Harrowing stories from patients being evacuated on Médecins Sans Frontières’ (MSF) medical referral train show that the war in Ukraine is being conducted with an outrageous lack of consideration for civilian protection.
More than 40 per cent of those with war wounds on the train have been elderly people and children with blast wounds, traumatic amputations, shrapnel and gunshot wounds. The age of these patients points to a complete lack of respect for civilians in a war zone—a serious violation of international humanitarian law.
After more than 100 days of war in Ukraine, the heavy toll on civilians is becoming clearer every day. The patients we speak to in MSF’s ambulance and train referral services—and through our teams’ support of hospitals in east and southeast Ukraine—tell us that airstrikes and shelling by Russian and Russian-backed armed forces are a daily occurrence and are inflicting enormous suffering on civilians and intense pressure on healthcare facilities.
There is nowhere that civilians are safe. They can be wounded in their homes, inside shelters, or during evacuations. Some are prevented from leaving and have been stuck in besieged cities or trapped in fighting with no or only limited access to essential services like healthcare and medication.
“The bombing was happening from all sides,” says a woman in her 70s* accompanying her disabled husband on MSF’s medical train. “So many people died… all the windows of my house shattered.
“My husband is disabled. Last year, the social services gave us a special care bed. I built an improvised shelter around it and covered it with blankets. At the beginning of the war, when the shelling was further away, I would hide under his bed. Every time there was an explosion, I screamed in fear. Later, when the shelling came closer, I hid in the basement of one of our neighbours’ houses leaving him on his bed.
“I couldn’t carry him with me. He’s immobile and is too heavy for me. Every time I was afraid of what I might see when I returned.”
People medically evacuated by MSF’s medical train are either long-term hospitalised patients or recent war-wounded who need post-operative care following traumatic injuries. Of more than 600 patients transported and cared for on MSF’s medical train over two months, 355 were injured as a direct result of the war, with the overwhelming majority of these patients suffering from blast injuries. On the 20- to 30-hour journey, nurses and doctors monitor patients and provide care to keep them stable.
The types of injuries we see on the train illustrate the extent to which civilians are exposed to and affected by the hostilities in this war. Wounds are often extremely severe, often with no identifiable discrimination between men and women, and vulnerable people including elderly and children constitute a significant percentage of the wounded—more than 40 per cent of those with war wounds on the train have been the elderly and children.
MSF patients and their caretakers tell unimaginable stories of children, men and women trapped in conflict, bombed in shelters, attacked during evacuations and seriously injured in explosions, by bombs, by gunshots, or by mines and shrapnel.
“…the decision to use heavy weaponry en masse on densely populated areas means that civilians are inescapably, and are therefore knowingly, being killed and wounded.”
“Our patients’ wounds and the stories they tell show unquestionably the shocking level of suffering the indiscriminate violence of this war is inflicting on civilians,” said Christopher Stokes, MSF emergency coordinator.
“Many patients on the MSF train were wounded by military strikes that hit civilian residential areas. Although we cannot specifically point to an intention to target civilians, the decision to use heavy weaponry en masse on densely populated areas means that civilians are inescapably, and are therefore knowingly, being killed and wounded.”
Artur Struminskyy, an MSF nurse aide working on the medical train, describes a conversation with a patient during a medical evacuation.
“During one trip we had a man on the train together with his eight-year-old daughter and his grandmother,” says Artur. “He was in a lot of pain as he had an amputated leg and the other one was broken.
He said, ‘I have two problems. I am in a lot of pain with my leg.’ I replied, ‘No problem. We will manage your pain with medication. And what is the other issue?’
He said, ‘As you can see, I have my daughter with me. I still haven’t found the courage to tell her that her mother died. I was with her when it happened. I saw her dying next to my side.’”
MSF is calling on armed groups to respect international humanitarian law and abide by their obligations to protect civilians and civilian infrastructure. All warring parties must allow people to flee to safety and for the safe and timely evacuation of the sick and wounded, allow the unobstructed supply of lifesaving medicines and medical supplies, and provide unhindered access to independent humanitarian assistance to those in need.
We remain deeply concerned about all people affected by this war and call for unhindered humanitarian access in order to provide assistance to those in need in Ukraine.
*patient requested anonymity for her family’s safety.
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