Following the escalation of the war, the international organization Medecins Sans Frontieres expanded its humanitarian activities in Ukraine, focusing on supporting people living near the front lines, where humanitarian and medical needs are most acute.. The focus of the organization, in particular surgical and emergency care; evacuation of patients to medical facilities away from the front line; provision of essential drugs and medical equipment to hospitals; ensuring the operation of mobile medical clinics; rehabilitation of the wounded in the war, psychological assistance to survivors of sexual violence.

After the front line shifted to the southeast, MSF teams visited 161 cities and villages in the Donetsk and Kherson regions, located between the front lines. The systemic destruction caused by the Russian army to Ukrainian civilian infrastructure is recorded in the report of the organization "

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Looted buildings and destroyed medical vehicles, in particular ambulances. Houses, shops, playgrounds, schools and hospitals were left in ruins after constant shelling and bombing. So in the regions of Kherson region, recaptured by Ukrainian troops, 89 medical institutions cannot be restored. More than 163 thousand people were left without access to these medical facilities. In addition, doctors who previously lived in territories occupied by Russian troops spoke of intimidation, detention, violence and ill-treatment they experienced at the hands of soldiers.

“In some cities and villages where we work, destruction is widespread. In 25 years of working in war zones, I probably only saw this once or twice - in places like Mosul or Grozny. Sections along the 1,000-kilometer frontline in Ukraine have been razed to the ground,” says MSF Ukraine chief emergency coordinator Christopher Stokes..

- Mr. Christopher, the report of your organization is far from the first, but probably more emotional, since it is built not so much on numbers as on the testimonies of people, in particular doctors. What are your personal impressions after meetings and direct communication with people?

- These are the stories of ordinary people from the villages of Kherson and Donetsk regions. None of them expected that there would be a war, none of them were ready for it.. And if someone fell ill while in the occupied territory, then he found himself in an extremely difficult situation, when it was impossible to find medicines, hospitals were destroyed, and doctors left. It was hard for everyone. But for those who were sick during this period, had some medical problems, it was even more difficult.. This is what we heard in all these stories.

- Perhaps there is some story that struck you personally, but was not included in the report?

— We included only a few stories in the report. One of the things I remember happened in a village in the Kherson region. For six months, people were not only not allowed to leave, they were even forbidden to go out. The villagers not only didn’t have medicines, they were forced to share a box of matches among themselves.. All over the street - a box of matches. Can you imagine how difficult the situation was there.

— You were in Afghanistan and Chechnya. To what extent what you saw there is comparable to what is happening in Ukraine?

— I have been to Afghanistan quite often since the 1990s.. In Chechnya - in 1994-1995, during the first war.

The level of destruction in the war in Ukraine is striking. Destroy all buildings - both civilians, and houses of the civilian population, and hospitals. Moreover, this does not happen in one place, as it was, for example, in Iraq, where terrible destruction was in the city of Mosul. In Ukraine, this happens throughout the territory.

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– Since the beginning of the full-scale war, Doctors Without Borders has been able to work only in the territories controlled by Ukraine. As far as I understand, the organization also turned to the Russian side. What answer did you get? What was the reason for the refusal to allow you to work in the occupied territories?

- During any conflict, we try to work from both sides of the front line, because there are people on both sides who need medical help.. We have been negotiating to start providing assistance in the territories that are now controlled by Russian troops.. Couldn't hear " They just didn't give us the green light.. It’s a pity, because from what people in the villages and towns recaptured by the Ukrainian side tell us, in other territories the population also has problems with access to medical care and medicines.

What were the most pressing issues?

— In the territories returned to Ukrainian control, we observed two types of situations. First, people with chronic diseases. For example diabetes, cardiovascular and hypertension. They had a problem accessing medicines. Pharmacies are destroyed, they could not go somewhere.

The second is people with wounds and injuries, sometimes from accidents, for example, during agricultural work.. People needed emergency medical care, but there were not enough medical supplies for this. We observed cases, and we talk about this in our report, when people reused old bandages (washed them), but because of this there was a risk of complications, infections. People needed emergency medical care and were not able to get it.

- Helped children?

— Yes, we had children seeking medical help.. But still, the majority, 65 percent of patients, are elderly people.. Many families with children left. Now we're watching them start to come back.

— How do you see the consequences for Ukraine due to such a destroyed medical infrastructure? Due to the fact that for more than a year people from territories where active hostilities are taking place, and even more so in territories that were and still remain occupied, in fact do not have access to medical services?

- In the liberated territories, we observe that most medical institutions have been destroyed. Many are completely destroyed.. It will take a lot of time to rebuild them.. The second aspect is that many doctors, medical workers, especially family workers with children, have left. There is a shortage of medical staff.

Another aspect is a very significant problem in psychological care.. We have mobile clinics, and in a week they conduct a thousand consultations. The mobile team includes a doctor, a psychologist, a gynecologist and a nurse. And it is the psychologist who is incredibly busy. People ask for psychological support. Of course, over the past year it has not been easy for everyone.. But it is especially difficult for people who are on the front line. They want to tell their story, get support. Perhaps they come to the mobile clinic for some kind of medical care.. But they see a psychologist and want to talk to him. Moreover, this often happens in some small isolated towns, villages, where people, probably, have never seen a psychologist before, but they are ready for such work.. We did not even expect that there would be so many appeals to psychologists.

Is it possible to at least roughly estimate how long it will take to recover? What resources will Ukraine need? What will be in the most acute deficit?

– In fact, Ukraine is a very impressive country, because people here are incredibly persistent. If there was peace, then, I think, Ukraine would be able to rebuild in one or two years. But if there is no peace, if shelling continues, it will be difficult to restore all this until stability comes..

We bring containers and install them in different villages. Now we have 12 such containers where we conduct medical consultations, if there are no other buildings suitable for this. We install such containers so that people have the opportunity to seek medical help, and do not wait until medical facilities are rebuilt.

Also, as an option, we have mobile clinics. They are placed in vehicles.. And they can also come to different settlements..

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- What, in your opinion, should be the reaction and actions of the world community to such actions by the Russian Federation in relation to civilians, doctors and medical institutions?

— One of the key aspects for us is that there is international law, and there are certain obligations under it. One of them is to provide access to medical care.. While the war continues, we call for ensuring access to medical care for people on both sides of the front line. If the belligerents cannot do it themselves, then we ask them to ensure that international organizations can do it..

- What is the organization's future plans

- Now very active work is underway in Konstantinovka. There is an emergency room where a lot of the wounded are admitted.. We also have ambulances.. In the Donetsk region, we made 200 referrals in a week, that is, we took patients to some safer places. It's hard to plan far ahead right now, but we'd like to increase the number of our ambulances to help patients get to places where they can get medical care and save lives..

We're not talking about short hauls. This is not a distance of 5-10 minutes. We pick up patients, for example, from Kramatorsk, Slavyansk, Druzhkovka and transport them to cities where they can receive medical care.

For example, in Dnipro. It takes five hours. And all this time you need to keep the patient alive. Now we want to strengthen our capabilities.

There is another aspect that concerns us. We communicated with many Ukrainian doctors. They are incredible. But we also see that they are very exhausted, after all, they have been working in a war for 13 months.. What will be the burden for them in the future, and how they will cope with it - this also worries us.