Supporting Healthcare in a Rural Ukrainian Town – Ukraine
Unlike some other humanitarian emergencies where local health systems collapse or struggle to meet the needs of the population, hospitals and civil society organizations in Ukraine continue to operate in the ongoing war in the country. As practical medical care is largely supported, Médecins Sans Frontières (MSF) teams are currently focusing on building a support network for hospitals and first responders, primarily through training and donations. . Here we share a window into a two-day visit by an MSF team in late May offering support to residents of a rural town in central Ukraine.
A mobile team on the way
At 7:30 a.m., we rush to the entrance of a hotel in Kropyvnytskyi, a town in central Ukraine 150 kilometers from the nearest front line. MSF set up a small base there in April. People load medical and logistical equipment into three cars, and the project coordinator gives final briefings on the situation and planned activities with members of the mobile team as they prepare to leave.
Fourteen people, including doctors, psychologists, translators, logisticians and drivers, head for Holovanivsk, a small town of 16,500 people, two and a half hours drive west. The convoy passes through vast, mostly empty fields of soybeans, corn, wheat and sunflowers, as the crops have not yet grown. Cloudy blue sky and yellow soybean flowers recreate the bicolor Ukrainian flag.
Division into groups according to tasks
At 11 a.m., the MSF team reached Holovanivsk. More than 1,000 people displaced by the war are registered in the city, but they live scattered, the majority in neighboring villages.
The team is divided into four groups. Olexander and Juan Pablo, doctors from Mariupol and Argentina, go to the local hospital and the ambulance center. In each site, they will organize training sessions on mass casualty response and decontamination; in other words, how to triage in a situation of large influx of casualties and how to proceed in the event of an attack with unconventional weapons.
Two Ukrainian psychologists, Olha and Alissa, will assess the condition of people in displaced communities. They would like to offer individual mental health consultations and try to organize a psychotherapy group. War has a huge psychological impact and many people suffer from symptoms such as intense fear, constant stress, persistent worry, despair and panic attacks.
Midwife, Florencia, and mental health activities manager, Ariadna, from Argentina and Mexico, accompanied by translator Olha, visit a school to launch a two-day workshop on sexual and gender-based violence gender (SGBV). Meanwhile, Brazilian logistician Tanain and other staff visit the humanitarian center to donate relief items.
Responding to the needs of displaced people
Olena is waiting at the humanitarian center. A former chemistry and biology teacher, Olena is currently secretary of the village council.
“During the first days of the war, 150 to 180 people arrived here daily, mainly at night,” says Olena, “Many transited to other places.”
“It was awful… nobody was prepared, so we organized ourselves to do different tasks: cooking, cleaning… Everyone brought things,” Olena continues. “As women with small babies could not stay in the social centers, some residents offered their accommodation. There was a lot of solidarity; I’ve never seen such a thing.”
Olena’s own son and partner lived in Kyiv, but they also moved here soon after the war started.
“It is now very important to get humanitarian aid,” says Olena. “We can temporarily ask farmers to provide food, but other things like hygiene items are useful… people are short of money, they have already spent a lot.”
An MSF team was in Holovanivsk two weeks earlier, so before this visit the local authorities had identified the needs: blankets, towels, bedding, solar torches and pillowcases.
Victimization and Barriers for Survivors of Sexual Violence
Nearby, around 35 health workers, social workers, teachers and psychologists, all women, are taking part in the training on SGBV. Facilitators talk about the feeling of victimization that some women may have after giving birth to a child following rape, or the obstacles encountered by male survivors.
“No matter what you’re wearing, you have no signs of being raped,” midwife Florencia told the group during the session. “It’s always the perpetrator’s guilt.”
“The training is very useful and instructive,” says Olga, a psychologist at the school. “It is extremely important in these times because we often come across cases of violence. We have examples from Luhansk, Donetsk, Kyiv region, Bucha… We want as many people as possible to know about these cases.
Understand the bureaucratic challenges of survivors
The next day, the group begins with a role play. Each participant assumes a different role: a policeman, a doctor, a psychologist. The woman depicting a survivor is holding a string and moving from person to person asking for help.
In doing so, she creates an intricate spider’s web out of string. The web represents the bureaucratic obstacles that survivors encounter in real life. The solution? To create a single pathway with all services, including medical treatment and psychological assistance, which MSF is trying to support health authorities in parts of Ukraine.
“Our goal is to educate these frontline responders in order to increase the number of people reaching services,” says Florencia. “But it’s proving difficult.”
Violence has placed people in vulnerable situations
In another room of the school, MSF psychologists carry out psychological support sessions with adults and their children displaced by the conflict. Maryna and Olena are from the Donetsk region and arrived here one and two months ago respectively. They live in an empty house in a village near Holovanivsk with another woman; all have children between 6 and 12 years old.
“A relative living here [in Holovanivsk] was informed by administration officials of our current location,” says Olena. “When we arrived, we were afraid of the reaction of people. We didn’t want them to feel sorry for us. But the attitude was very good, people were very warm.
Both are entrepreneurs. Before the war, Maryna had a beauty salon, and Olena ran a small store. Now they help in a local kitchen to prepare food and grow vegetables.
Sandra also shares her experience on the effects of war. She is in her final year of a bachelor’s degree in international management and comes from Kharkiv, the second largest city in Ukraine.
“I feel good, in general. I am alive and my parents and my husband are with me,” says Sandra. “We got married here barely a month ago. But I can’t read the news. It only takes me a minute to get frustrated, to start crying… I still can’t believe it’s possible.
She does her best to occupy her mind with tasks, be it drawing or writing poems. She says some of her friends chose to stay in Kharkiv, despite the extremely difficult situation – a girlfriend who has a baby girl lives in a partially destroyed house.
“I don’t miss any material possessions,” says Sandra, “but I miss my city, the trees, the buildings. I just wanna go home.
But then she remembers why they fled.
“It was very stressful. I couldn’t face it. I felt nauseous just looking at food,” Sandra continues. “During the first days, we always moved towards the bunker. Later, when the bombs fell, we went to the toilet and covered our heads with pillows and blankets. We sat down squatted and prayed.
“Fighter jets flew over the building,” she said. “The sound of the bombs was so loud, every time it seemed like they were hitting us.”
Strengthen hospital readiness
At the hospital, the MSF medical team completes the training; Yanina and Oleksii are again sitting in their pediatric office in white coats. They studied medicine together. She is from Zaporizhzhia and he is from Melitopol in the southeast, but both moved to Holovanivsk two years ago.
“We have had fewer patients since February 24 [start of the war] but they come with more serious conditions,” says Yanina. “Many people from the region have left Ukraine and many displaced people in the region do not know exactly what we are doing.”
The wall is full of drawings, made by children who have received medical support. Patients recount their experiences with health problems. A cat, for example, was drawn by a girl with asthma.
“During the first month of the war, we worked at night and the surgical team was on standby 24 hours a day,” explains Yanina. “During the siren alerts, we went to the bunker with the patients. These days we stay in the hallway security zone.
“We have received humanitarian aid over the past few months. Training is important in rural areas so that staff develop knowledge, do not panic and know how to act step by step,” she continues. “We had children from the occupied territories, like a boy from Mariupol. He developed allergic rhinitis [inflammation of the lining of the nose] to have spent a month in the bunker and was in a bad psychological state.
Things are not easy for the doctors themselves either. They check on their own families every day.
“I try to avoid overthinking, the easiest way is to just come to work,” says Oleksii. “I still have so many relatives in Melitopol. My parents live near the military airport and keep hearing military planes. People trying to leave Melitopol to other parts of Ukraine spend days at each checkpoint.
During the conversation, the siren alert sounds on everyone’s cell phones. This is the third time today. The previous two were in the middle of the night. In town, the different members of the MSF team gather together. They have lunch, finish their work and get into the three cars to return to Kropyvnytskyi. The two-day visit to support the people of Holovanisk is over.