlana.jpg

KAR_5057[1] - A damaged home, with blown out windows and shrapnel stands in the village of Opytne.jpg

A mobile clinic delivering healthcare to displaced people in Eastern Ukraine

Kielpak, a 76 year old, talks with MSF doctor, Iriena and MSF nurse, Svitlana, about her health problems. “ I come to this clinic a couple times a month to help treat my high blood pressure and other minor age problems. It also helps that the medication I am receiving is for free, as I have a very low pension. I only receive 1,700 UAH (55 Euros) a month, and my son, who I live with, he cannot find work because of the conflict. We both live off my pension, it’s really tough. Most young people don’t have jobs, they used to all work in Donetsk. No one before the war, would ever think it would turn out this way for these people. I live in a two story house, so there’s no ground around us, so we cannot grow any vegetables or fruits. We try to survive on the pension as best we can; we fix lawns from time to time for people nearby. I was receiving my pension at the beginning of the month, then it was later in the month. Now, I haven’t received my pension in almost four months. I don’t even have much money to buy bread.” Today, the Donbas war is among the worst humanitarian crises in the world, with frequent attacks occurring from both sides across the Oblasts (provinces) of Donetsk and Luhansk. Before the war, this compact, heavily urbanized and industrialized region held nearly 15 percent of Ukraine’s population (6.6 million) and generated 16 percent of its gross domestic product. This active war zone has left a devastating psychological toll and access to healthcare almost impossible for the ordinary people in the Donbas region; spread out along the frontline, as its hospitals and medical facilities are destroyed — perhaps even targeted — its citizens are being deprived of basic health-care services, public transport, or displaced from their homes and living in cities, such as Mariupol and Kurakhove, echoing Syria’s similar if larger crisis.

KAR_3790[1] - An apartment building in the city of Avdiikva, sits partially destroyed, from multiple attacks throughout the last four years of war in the area..jpg — Four years of conflict have severely altered the lives of people living in eastern Ukraine. Over a million people have been forced from their homes by a lack of security, loss of livelihoods and damage to their property. Partially abandoned villages are mostly home to elderly people living in relative isolation, who struggle to afford daily necessities as they cope with rising prices and insufficient pensions.
Many of these residents are in desperate need of medical care to treat chronic diseases and psychological support to help them cope with issues of stress and loneliness that have been exacerbated by the conflict. Unfortunately, healthcare is often out of reach both physically and financially. Medical personnel are among those who fled the region, and many hospitals and medical clinics were damaged or destroyed by the fighting.
To alleviate some of the suffering of eastern Ukraine’s most vulnerable groups, Médecins Sans Frontières (MSF) runs mobile clinics in 28 locations across the Donetsk region from their base in Mariupol and sub-base in Kurakhove. The mobile clinics provide primary healthcare and mental health consultations. MSF also supplies medical facilities in the area with drugs and equipment and conducts mental health support training for teachers and government healthcare professionals still living or working in the conflict zone.
It is clear some medical conditions — such as hypertension, high blood pressure and diabetes — are related to the stress people are experiencing due to the conflict. Reflecting this, MSF has accompanied its medical activities with mental health support ever since it began working in this region. Among the patients benefiting from MSF’s mental health consultations, more than half are affected by anxiety. Other common conditions include psychosomatic disorders and depression.

KAR_3084[1] - Doctor Konstantin goes over the next treatment options for Yuriy.jpg

MSF Doctor Kostiantyn goes over the next treatment options for Yurii with him and his wife, Valentyna. During the discussion Yurii starts to cry about the on-going pain and just wanting to feel himself again. He has problems with very high blood pressure and has insufficient blood flow to the brain. Doctor Kostiantyn recounts, “After my examination of Yurii, we changed his treatment and upped his medicine dosage to help him relax more. The [previously prescribed] dosage was not enough; it was not helping this man. During our visit we discovered he had very high blood pressure, more than 220 mm Hg. We gave Yurii a pill that would have a fast reaction time to help with his hypertension. After the pill, we checked his glucose level of his blood and did a few tests to check how the kidneys were functioning. We then gave him a type of aspirin to help with a blood clot. The pills are very important to help prevent the increases in his high blood pressure.” MSF operates mobile clinics in 28 locations in or near the conflict zone in Volnovakha, Mariinka and Yasynuvata Rayons and the city of Mariupol. Clinics are multidisciplinary, consisting of doctors, nurses, psychologists and health educators, and provide primary healthcare and psychological support. Most patients are over the age of 50 and suffer from chronic diseases, such as diabetes and hypertension. Due to direct and indirect exposures to the conflict, the population is also suffering from the psychological disorders such as PTSD, depression, anxiety, and hopelessness from war.

KAR_3124[1] - Valentina Pichakhchi, 77, from the village Starognativka.jpg

Valentyna, 77, from the village of Starohnativka, sits in her kitchen. The village saw constant shelling from the start of the conflict in 2014 til middle of 2016. “ My husband Yurii and I have lived in this village for seventeen years now. The last two years, this territory is somewhat peaceful, there were many military men living near by. A lady I knew was hurt pretty bad, lots of buildings were destroyed. When we needed medicine before, we had to travel almost one hour to Volnovakha, it was quite expensive. As with everything right now, because of the conflict. Yurii has been ill for some time; with the car being broke, we couldn’t make a hospital visit. Also he can barely walk and has trouble speaking. My husband has many health issues over the years; he took many medicines for a stomach problem and he had a stroke four years ago. It’s sad to see him laying around, as he can barely move. Since this new treatment, he can move a bit more and doesn’t have to lay down as much. He’s more active. Which makes me very happy.” Four years on and despite two ceasefires, the conflict in eastern Donetsk and Luhansk regions — which are known collectively as Donbas, has displaced over two million people and caused an estimated 10,600 casualties. And the war still rages on. Every basic service in this region has suffered from major degradation. Many health services have been affected and a lot of hospitals have been destroyed. Some health centers are empty because their staff have often been forced to flee. While other centers are almost inaccessible. All of them lack resources — in medical materials among other — because of the conflict.

KAR_4503[1] - Three elderly residents wait to be seen by an MSF medical personal..jpg

An elderly women waits for a consultation with an MSF nurse at a mobile clinic in the small village of Netailove. The village is located in the Donetsk region, some 12 km from the frontline of fighting between Ukrainian government troops and pro-Russian insurgents. Netailove is still facing shortages in food and medicine some four + years since the conflict started. Before the war, Netailove was a well developed agricultural village, with a population of about 1,600. But clashes in the area in the summer of 2014 left the nearby crop fields littered with landmines and unexploded shells, forcing many of its residents to flee their homes. The assistance from Médecins Sans Frontières is a lifeline for the villagers. The aid group runs mobile clinics along the frontlines, offering psychological and medical support to people living in the areas controlled by the Ukrainian government, including those who had been displaced. Most people that queue in the small village of Netailove are women over the age of 50, suffering from chronic illnesses such as cardiovascular diseases, hypertension and diabetes. The people in the crowd are tired looking, from poverty, unemployment and instability. Many of the retired people rely on their pensions, humanitarian aid, and many are living off the land. Despite the threat from landmines, some of them have started small-scale farming as it is the only way to feed themselves and their families.

KAR_3657 - An elderly women waits for a consultation with an MSF nurse at a mobile clinic in the small village of Netailove..jpg

KAR_2209[1] - A house is riddled with bullets,.jpg

KAR_4862[1] - Marie, 79, from the village of Opytne, waits in a residents home to be seen by an MSF medical team..jpg

Marie, 79, from the village of Opytne, waits in a residents home to be seen by an MSF medical team. “I am one of the 42 people left in the village of Optyne. Life is difficult right now, we have no electricity, running water or gas. This war has left me hopeless, my health has gotten worse since the start, all this war has brought is misery and destroyed lives; it has destroyed mine. Viktor was my helper. My everything. My son. In October 2015, there were shootings and explosions happening all around my house. I was terrified. I remember hiding in a back room and getting horrible news. My neighbor after a break in the shelling ran into my home and told me my son was badly injured. I started to cry seeing him outside with his wounds. I still remember the large wound in his head. I tried to give him the first aid. During this period, I received my pension for the entire year, 11,000 UAH (350 Euros) and spent it all on his treatment; my son also needed some injections, so I spent a further 850 UAH (27 Euros). After his death, my nerves were destroyed. I was shaking a lot. I couldn’t eat. I could never leave this place. It’s my home and my son and husband are buried here. It would be better for my health, if I stayed here. I rather die here, than anywhere else. I’ve been visiting this clinic for a while now, for treatment with my nerves and high blood pressure. Before his death (her son) I didn’t have such problems. But I enjoy coming here, the doctors talk and joke around with me all the time. It feels like family here.” Opytne is only reachable via a narrow dirt road along the frontline, with hundreds of destroyed homes that have since been taken over by nature — with other entrances possibly mined or restricted to use by the Ukrainian military. The residents that have stayed in the small village still hear shelling & shooting in the late hours of night, most of the people like Mariia, live in partially destroyed homes and rely on NGOs for medical care and food. But despite the conditions, the so-few residents left are still reluctant to flee their homes. One resident, Eleva, for the last year, has offered her home to MSF, to run it’s mobile clinic.

MSF doctor, Irina, checks the lungs of Aleksey at a mobile clinic in the village of Pervomais’k. “I have chronic asthma, for nearly six years now, before coming here, I received my medicine from a government health program. There was pharmacy near my house, so I would pick up my medication there, or see my doctor, who is located in Donetsk, now under control of the DPR (The Donetsk People’s Republic is a proto-state recognized only by the partially recognized South Ossetia. It receives humanitarian and military backing from Russia) So I can no longer visit him. If you wanna pick up medication on the DPR territory, you’re gonna pay a lot of money, which I do not have. I did the crossing once, it took me more than 8 hours. I’ve heard from other’s taking this route, it lasting sometimes two days, and people were sleeping in their cars. I would only buy meds that would subside my asthma, not really help it. In my small town where I live now, there’s a huge lack of medical services, because of our current situation we’re in. With no income, my family cannot afford even the most necessary; food and to pay bills. Thankful the medication is free here. It’s worse for much older people, I know many; there’s no infrastructure, no buses, or you are too poor, and cannot afford to hire a ride. Before the war, I worked in another village at a factory overseeing the daily operations. The factory produced mineral powder for the roads and was also used in the mines. Anumber of bombings went off and one huge explosion hit the factory directly, destroying everything. I felt so much disappointment when I heard the news about the factory; I lost my job, everything was gone. Everyday there were bombings from one side; then the other side, non-stop from 4am, to 2am. The horror of seeing shelling and artillery fire will forever stay with me. Pervomais’k, a town very close to the contact line has seen it’s population drop from 80,000 inhabitants in 2014 to just above 10,000. The town, was being shelled by both Ukrainian military forces and Russian armed forces groups; almost all apartment blocks in the town had sustained damage and only 30% of detached houses were intact.

Nadiia, 79. from Mariupol, waiting in the hallway of a Mariupol Hospital, where MSF runs a mobile clinic. “I live alone in Mariupol. It was very hard being by myself during the conflict, as I live on the fourteenth floor of my building. I could hear shooting all the time and the flying of airplanes above, scared me a lot. It was a trying experience for me, but there are other people who have suffered more than me. So I don’t feel I suffered that much. The conflict has affected many people in different ways. It destroyed them. My next door neighbor looked ill a few weeks ago. When I spoke with her, she mentioned she wasn’t feeling great and could not sleep. So I ordered some medicine from Kiev; that would relax and make her sleep better. After a week or so, my neighbor feels much better now. It’s a small detail in life, but I am glad I could help her. We must help each other. Doing such things, makes me feel and look younger. The social service told me about MSF and I have been coming to the clinic for, four and half months now. I receive medical treatment for my heart and kidney. After receiving the injections, the results were good. At first I had high levels, then after the second injections, I felt much better. I make sure to follow all the recommendations from the doctors. He told me, he likes where my health is, it’s improving and that I’m a completely different person from my first visit. I have another coarse of injections soon, afterwards I hope I improved even more. My life philosophy is always being kind and good to the people.”

An elderly women speaks with MSF health promoter, Katerina, outside of a mobile clinic held in the village of Vodiane. Before the conflict, Vodiane was a holiday spot, many people from all over Eastern Ukraine would spend their summer holidays here. Tons of families would visit with their children, go swimming, buy fruits and vegetables from local farmers. Since the war in Donbas, that started in mid-April 2014, has brought only civilian and military casualties to the small village. Mariupol, a city inhabited by half-a-million people, is less than 24 kilometers away and in this once quiet village, you can hear almost a daily exchange of shelling and shootings. Of the 300 + families that once called Vodiane home, less than 10 people remain, the war has taken a heavy toll on the village and it’s inhabitants. Most of the villagers that are left depend on medical NGO’s for everything, from medicine, fresh water, and candles to light their homes. I spoke with another resident of Vodiane, Soshenko, 58. I first noticed him walking up the dirt path to the clinic carrying two brightly colored bags, full of fruits and vegetables. As he saw me, he quickly tossed the bags into my arms and said in a deep Ukrainian tone, “Це для всі” (This is for all of you). He then tells me about why he visits the clinic. “I’ve always had high blood pressure, even before the war, so after the first couple treatments, my blood pressure has lowered. My previous visit the sugar level was 6.9, and now it’s dropped to 6.5. I stopped a few years ago, drinking any sorta alcoholic drinks, but I do enjoy chocolate quite a lot. After every visit, I am told by the staff here, I can enjoy one piece of chocolate. It’s a reward for myself. There’s not much left in this village to do. So I try to take the best care of my family. My mother, she had a stroke not too long ago. She also takes treatment here, I have noticed it is helping her, she is a bit more active and happier. That’s all I ask. Before the war, I worked at a station delivering gasoline, I really miss the work. I only needed five more years on the job and I would receive a pension, but the war happened and now the company no longer exists. We only live off of the pension from my mother, but the last three months she hasn’t received any money. We sell the vegetables I grow and bread to make some money. I tend to my garden everyday. I am growing everything from; potatoes, onions, cabbage, carrots, cherries, pears, peaches, apples, grapes, watermelon, corn and many others.

KAR_2861[1] - Richak 62, from Mariupol visits a local hospital that MSF runs a mobile clinic inside of. MSF Nurse Tana slips on an inflatable cuff.jpg

MSF Nurse Tetiana, checks the blood pressure of Mariupol resident Richak, 62. “My husband and I are renting an apartment in the center of Mariupol. We lived previously in a small village near Luhansk; our home was bombed & destroyed. So we were forced to flee to this region. When the war happened, it was so sudden, no one expected this to happen. When the bomb hit our house, the explosion tossed me threw two rooms and into a wall. A further two shells hit the road outside our house, another just in front of the main entrance. At first, I couldn’t move after the incident or hear for weeks after the bombing. I thought this condition would remain for a long time, but luckily it went away, the fear though does not go away. That day will always remain with me. I’m in constant fear, even now. Nowadays in Mariupol, it is quite average here, we live pension to pension, it’s very trying to survive by this. I have had ten operations since that day, one on my heart, my spine, also an operation on my belly. I come to the clinic here for medicines that will help make me not hurt so often. My pension is 1,430 UAH (45 Euros) a month; it’s not enough to buy medicines. You can enter the pharmacy once, and send all your pension. I worked for thirty-eight years at one job, this is all I receive. My husband, he worked forty years as a miner, and his pension is low. With him working so much in the mines, he has health issues, with his back & sight and his lungs. ”A total of 1.5 million 519 thousand 132 IDPs from Donbas and Crimea were registered in Ukraine as of September, 3, 2018, the Ukrainian Social Policy Ministry has reported. Only 42% of internally displaced persons in Ukraine are employed, according to a report issued by the International Organization for Migration (IOM)

KAR_2261[1] - The waiting area at a local medical hospital in Mariupol, where MSF runs a mobile clinic offering medical and psychological support..jpg

The waiting area at a local medical hospital in Mariupol, where MSF runs a mobile clinic offering medical and psychological support. Mariupol, a port and industrial city that lies on the coast of the Sea of Azov, was briefly controlled by Pro-Russian militants during the peak of fighting in 2015, appears tranquil in the warm spring morning as we make our way to Hospital One, located in the east of the city. But the calm hides the nervousness amid the city’s inhabitants. The conflict has torn apart the infrastructure, interrupted access to drugs and medical services & has seen rampant inflation and higher rates of unemployment. The lack of treatment for chronic illnesses such as cardiovascular diseases, hypertension and diabetes. is one of the more critical medical needs facing elderly people. With higher inflation people living with such conditions simply cannot afford their medical treatments. Without this care, many are left at a higher risk of medical complications. In Mariupol’s Hospital One, MSF staff have use of two small rooms at the end of a dimly lit corridor. The patients are provided free access to a nurse, doctor and psychologist. The waiting room is loud at times and crowded, filling up the benches along the wall, many fanatically waiting to be seen next. A few women describe to me their fears of lingering health issues and not receiving their pensions, as another elderly lady, wearing all pink, broke into tears and violent shaking, as she asked for help to find out where her husband is buried. She shows me in muffled tears a picture of her husband, most likely taken 60 years ago, and tells me this picture and her memories is all she has left. Eventually, the women start smiling as one by one they leave with their medicine in hand. Most of the people visit this clinic a couple times a month, as a 67 year old women begins to tell me her story, “I’ve been visiting this clinic for the last couple of years. I have heart problems and high blood pressure. I also have diabetes. I traveled more than 40km for my treatment, I usually hired a car or took the bus to get there. Sometimes the hospital didn’t have my pills, so I spent the money on the travels, for nothing. Prior to the war I had these health issues, but since the war began, I found my health has gotten worse.”

Oksana, an MSF nurse checks the blood pressure of 67 year old Golikova, at a clinic in the village of Pavlopi. Most of patients seen by MSF at the mobile clinics are mainly elderly women, who remain stuck with little to no assistance, suffering with acute mental health needs and minimal access to essential healthcare for chronic diseases. As the women queue up to receive their medical treatment, I heard stories range from loss of family members from shelling, to hiding in damp dark basements for days on end and the hopelessness of life as it is now. A 76 year old resident from Pavlopi spoke to me about her medical treatment and the conflict. “I have lived alone in this village since 2001, when my husband passed away. I have been visiting this clinic since 2016, because I have some heart issues and also I have high blood pressure; all these problems are from war & our current living situation. I noticed many positive changes since having treatment here, for one it is much closer, I can visit often for my health, as I live half a kilometer away and I am provided free medicine. The issue before, is that medications were not available here, and when they were, they’re too expensive. The price of medicine has doubled since the war. As my pension is quite low, I cannot afford to buy this medicine myself. Our village was shelled for many months, there were very serious shootings here and bombing going off right above my building. When I clean my garden I find many pieces of shrapnel in the dirt. I still have anxiety as I can hear fighting in the distance. This village is very beautiful, as you can see. Before the war started there were many places for working people, like on the farms. We also had a better connection to the bigger cities, there were buses every forty minutes, now these buses run some days, but rarely. Everything from this conflict, has ruined life here.”

Murmur from Kamianka, Ukraine, in the consultation room of the health center in Kamianka ( Volnavakha), where MSF runs a mobile clinic. Here Murmur is receiving medicine from nurse Vitalii, to treat his high blood pressure. Alongside his hypertension, he also suffers from other cardiovascular problems. After he receives his medication, he gestures me over to a number of photographs displayed on a wall near the entrance. He points to one after another of him performing for a traditional Ukrainian dance company. “ Other villagers my age cannot even walk much less dance, so I dance to keep my mind and body in a positive mood. Our group, we enter competitions all over Ukraine & Russia.” As I look over the pictures, Murmur continues to laugh while clutching a small plastic bag bulging with medication. He says, it’s for him and his wife. “ I need to take this medicine three times per day to help normalize my health. As my pension is low, I cannot afford what my wife & I need, so I come here, because the doctors support our health. I live with my wife, we’ve been married for sixty years now. My wife has been sick for two years now. She fell during the winter time on ice and broke her arm. My wife needs an operation. We were told it would cost us 15,000 UAH (480 Euros). We don’t have such amount of money. Sadly her arm has remained broke since. I help my wife everyday and luckily there is an organization that from time to time helps us out with food. On my pension, I cannot afford much of anything. Not only for pills, for food, for everything. It’s getting difficult for us. After fourteen years, prices have become higher, and we have struggled to buy food products, so this summer I started growing vegetables in my garden to help us out. I try not to give up and remain in positive spirits.”

MSF Nurse Oksana checks the pulse of 64 year old Donatina, from the village of Starohnativka. She visit’s the clinic quite often for her high blood pressure. I have been walking to the clinic here for half-a-year, before there was no medical support in this village, so I traveled with four other women, we hired a car to take us there. This village is 7km away; for medical help, this is too far, too stressful and tiring for me. I have trouble with high blood pressure and general age changes that caused my health to become worse. I have high stress levels, because of the situations of the conflict. By coming to this clinic, I noticed a big improvement in my health, but also my mental well being. All the people here have become like family. The doctors are always willing to see me and make sure my health is improving. Like today, I felt something wrong with my heart & body, so I was seen by the nurse & doctor. The war was horrible here. It caused so much pain for me. My children had to leave. I miss them very much. First of all, peaceful people have been hurt by this situation; no one wanted to be in this war. It’s horrible it has turned out this way, very similar to other wars, like in Bosnia, Moldova…The people who could leave, would send their children and grandchildren away, while the rest of us stayed here to protect our homes, to make sure no one would steal everything. We had some savings before, to heat the house, but now, we don’t have much money, because the war; everything is much higher. Our pensions are very low, we cannot afford to buy much. We have very rich ground in Ukraine, we can grow cabbages here; many other fruits and vegetables. I garden. I have education as agriculture engineer, for over forty years. I also have a cow, so we produce our own cheese. With our financial situation, we grow everything for ourselves.”