MSF Live from Ukraine

Avril Benoît: 

Hello, welcome and thank you so much for joining us for this live briefing with our MSF colleagues joining us from Ukraine. My name is Avril Benoît, I'm the executive director of Doctors Without Borders, joining you from New York City, and we also go by the name Médecins Sans Frontières internationally, which brings us the acronym you're likely to hear over the course of this discussion MSF. So that's Doctors Without Borders. And the reason we've invited you here today is that it was a year ago, in February, 2022, that Russia launched a major military operation in Ukraine that rapidly escalated into a full-blown war across most of the country. And it's important to note that this conflict actually dates back to 2014, and that's when fighting broke out in Eastern Ukraine. And it was at that moment that MSF also started responding to much needed medical care gaps, including mental healthcare. 

And so we've been there ever since. And obviously, when this latest escalation happened in February of last year, we had to suspend some of our activities, including in places like Mariupol, and pivot, so it was a question of really adjusting very quickly to the urgent needs that were mounting across different parts of the country. And as we did so, we learned a lot of things. And our two special guests today are going to share some of their learnings, their perspectives from Ukraine itself. So we're going to talk about how we adapted to the humanitarian situation at various points in the conflict, and also give you some insights around what's happening right now from our perspective. So before we continue, I just want to invite you to participate. Here's how the live webinar is going to work. If you have a question over the course of these next 30 minutes, you can submit them to our panelists. 

There are a couple of ways to do it. The best on Zoom is to just go into the Q&A feature type your question. It will be relayed to me. And if you're watching the live stream, the simulcast on YouTube, LinkedIn, or Twitch, you can also send your questions into the comments section on those different platforms. So we do also have live captions for this, so you can just toggle around with the settings to be able to get that. So we have a couple of guests with us today. Christopher Stokes, emergency coordinator for MSF in Ukraine. He is joining us today from Kyiv. Hello Christopher? 

Christopher Stokes: 

Yeah, hello. 

Avril Benoît: 

Hi. Good to see you again. And also Albina Zharkova, she is a medical doctor, deputy project coordinator for MSF's medical evacuation train and she is joining us today from Lviv. Hello Albina, good to see you again, too. 

Dr. Albina Zharkova: 

Hello, Avril, good to see you. 

Avril Benoît: 

And as we look back over the last year, maybe I could start with you Christopher, you've been there since just a couple of days before the escalation. How have our operations changed over that time? How would you summarize what happened over the last 12 months? 

Christopher Stokes: 

Oh, that's a big question. So, yeah, I mean, we had to start actually with an initial small evacuation of our teams because the front line was moving so quickly, but we never completely left the country. And from day one, we had discussions with the Ministry of Health of Ukraine to try and see what we could do. And we've had a very good collaborative relationship with the Ministry of Health, and we decided to really try and fill the gaps that were progressively appearing. So, in the beginning we were providing medical supplies, drugs, medical equipment that were requested by hospitals that were receiving a lot of wounded patients. And later, we realized there was a significant gap in medical referrals. People were stuck close to the frontline, wounded in hospitals that were beginning to overflow. And then we launched this MSF Medical train, which is the first time in our history we've actually done this. 

And Avril, you were on this as well. I think you saw how it functioned. And we progressively moved from there into launching ambulances. Ambulance services are very necessary, especially in frontline areas. A lot of ambulances were destroyed, some were looted, A lot of ambulance staff were even killed in the first few weeks and months. So, we filled that gap. And then in the later phases, in the last few months, as the Ukrainians have regained part of their territory, we've discovered the terrible state of healthcare in these recaptured villages and provinces like Kherson, Kharkiv. And we've launched mobile clinics, primary healthcare with doctors, nurses, gynecologists, psychological support, which is a big thing, a big need actually in these villages that were cut off for many forms of medical assistance for eight to nine months. So, it's really progressed as the war has progressed and we've tried to be creative and adapt to the needs of the population. 

Avril Benoît: 

Albina, I remember you telling me that you were a senior faculty member at a medical school in Ukraine at the time of the outbreak of the war. And then you came in and joined MSF working on the train. Can you tell me the story of what has happened to you and your life over the course of the last year? 

Dr. Albina Zharkova: 

Yeah, actually, before war started, I've been working at the east of Ukraine as an associate professor at the medical university, and we had a lot of international students who were blocked with us not too far from the border. And then, we were able to move, and we moved to the Western Ukraine. And I've been thinking, how can I be useful in this situation with my knowledge and skills? And I saw the announcement for MSF and I decided to apply and I got this position as a medical doctor at the Medical Evacuation Train. 

Avril Benoît: 

One of the things that I still get asked is how is it possible that the train system, which is a vast network crisscrossing the country, is still functioning so well in Ukraine. Can you just explain how it is that the trains became the way that we were so much able to transport people across this vast country? 

Dr. Albina Zharkova: 

Actually, we always had a good train system in Ukraine and at the beginning of the war it became the main road for surviving for the people. And we have quite good management of the railway system, and it helps us to work like this and helps people to use railways to transport everywhere and as well to provide activities like our medical train. 

Avril Benoît: 

And so, what kind of services? I know that we kept improving the quality of care on the trains. What can we do on the trains and what medical services are available there? 

Dr. Albina Zharkova: 

Right now, in our medical train we have ICU wagon, ICU car, which can treat patients with needs as ICU patients, including patients on the mechanical ventilation as well. We can transfer patients in the moderate stage. We can provide some management like antibiotic treatment, wound dressing, pain management for those patients. And so, we can transfer them for very long distances. Actually, a trip will last usually about 24 hours. 

Avril Benoît: 

Something that I was so pleased to see how well it was working and how it was very much meeting a need that was identified by local health officials, that we were trying to find out how can MSF, how can Doctors Without Borders help? And Christopher, you are part of those negotiations. I already have some questions coming in from those who are joining us for this briefing with you in Kyiv. Suzanne on Zoom is asking, "First of all, how many staff does MSF have in Ukraine and what's the role of Ukrainian colleagues in terms of our operations?" And then a really good follow up question from Warren, who submitted this one during the registration process asking, "How does MSF collaborate with local Ukrainian authorities or organizations or health officials that are not part of MSF, but we want to be able to offer our support?" 

Christopher Stokes: 

Yeah, I think the way the train works is a good illustration. So, the trains are put at our disposal [to MSF]. We rebuilt them entirely together with a railway company. They're staffed, we don't know how to drive trains, obviously, or manage these. So, they manage those technical aspects, and we manage all the medical aspects, and we work closely with the Ministry of Health and Albina herself. We make all the phone calls, and the Ministry of Health does as well to try and identify the patients where they are and where we can bring them back to. So, it's really a joint venture between us and the railway company. And from day one, I met the railway company in early March. So, a few days after the beginning of the war. And initially we used trains to send medical supplies into Kyiv, which was being surrounded by the Russian armed forces at that moment. 

And the trains were a bit safer than convoys because some trucks had been destroyed. And that's where it all started. And then we had a meeting and I offered to try and evacuate the medical patients. And we continued since then. And to date we've moved around 2,800, a little bit more. Albina will correct me, but over 2,800 patients in over 90 trips. So much more than we ever expected to do. And we've added a few extra services because we bring people all the way across the country. 

So, some people come, they don't have identification documents, they lost it in the shelling, or their houses were destroyed, they don't have their papers, some people have problems, they don't have even clothes. So, we give them clothes, soap, etc. So even these small little things really help restore people's dignity because it's a long trip and they end up in a part of the country that they don't really, really know. They move 600 to 800 miles across the country, basically. So, we've extended our services to try and help people in their new lives in the west of the country where it's a little bit safer than the east. 

Avril Benoît: 

And I've pulled up the numbers for Suzanne. So, it looks like around 690 Ukrainian colleagues working with us with 125 - or so - international mobile staff that are specialists coming from other countries. Albina, maybe you could describe what is the role of the Ukrainian colleagues in our operations in your project, obviously, your role. 

Dr. Albina Zharkova: 

Actually, we started to work with MSF. We didn't know a lot about MSF at the time, but during this year we know much better about MSF for purposes, about MSF management, about some concepts. And this way we're becoming interested in continuing the work with MSF. And actually, our role is very important. We have quite a huge number of resident workers in Ukraine and our doctors manage patients in different projects. Our doctors who become managers, they do follow MSF protocols and help the rest of the people, the rest of the people in the projects, to work with patients and to work in the team. And I think that it is amazing what we can do now together with our international colleagues who still help us. Actually, what we've been discussing with our colleagues is that it is really important that our international colleagues share their experience of work in these circumstances because we never had that experience before. And it's really useful what we have now with MSF help and what we can do now. We definitely couldn't do it before, and it is very important, and we appreciate it a lot. 

Avril Benoît: 

Well, we know that there was always a lot of medical specialty capacity that remained in the country. At the same time, there was a request for supplies for MSF with our logistical know-how, which comes from all these decades of responding to emergencies to be able to support with supplies. And we have a question from Daniel, who sent it in during the registration. Oh, actually, it's from Rudolfo asking, how did we handle this request? The lack of medical supplies, the disruption of the supply chain in order to meet the demands, the requests that were coming into MSF? Christopher, you want to speak to that one? 

Christopher Stokes: 

Yeah, maybe also just to say Albina was too modest, but Albina started as a doctor on the train, now she manages the project. I don't think you have an idea. And she's one of many, actually because there's a good level of training and education in Ukraine and people are very committed. 

So, I'd say in the beginning, supplies were an issue because a lot of aid agencies actually left the country entirely. We were hanging on by our fingernails in the beginning, but we didn't maintain a presence in the country, and we never moved further than Lviv. Then we restarted, providing supplies actually by the train, as mentioned before. And then, actually, what happened is as the big aid machines like the United Nations, etc, came into play, we realized that medical supplies were less critical. But staff, innovative projects, filling gaps, and then working close to the front lines, so going as close as possible within reason to areas that were regularly being shelled. We have an example now, it's the whole of Kherson Oblast, so the Kherson region which is under and big parts of Donetsk as well. And that's where we started noticing there were very significant gaps because of the security risks and the access involved. So, we moved away from supply and more to providing direct assistance. 

Avril Benoît: 

We have a question from Daniel, submitted during registration, about health promotion and community outreach, which is a big part of what MSF does in many parts of the world as part of our humanitarian response. He asks, "How have you ensured that communities have sufficient knowledge of the health services available? And how have MSFs health promotion activities in Ukraine changed over the last year?" 

Christopher Stokes: 

Well, I'd give the example of Kherson. So, when Russian forces left, we were able to work. We're not able to work on both sides of the frontline, unfortunately. And actually we went village to village. We visited over 140 villages. Most of them were destroyed. I mean, in some places villages were down to two people. So, you have a huge variety between 5,002 people left because the villages were completely destroyed. And slowly but surely the Ukrainian local administrators, the local mayors of each village or town would restart and would come back and they'd have lists of people who'd survived the war in Kherson, and this period of Russian control. And they informed everybody locally that the MSF clinic would be restarting or would be coming into the town on a fixed date. And actually, it's been from word of mouth and through the local administration, especially through the local communities, it's been quite successful. 

And often we see nearly every person in need of medical attention in these places. Remember that, I mean, some people, it really depended on which military force was occupying their village, but some units would let people move, but other units would really prevent people from moving, and they weren't allowed to go to a pharmacy or to the city. So, we've had cases of people with diabetes who didn't receive medical supplies for eight months. But anyway, but we are pretty confident that we've been able to reach most of the people, most in need, in these places. But with a lot of groundwork. 

Avril Benoît: 

One of the questions we also got ahead of time was around meeting the medical needs of people who are in territories occupied by Russian forces now. What do we know about what they're living through and what they need? 

Christopher Stokes: 

So, people are on the other side of the frontline under Russian control. Unfortunately, it's impossible to cross the frontline. It's just too dangerous and it's really closed off. We do sometimes manage to get information. We were, in the summer of last year, we were able to provide some medical supplies, notably for victims of sexual violence. And we were able to get some things across, often using Ukrainian activist organizations, Ukrainian volunteer organizations. I have to say that they're doing an amazing, amazing job and they do most of the work in these really dangerous areas. But since about throughout the winter, it's been practically impossible to cross. And we know that people, some of our staff have family members, like in Mariupol. I know there's one of our staff members whose father is on the other side. I know another one. And they're telling us that it's very difficult to get medical supplies on the other side. Some drugs are imported from Russia. They're very expensive, and there's not a lot available. So, they're going through a very tough time on the other side as well, Ukrainians living under in Russian controlled areas. 

Avril Benoît: 

We have a colleague, Felicia, who worked in Ukraine last summer and is tuning into this webcast with you, Christopher, in Kyiv. And Albina in Lviv. And she's asking, well, first of all, she says hello, and is wondering if you can share any updates about Kharkiv and projects in the east of Ukraine. Albina, have you been following what's happening in Kharkiv and in some of those other projects? 

Dr. Albina Zharkova: 

Actually, we don't have an activity for our section in Kharkiv right now, but we participated in some evacuation process with our project with the medical train after the territories of Kharkiv region came back under control of Ukrainian. And we did an evacuation of the psychiatry hospital from Kharkiv region in September. And as well, there was some explore at these territories in our Dnipro East Project as well. And they provided some supplies, they provided some mental health support over there in the region. 

Avril Benoît: 

Anything to add, Christopher? 

Christopher Stokes: 

Oh, just a complete as well. So, some of our colleagues from the Dutch section are working in that area, and they've seen similar things to what we've seen in other parts. So, a massive destruction of medical infrastructure, and as Albina said, a need for certain specific issues which come to support. So, evacuation is one. So, a lot of these institutions, psychiatric institutions, or people's homes, etc., are not really viable in these areas. So that's one area that we've focused on. I mean, they've run out of electricity, medical supply, some of the staff have left. So that's one aspect. And MSF has deployed mobile clinics to try and reach the villages where the health system has been obliterated, basically. And staff is no longer working. 

Avril Benoît: 

And we are coming to the end of the briefing. I have a couple of last questions for you. One of them has to do with the mental health care for Ukrainian people. I know there's a new project that has just gotten off the ground now to support people who are victims of torture. Can you tell us about this, Christopher? 

Christopher Stokes: 

Yeah, actually, we started only a week ago. So, we're in week two and we've started a project for survivors of torture. It's quite clear that a lot of people have suffered very, very severe mistreatment. They're in need of medical attention, they're in need of psychological support, also, physiotherapy, also social support. It's really quite a broad range of needs that they have. And so, we've started on that side. I'd say when it comes to mental health, one of the things we've noted, and I was discussing with one of my colleagues in a hospital where we're working in Cherkasy is that it's been one year of this intense period of the war. As you said, Avril, the war started earlier in for Ukrainians, they're right to remind us 2014, 2015. But this particular period has been particularly heavy, and we are really noting the stress on the health staff. 

So, a lot of people are really actually openly asking for psychological support, for relief. Some people have been working for a year without holidays, without taking a break, basically. Surgeons in hospitals across the country. And I've seen the evolution from the fear that took hold and the determination in the first few months. Then there was a bit of euphoria in the summer, and now through this rather long, harsh winter with big electricity cuts, water supplies, etc., and one year of uncertainty. Every time you wake up in the morning, you don't know when the next air raid alarm will go off. And this is across the whole country. So, it's taking a very significant toll and notably on health staff who are on the front line and dealing with the war wounded across the country. 

Avril Benoît: 

Well, this brings me to a final question for you, Albina, coming in from Paola, asking about the mental health services, not only for the Ukrainian people affected by the war, but our own staff from Ukraine affected by the war. What is MSF doing for MSF staff to help people through all this uncertainty, all this danger, the stress of it all? 

Dr. Albina Zharkova: 

Actually, our teams were suggested to have mental health support as a part of some medical aid we can be provided under MSF control. And as well, we had some training for the mental health of the team in our project. For me, saying for our medical train team, we had it three times already. And we have the opportunity to have some sessions with psychologists, and we had some members of our teams who had already attended their meetings with psychologists. 

Avril Benoît: 

Well, I hope you're doing okay, Albina. It's really reassuring to know that you're still there and you're running things for the train. 

Dr. Albina Zharkova: 

Yes. Yeah. 

Avril Benoît: 

So, I wish you- 

Dr. Albina Zharkova: 

Our team- 

Avril Benoît: 

Go ahead, sorry. 

Dr. Albina Zharkova: 

... is very, very good support for each other. And one of the moments for mental health support is working together as a team and supporting each other. Yeah. 

Avril Benoît: 

Yeah, I saw that with my own eyes. There was a tremendous team spirit and camaraderie really pulling together. So impressive. And I'm glad to see that you're both there, still supporting the work. So, thank you both so much. Great to see you and to know that you're still working, able to provide as representatives of all of our operations in Ukraine, a window into what's happening. So, I wish you both well, and thank you, again. 

Christopher Stokes, emergency coordinator in Kyiv, and Dr. Albina Zharkova, deputy project coordinator in Lviv, today, normally working on the medical evacuation train across the country. And so, for those of you watching and joining and tuning in, thank you so much. If we didn't get to your question, I apologize, you can always stay in touch with us. We have an email address, it's event.rsvp@newyork.msf.org. And, of course, for information around what Doctors Without Borders is doing in Ukraine and in more than 70 countries around the world, you can go to our websites, doctorswithoutborders.org, or the international site is msf.org. And of course, find us on all of the social media channels, Instagram, Facebook, Twitter, all the rest. So, thanks so much and I'm wishing you an excellent day. Bye for now. 

Christopher Stokes: 

Thank you, Avril. Bye-bye. 

Avril Benoît: 

Bye.