Two years on in Ukraine: “Everything was shelled. But it wasn’t the end.”

Near Kupiansk, northeastern Ukraine, 75-year-old Liudmyla Karatsiuba and her neighbours live their lives in one of the most volatile areas on the frontlines. Following Ukrainian forces’ partial retaking of the Kharkiv region in September 2022 and the frontline shifting further from Kupiansk, a Médecins Sans Frontières (MSF) medical team arrived in Liudmyla's village to offer medical treatment. 

“About six months ago, everything was shelled—the medical point, the pharmacy, and all the infrastructure destroyed. But it wasn’t the end,” says Liudmyla Karatsiuba. “We built houses, we strengthened our community.”

The shelling had left no public buildings for the team to set up a clinic, so Liudmyla agreed to let the team use her home, where they provided medical and psychological consultations to people from the community.

"Our medical centre is now among citizens referred to as the ‘museum,’ because it’s so new,” Liudmyla says, smiling. “Now there’s somewhere to go when we need treatment or medicine." 

Liudmyla is typical of the types of patient MSF sees near the frontline. Following the dramatic escalation of the war in February 2022, MSF has been conducting mobile clinics in the adjacent regions. Since the start of the war in 2014, villages near the frontlines have dwindled, with fewer supplies in the markets and medical centres, and fewer people. But following the war’s escalation, nearly 10 million people are displaced today, either inside Ukraine or as refugees abroad. 

“Most of our patients have been women over the age of 60, many of them suffering from chronic diseases like hypertension and diabetes.” says Maksym Zharikov, MSF deputy medical coordinator in Ukraine. “While some were evacuated, others either couldn’t leave, or chose to remain in their communities. The urgent need remains to provide medical services to patients residing 20-30 kilometres from the frontlines.” 

Organisations like MSF have been able to support some of these communities with supplies, medical care and reconstruction. But more often it is the communities themselves, with the aid of local volunteer organisations, that carry out this work: in the last two years it has become increasingly difficult to reach areas cut off by fighting or close to the frontlines.

Today, MSF runs mobile clinics in 100 different towns and villages near the frontline in the Donetsk, Kharkiv, and Kherson regions. These clinics usually comprise a therapist, a psychologist, a medical doctor, and a social worker.

Providing psychological support 

Olena Beda, the mother of 9-year-old Vania, has been living in a shelter for displaced people in Kirovohrad region for over a year with her two children after fleeing war in Donetsk region. Although they settled in an area relatively far from the frontlines, drones and missiles have become a relentless part of life in the last two years. Vania began to have trouble sleeping, particularly after shelling. 

“I can see that Vania needs more care and attention now,” says Olena. “He often asks to be hugged and asks how much I love him.”

“Sudden loud noises and conversations about the war can trigger a sudden change in his condition.”

After a team of MSF psychologists began conducting group play sessions for the children at the shelter, Olena felt that Vania’s anxiety was diminishing; he was able to go back to school and made new friends.

In the last two years in Ukraine, Médecins Sans Frontières has provided 26,324 individual psychological consultations for families like Olena’s. In shelters for internally displaced people, the main group of patients consists of mothers with children.

“At the onset of the escalation, we observed symptoms in children such as anxiety, panic attacks, and fear,” says Alisa Kushnirova, an MSF psychologist. “However, we now notice that children have begun to perceive the abnormal situation as normal—they have adapted to the sounds of explosions, though we still observe neurotic reactions.”

Emergency evacuations

“On 18 April 2023, I lost my leg,” says Tetiana Doloza. “The market where I worked as a salesperson in the city of Ukrainsk, in Donetsk region, was hit by missiles, and I was severely injured.”

It’s been ten months since Tetiana lost her leg, and today she walks in Kyiv with confidence, relying on a prosthetic limb and crutches for support. She was evacuated from the market to a hospital and transported by an MSF medical train to the Lviv region, where doctors and physiotherapists have fitted her with a prosthesis.

“When MSF doctors took me to the hospital in the west of the country, I felt lost. I didn't know how I would cope with an amputation,” says Tetiana. “Now, with a prosthetic limb, I live in Kyiv with my son, and at 72 years old, I am happy to have survived.”

Between March 2022 to December 2023, MSF’s medical evacuation train transported 3,808 patients, 310 of whom were in critical condition. Today, due to a change in the war’s dynamic, patients are now staying in eastern Ukraine, rather than being referred to the west. But our teams continue to operate 15 ambulances that refer people wounded by the shelling or chronically ill patients to medical facilities farther away from the front. 

As international attention on the humanitarian consequences of the war in Ukraine diminishes, the fighting on the frontlines remains as devastating as ever. From 2014 to 2022, more than 14,000 people were killed. Since February 2022 this number has multiplied, with hundreds of thousands wounded physically and psychologically, and almost 10 million people displaced.