Donetsk, Ukraine– It is quiet in the hospital. The corridors are poorly lit despite the bright sunny morning. At night, Russian military drones were flying over the city, the resulting sound of explosions made it hard for patients to sleep, so now they are napping in their rooms.
Volodymyr is waiting for his second surgery. He is from the village of Komar, Donetsk region, located less than 10 kilometers from the frontline. He came to the hospital four days ago with Fournier’s gangrene – a type of flesh-eating disease that should have been treated much earlier.
“I could no longer walk, my neighbour had to bring me to the hospital. I should have come about a month ago, but I just couldn’t make it,” says Volodymyr. “It is hell in our village now. The entire street was destroyed, everyone is hiding in their basements. As soon as it seems to become quieter, the shelling starts again.”
Consequences of delayed treatment
Patients such as Volodymyr who have neglected diseases are common in this hospital, the closest medical facility to the eastern frontline that provides secondary care. It is located at the intersection of three regions with active fighting, which receive a high influx of people seeking medical help.
Médecins Sans Frontières (MSF) supports the facility’s emergency department and operating theatre. MSF also conducts ambulance referrals for patients who need to be examined by highly specialised surgeons in hospitals further away from the frontline. This helps to alleviate the burden on the health facility, however, patients with complications do not stop coming.
People come here from the frontline communities of Donetsk, Dnipropetrovsk and Zaporizhzhia regions, where the shelling does not stop even for a day. The living conditions there are difficult. Patients often do not have access to medicines and medical care, or to food and hygiene items, spending most of their time hiding in the basements of their homes.
The most intense fighting continues in Donetsk region, where the frontline remains unstable and shifts rapidly, leaving behind devastated towns and villages with people trapped in them. The current hotspots are near Pokrovsk, Kurakhove, and Chasiv Yar. Hospitals in these areas have had to evacuate their medical staff and equipment, forcing residents to travel long distances to reach the nearest medical facility. Roads are often littered with remnants of weapons, some of which may still contain unexploded ordnance, making travel extremely dangerous. As a result, many people delay seeking medical help, and their conditions worsen.
“Once we had a patient with a three-day-old peritonitis (inflammation of the abdomen’s inner wall), so we had to take him to the operating theatre immediately” recalls MSF medical activity manager, Dr Khassan El-Kafarna. “People have limited access to healthcare, and we see how it affects them. There are lots of patients with exacerbated non-communicable diseases: hypertensive crisis, strokes, neglected surgical diseases.”
As we speak, Dr Khassan is preparing to perform the operation. He washes his hands thoroughly, as only surgeons can do. He cleans his nails with a brush and then puts on gloves. A nurse helps him pull on a medical gown. Volodymyr is on the operating table, he has already received anaesthesia. The hospital nurses, Dr Khassan and the second operating surgeon are ready to begin.
Dr Khassan works with a headlamp. There is no urgent need for it now, as the special lighting in the room is working at full capacity, but he’s used to having it, just in case. Due to attacks on the energy infrastructure, power outages happen unexpectedly. The hospital has generators, but the surgeons cannot afford to have any interruptions in their work.
Hospital staff are usually quick to switch on generators, as they’ve become used to the power cuts. However, delays and difficulties still occur. Hospitals must maintain sufficient fuel reserves, and while MSF supports some hospitals with fuel donations, it remains an additional challenge in providing healthcare.
Supporting hospitals in Ukraine
Another category of patients near the frontline who come to our medical teams are those with war-related injuries. They sustain trauma from shelling, landmines, and bomb and shrapnel blasts. “These people often have multiple traumas to various parts of their bodies, including head trauma, penetrating abdominal and chest wounds, soft tissue trauma. A lot of patients we receive have open fractures,” explains Dr Khassan.
People with war-related injuries also do not come to us immediately after they sustain their trauma, says Dr Khassan: “We are dealing with infected wounds. Patients could not get help for a long time and they come to us in advanced stages of sepsis. For the past month we treated seven patients with septic complications.”
MSF continues to support medical facilities in Ukraine near the frontline. Our medical teams operate in the hospital in Dnipropetrovsk region and in Kherson city. In 2024, they assisted and performed 1,149 surgeries, and supported 435 patients in intensive care units.
In Kherson city, an MSF medical team also provide surgical and trauma care. They run triage and perform surgeries.
Volodymyr’s operation lasted less than an hour. This was not the first surgery he had to undergo. “When he first came to us, he had septic shock and anaemia. Now we got rid of the source of the infection, but he definitely needs tertiary care. We need to stabilise him before we can refer him to a higher-level facility, because he needs a plastic surgeon, a urologist, and admission to intensive care,” explains Dr Khassan.
The nurse finishes bandaging Volodymyr, and he is sent to the intensive care unit. There is a long road to recovery ahead of him. Despite his condition and the approach of the frontline closer to his village, Volodymyr says that most of all he wants to get back home.
