Dispatch

In Eastern Ukraine, Doctors Are ‘Terrorists’ and Antibiotics Are Herbs

Donetsk's medical system is crumbling and starved of even the most basic supplies. What will happen when the current cease-fire collapses?

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DONETSK, Ukraine — The light illuminating the dilapidated halls of Hospital 21 filters through half-boarded-up windows. Electricity has been out in the hospital for more than six months.

Hospital 21, in Donetsk’s Kievsky district, is only half a mile away from Donetsk’s airport — the scene of a four-month-long battle between fighters from the separatist Donetsk People’s Republic (DNR) and Ukrainian forces. The residential area surrounding the hospital is mostly abandoned. Nearly every house has been hit by shelling. Deep blast holes scar the streets, live wires hang from splintered electric poles, and tree branches are strewn across the ground.

But doctors and nurses at Hospital 21 say it’s not the damaged infrastructure that worries them. It’s the lack of medicine. The shelves of the hospital pharmacy on the ground floor are empty. Two Bibles greet patients at the pharmacy’s unattended window — sometimes the only help available is prayer, said one nurse.

A cease-fire was announced on Feb. 12, but the agreement is seen as a dark joke by Hospital 21’s medical staff and patients, who hear nearby shelling and artillery fire every day. The cease-fire, called the Minsk II agreement, came about after September 2014’s Minsk I cease-fire fell apart completely. By January, DNR separatist fighters finally wrestled control of Donetsk’s airport from the Ukrainian army. Around the airport, fighting has never stopped. Like the airport district, Debaltseve, a large town to the north of Donetsk, has been reduced to rubble after months of fighting finally resulted in a DNR victory on Feb. 20, a week after the cease-fire agreement.

On April 13, fierce fighting erupted in Shyrokyne, on the outskirts of Donetsk, killing six Ukrainian soldiers and one rebel fighter — the highest casualty toll since the signing of the cease-fire agreement. On April 26, fighting escalated near the strategic port city of Mariupol, southwest of Donetsk, and at Donetsk’s airport. Kiev announced one soldier dead and seven wounded during clashes.

Alekseyenko Aleksandrovich, the head of Hospital 21’s surgical department, is adamant that the fighting will increase and that what remains of the cease-fire will fall apart. When this happens, Donetsk’s hospitals will face a crisis. Medicine is already limited and infrastructure is severely damaged, said Aleksandrovich. An increase in fighting, with its subsequent influx of civilians to a hospital caught in the crossfire, would pose significant problems.

“We have some help from organizations in providing emergency care for our patients,” Aleksandrovich said. “But we have a limited amount of medical supplies and a limited amount of food for our patients. Right now there isn’t enough — when the fighting increases it will be worse.”

Yulia Gorbunova of Human Rights Watch said that despite the cease-fire, the situation in medical facilities in Donetsk, like Hospital 21, is “quite dire and not far from catastrophic because medical facilities in the DNR are running out of medical supplies and lifesaving medicines.” The problem, she said, has been exacerbated by the Ukrainian government’s decision in November 2014 to halt funding for hospitals and medical services in rebel-held areas.

On Aug. 22, 2014, a Russian aid convoy of 184 vehicles crossed illegally into rebel-controlled eastern Ukraine. Similar Russian convoys have been going back and forth regularly since. Despite this, hospitals in Donetsk continue to be starved of vital medicines.

At Hospital 1, one of the city’s largest hospitals, Alexander Petrovich Stanitskly, the head of the traumatology department, lists the medicines he needs most: antibiotics, analgesics, and anesthetics. The corridors of Hospital 1 have the luxury of electricity, but the patients whose beds line the dirty walls still do not have needed medicines.

The hospital has not been hit by shelling — a blessing, Stanitskly says. But because it is still intact and the electricity and heating still work, the hospital has become the No. 1 destination for Donetsk’s ill and injured. It is not just the war wounded who are suffering, but also patients with pre-existing conditions.

The shortage of medical supplies has Stanitskly and other doctors resorting to desperate measures. “There are less and less medicines and drugs now, and it’s more difficult for me to treat older people, who are not taking part in war actions but who are truly ill. I have to remember the recipes of our ancestors — herbs, tinctures, homemade remedies — in order to try and make the patient’s condition better,” said Stanitskly, from behind a desk stacked high with piles of papers. “Sometimes, I’m sorry, but we are treating people just by kind words. We talk with the patient, calm them down, and try and distract them from everything and their pain.”

Working under immense pressure and dealing with horrific injuries from war have become a daily routine for Stanitskly. And he has been without a wage for months. So have all his colleagues. After separatist fighters proclaimed Donetsk’s independence from Kiev in April 2014, the Ukrainian government took steps to freeze all salaries and support to medical staff in Donetsk. The move was implemented in full by November 2014. Stanitskly decided to carry on working for free. This is when his services were needed most, he says.

In early April, Stanitskly was given a month’s salary by the DNR government. The salary, Stanitskly was told, was for the month of January, with the wages for the following months to be processed by the DNR in the following weeks. But by accepting the much-needed cash from the DNR’s leadership, he claims that he has now been designated an enemy of the state by the Ukrainian government. “They call me a terrorist now. Can you believe that? I am a doctor, and they call me a terrorist.”

Stanitskly said he thought for a brief moment about fleeing Donetsk when the war started. He had enough money saved to leave and start a new life elsewhere. Politics is not his business, he says, but saving people is, and here in Donetsk people need help now more than ever.

Although all parties to the conflict were to withdraw heavy weaponry to 15 kilometers from the front line as per the Minsk II agreement — in effect creating a 30-kilometer buffer zone — Alexander Hug, deputy chief monitor of the Organization for Security and Co-operation in Europe’s Special Monitoring Mission to Ukraine, said violations still continue on both sides. With the cease-fire only holding on paper, doctors and aid workers worry that a resumption of fighting will jolt the DNR’s bare-bones health-care system into full-fledged crisis.

Aleksandrovich has no illusions about the task he and his team will face if the fighting increases. His office window has been shattered twice, he says, but no real damage was done. The children’s department across the courtyard wasn’t so fortunate, he said, pointing toward the shell-riddled roof.

Only a few days after Aleksandrovich spoke to Foreign Policy at the beginning of April, the surgical department of Hospital 21 and the hospital grounds were hit by shelling. There were no fatalities.

Without electricity and with much of the infrastructure destroyed, the medical staff has still found ways to cope. The murky basements of Hospital 21 were never intended for patients, much less complex and lifesaving surgeries. But when shelling increases, patients are moved there to provide safety, Aleksandrovich said. While it has been weeks since patients have had to be evacuated underground, areas of the basement continue to be used as operating rooms due to unrepaired damage in the standard operating wards.

Despite everything, Aleksandrovich tries to remain positive. “What else can we do but stay here and treat people?” he said. “It’s our job even if we do not have the tools we need.”

DOMINIQUE FAGET/AFP/Getty Images

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