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Iain Overton reports on a medical centre in eastern Ukraine which was caught in an unexpected war – a war which transformed everything
Abandoned hospitals are, like former asylums and empty prisons, places that unnerve. Leprous walls, where wallpaper peels off like a diseased skin. Dark corridors that lead to locked doors, silent as a morgue. Empty chairs waiting for patients who will never come. The stuff of nightmares.
In Avdiivka hospital’s abandoned wing though, this nightmare is born from a living one. In the Spring of 2014, this hospital was caught in a whirlwind of violence. What first began as dispute over a trade agreement, transmuted into what became the bloodiest conflict Europe had seen since the former Yugoslavia was engulfed in war in the early 1990s. Russian troops, and those they supported, launched a major assault across this region, after annexing the Crimea. The eye of that bloody storm was to become the eastern Ukrainian city of Donetsk. Avdiivka lies 20km from that city centre, and just 6km from the regional airport.
Separatists in Donetsk and nearby Luhansk declared independence after unrecognised referendums and, as fighting intensified, the numbers of civilians harmed began to rise significantly. Avdiivka hospital found itself over-run with casualties – more than 500 civilians wounded, many by shrapnel from explosive weapons. At least 54 more locals were killed.
The hospital was to see the war unfold terrible chapter by terrible chapter. Water and electricity were cut off. Eight missile strikes hit the medical centre; two doctors were killed and one nurse badly wounded. Patients died on operating tables with the sound of mortar-fire creeping inwards. Mothers gave birth in crowded corridors. Medical supplies ran dangerously short, and all but the most urgent of medical procedures were abandoned.
Throughout those dark months, the staff worked tirelessly. Three-day shifts became commonplace, doctors taking brief naps where they could, sleeping upright wrapped in borrowed blankets. It was still April, the cruellest month, and the winter winds had not lessened. With no heating, the staff would crowd around coal and wood burners, urging their frozen fingers back to life so that they could operate on the incoming wounded.
The war changed everything.
Today, swathes of the hospital lie unused. Meanwhile, the lands that surround the hospital are filled with late summer wheat that undulates in an eastern wind; beneath those golden waves, landmines lie. The doctors call them the “forbidden fields”, and the legacy that explosive violence has visited on this medical centre seeps into everything.
This war has done as much as diseases can ever do. It has contaminated all that it touched, including the people and places that survived.
Dr Vitaliy Danylovych Sytnik has a nervous tic. He rolls his wedding ring in his fingers when he speaks, but his voice resonates with the authority that comes with his position: the deputy director of the hospital. A specialist in systemic diseases, he oversees the care for in– and outpatients for a region that now covers 34,000 citizens in the local city, and some 15,000 in the regions surrounding.
He has spent the past 25 years working in this hospital – half his life – and the staff are, to him, like family. He was here when the news on their television screens turned, terribly, into reality, and the first patients began pouring into the emergency clinics. They bore injuries that a civilian centre rarely saw. Bullet wounds in the arms of children. Shrapnel embedded in the heads of pensioners. Flesh ripped apart by a storm of steel. For every death, 10 more were wounded.
Without urgent medical intervention, he estimates that at least 50% would have died. And the same percentage needed blood transfusions too – a sudden descent into conflict surgery for him and his team.
“We did what we had to do,” he says, his glasses perched upon his forehead, under his cropped, greying hair. “We were covered in blood, but we went into autopilot.” The conditions worsened and soon they were doing surgery by candlelight, shadows cast against the operating theatre’s walls.
“While the hospital had enough medicines in reserve, what we lacked most was manpower. Before the war, we had 80 doctors, now we have just 40. We had 450 workers in total – now just 190.”
This drop in his workforce came alongside a sharp increase in patients demanding care. In addition, the establishment of an artificial border between Avdiivka and Donetsk, where the main regional hospital stood, meant they had to take on an added burden. At the same time, damage to the hospital meant that they were forced to shut down crucial departments. In turn, the infectious diseases, paediatric and neo-natal clinics closed.
“We just lost specialists,” Dr Sytnik says. “First a cardiologist, then an endocrinologist, then more.” Now, they have to refer patients to clinics 40 or 50km away. Even their ambulance crews struggle to find staff. There is also a crucial shortage of family doctors and the few specialist clinics they can operate are over-run.
For those with life-long disabilities caused by explosive weapons, this lack of specialist care can be devastating. The hospital has no rehabilitation centre and even lacks an operating lift. Incredibly, its x-ray department is up four flights of stairs. Patients have to be carried up the broken steps cradled in blankets carried by relatives. One doctor later complained of having hurt his back carrying an injured patient up those flights.
Dr Sytnik points through a dirty window over to the abandoned wing of his hospital. It could once accommodate 220 patient beds, he says. Now it’s down to 150. Some rooms have eight beds in a space designed for four.
Below us, the sound of drilling can be heard. They are renovating an entire floor, he explains, funded by the local Avdeyevskiy Coke Plant, which produces 18% of Ukraine’s coal coke output. The repairs are much needed, judging by the chipped floors and peeling wallpaper of the doctor’s office, but they are expensive – costing as much as seven million Ukrainian hryvnia or some $300,000, a fortune in a place where some junior doctors get paid just $120 a month. The hospital is in dire need of an upgrade, but any repairs are costs that come on top of a budget already stretched thin by the war.
With the poor conditions and overwork, his job seems Sisyphean. “Doctors who have left, ring us up and call us crazy,” he says. “The levels of work, the conditions, the lack