While evacuating a psychiatric hospital in Ukraine, there was one question on my mind

As we drove through Kherson oblast and into the city, the face of this war was visible. For several kilometres, the destruction was absolute, with towns and villages wiped off the map by continuous shelling – not a single school, home or medical facility left intact.

When we reached Kherson city, the explosions were near constant. In different parts of the city, there were incoming Russian shells, outgoing Ukrainian shells and demining teams detonating ordinance left behind by retreating Russian forces. In two to three minutes, we heard around 10 blasts from the demining teams. The sound was deafening; we felt the resonance of each explosion in our chests.

The request to evacuate Kherson’s psychiatric hospital came from the Ukrainian Ministry of Health. Some 400 patients, in need of 24-hour medical support, had survived months in a warzone without the medicines they depend on. The loss of power meant that the hospital’s medical staff were unable to continue providing essential care, or even adequate food to their patients, and the hospital remained within range of artillery fire.

We rented two 50-person coaches and made a plan to evacuate the patients in four groups, with a transfer to a specialised medical evacuation train for the second leg of the journey. The destination was Odessa via Mykolaiv. A hospital had been identified in Odessa to take the patients and provide them with ongoing care.

As the advisor for the Risk Management Unit, the question that’s always on my mind is: are the risks worth the impact of our work? Every day, medical and humanitarian workers in Ukraine (often from the Ministry of Health and local civil society organisations) have to make difficult and often courageous choices for the sake of their patients. For the team conducting the Kherson evacuation it was clear: the personal risks they faced were worth it, if it meant safeguarding the lives of 400 people.

When we arrived with the buses to evacuate the first 100 patients, it was clear that months without proper medical supplies and days without power had taken a toll. Many of the patients were gaunt, clutching plastic bags with dried bread inside. Without essential medicines and energy to cook, they had become visibly weakened. As people boarded the bus, the explosions continued. Some of the patients hadn’t been outside in quite a while, and now they faced the shock of freezing temperatures and explosions that rattled the bus windows.

As the evacuation was in progress, most of the hospital’s medical staff were crying – these were their patients, with whom they had worked for a very long time and now the hospital would close and they might never see them again. I saw the hospital director take an old, elegant pen from his pocket and give it to one of the nurses. I later found out that it had belonged to the director’s father, who founded the hospital. The director had been in his position for 30 years, but he knew that once he left, it was unlikely he’d be coming back.

Once the patients were on the bus – there was no going back, and our duty of care extended to everyone on board. Every human being we transported had specific medical needs, and likely felt the same fear we did. To ensure good communications, and continuity of care, each bus had three nurses from the hospital onboard – our own medical doctor, Albina, was there to work with the nurses and patients and ensure continuity of care. Travelling through contested territory near the frontline in a crowded bus is frightening for anyone; I can’t imagine how it felt for our patients, many of whom had conditions limiting their mobility.

The truth is that not every team would have done what they did – the level of risk was clear, but their desire to protect human life was courageous. The evacuation was carried out safely in the end, but there are still so many people living in areas close to the frontline, in need of assistance – many of these people are older, living with chronic diseases, or limited in their mobility; for organisations like ours, there’s a lot more to be done.

The evacuation and safe referral of all 400 patients concluded on 6 December 2022 and in six days, Médecins Sans Frontières (MSF) teams in Kherson carried out 818 health care consultations. Since the escalation of the war in February, MSF has referred 2,538 patients from areas close to the frontline, which now stretches 1,000 kilometres. The war in Ukraine has raged for almost nine years.

Julien Binet is the security focal point of Médecins Sans Frontières