Russia’s 11-year war on Ukraine, which started with militia attacks on the eastern Donbas region in 2014 and became a full-scale invasion in 2022, has forced many of its people to acquire skills that they wish their nation had never needed.
The Mechnikov hospital in the city of Dnipro is the closest major medical centre to Donbas, the main theatre of fighting throughout the war, and hard experience has made its staff expert in treating injured soldiers, tens of thousands of whom have passed through its wards.
“Mechnikov has been providing care to the wounded since 2014, so we were ready in 2022. We understood that the number of wounded would be much higher. In 2014 ... when the first wounded began to arrive, neither military nor civilian medicine was ready,” says Oleksandr Tolubaiev, the hospital’s medical director.
“In 2014, casualties were brought directly from the battlefield by whatever vehicles were available. Not a single organised medical evacuation route existed at that time. Patients arrived to us with little or no medical care, or it was given in improvised ways – for example, a severed leg was strapped with tape or a broken leg was tied to some stick as a makeshift splint, and patients were loaded into cars and brought a long way to Mechnikov,” he explains.
“No surgery was performed on the battlefield or at nearby stabilisation points, because there were none ... But very quickly, in a few months, Mechnikov improved its readiness and military doctors introduced a system of evacuation and first aid provision, so by the end of 2014 the system was more or less working.”
Now a casualty is usually treated at stabilisation point near the front line and a field hospital before being moved by ambulance to Mechnikov, which has grown to have some 2,500 staff – including 500 doctors – and several intensive care units with a total of nearly 200 beds.
“The hospital is designed to accommodate 1,200 beds, and we are almost always 1½ times over capacity. This includes not only wounded soldiers. There are also civilians from our region ... and people who come from areas where it is no longer possible to provide medical care,” says Tolubaiev.
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Mechnikov also employs doctors and nurses from places that Russia has occupied, including some, such as the small Donbas city of Bakhmut, that it obliterated in the process.
“They have joined our team very effectively and they provide the highest level of care to the wounded. They hope the time will come when they can return and work again in their hometowns,” says Tolubaiev. “Some of them realise they will never return because those places have already been utterly destroyed. For example, we have a doctor from Bakhmut who will never return there, because Bakhmut has ceased to exist.”
Oleksandr Lavrenyuk spent part of his childhood in Bakhmut and returned there as a member of a Ukrainian Red Cross evacuation team before its ruins finally fell to Russia in May 2023.
“I went back there on a Red Cross mission in 2022, taking in humanitarian aid and evacuating the injured and elderly. And the last time I was there was in January 2023, when we went in under shelling to evacuate someone,” he says.
Despite the danger and looming threat of occupation to Bakhmut, Lavrenyuk says it “was good to go back, to see the yard of the building where we used to live, to deliver aid to the cultural centre where I did traditional dancing. But of course it was painful to see how the city was being destroyed.”
Lavrenyuk was working in radio in Kyiv and volunteering for the Ukrainian Red Cross when Russia began its full-scale invasion on February 24th, 2022, and joined the organisation’s staff later that year.
He quickly took his family to a safer part of Ukraine and returned to the capital, where he joined a Red Cross rapid reaction team that set up a field hospital, distributed aid to people taking refuge from missile attacks in metro stations and other shelters, and then launched evacuation missions to help people escape the advancing Russian troops.
Amid frequent shelling and gunfire, the team evacuated locals who streamed over a rickety makeshift crossing on the Irpin river, in the suburb of the same name just 25km northwest of central Kyiv, after Ukrainian forces blew the road bridge to slow Russia’s progress.
“During pauses in the shelling people would come across. But it was dangerous. Snipers were shooting nearby. We took as many people as we could each time, cramming 10 or more into our car with their belongings and their pets,” says Lavrenyuk.
Fierce Ukrainian defence stopped Russian troops in northern suburbs of Kyiv such as Bucha, where they committed atrocities including war crimes against residents whose homes they raided, looted and commandeered.
“We organised evacuation convoys from occupied areas, and it was scary going in there. You didn’t know what to expect, how the Russians would behave and react to what you were doing and saying. It felt like a gamble every time,” says Lavrenyuk (37).
Now he is a field mission specialist for the Ukrainian Red Cross and works in towns and villages near the eastern front line that are under heavy Russian missile and drone fire.
“You feel the danger, you’re worried about your own loved ones, the situation is constantly changing and you have to adapt fast all the time,” he says. “But it’s been three years now and it feels like this is our job. It doesn’t hit you as hard as at the start – people can get used to anything.”
Europe’s biggest conflict since 1945 has triggered the rapid development of drone warfare, and explosive-laden attack drones are now a constant threat to Red Cross and other civilian evacuation teams and to soldiers trying to get wounded comrades off the battlefield.
“When a wounded man is down in the field, an enemy drone is hovering over him and waiting for someone to come and evacuate him,” says Tolubaiev.
“And sometimes it is impossible to evacuate a patient from the battlefield, not just for a few hours ... but for several days. And particularly now, when it is very cold, their injuries can be accompanied by frostbite,” he adds.
“A big problem now is ‘tourniquet syndrome’. Because it may be impossible to evacuate a wounded patient quickly, they can end up having a tourniquet in place not for the recommended two hours, but much, much longer.” A tourniquet can stop blood loss, but prolonged lack of circulation may irreparably damage a limb, making amputation inevitable.
Foreign specialists frequently visit Mechnikov, which was damaged in a missile attack last October that killed at least five people in Dnipro.
“We adopted some skills from the military, we learned some skills from our American and Israeli colleagues who visit us quite often, and we teach our foreign colleagues a few things – it’s an exchange of experience,” says Tolubaiev.
“We all know that this is our war, our country, that this is about defending our country and ... we are fulfilling our professional duty here. That’s why we cannot just say, ‘That’s it, I can’t work any more,’” he adds.
“Of course, stress and fatigue have been extremely high for a long time, but there is no other way – we have to stand strong, endure and keep going until we win. And then we will rest.”
