Natalie Vikhrov reports from a village north of Kharkiv where doctors have stopped counting the number of times they have been shelled

In Ukraine’s northeastern village of Zolochiv, neurologist Ilona Butova has stopped counting the number of times the hospital has suffered from shelling. But she keeps close track of what needs mending at the facility. 

“There are 92 windows missing, three doors… ” she starts recounting. 

Russian artillery has devastated hospitals around the country, with more than 900 medical facilities either damaged or destroyed since the start of the invasion, according to Ukraine’s health ministry. 

At the Zolochiv hospital, some 38 kilometres from Ukraine’s second largest city Kharkiv, Russian attacks have taken their toll. Doctors here have had to quickly adapt, learning to operate under shelling and treat war-wounded civilians and soldiers in dire conditions. 

“At the start, there were times when we didn’t have power for three days,” said Butova, who is also the head doctor at the hospital. 

Her staff, who were used to treating strokes and fractures, were soon tending to bullet and shrapnel wounds. She still remembers the hospital’s first bullet wound patient – a 17-year-old student who was shot when Russian troops opened fire on her car. Then another civilian car came under fire, with a father and son brought into the hospital. 

“Personally, I think this is genocide of the Ukrainian people,” Butova said. “I see that they are shooting civilians.”  

Cardiologist Oksana Yanchuk and neurologist Ilona Butova stand in an operating theatre that hasn’t been used for surgery in months. Doctors say the large windows put staff and patients at risk of attack. Photo: Natalie Vikhrov

Widespread Damage

Russian artillery hasn’t spared a single building at the hospital. Staff have patched up some areas, boarding up blown out windows with pieces of broken furniture, but parts of the hospital have been reduced to rubble.

The bright operating theatre on the third floor of the hospital hasn’t been used in months. Doctors feared that its large windows would leave patients and staff vulnerable to Russian attacks. So they moved all surgeries to the first floor and stacked sandbags against the windows. 

Patient rooms have also been sitting empty for months. 

In March, the hospital came under shelling, with the attack shattering the windows and sending fragments flying into the wall and a bed with a patient, narrowly missing him.

Since then, patients have been living in corridors. 

Russian artillery hasn’t spared a single building at the hospital. Staff have patched up some areas, boarding up blown out windows with pieces of broken furniture, but parts of the hospital have been reduced to rubble.


Counteroffensive

The Kharkiv region has been under bombardment since the start of the full-scale war. In recent days, Ukrainian forces have retaken most of the region in a rapid counteroffensive, driving the fighting further away from Zolochiv. 

But Russia has continued to shell the Kharkic region, striking critical infrastructure and causing blackouts. 

Butova said the hospital had no power on Monday and had been forced to rely on a generator while treating a patient in a serious condition. 

She said the injuries patients were being admitted with have also changed recently. 

“If before, they were coming in with… shrapnel or bullet wounds, now we’re seeing mine explosive injuries,” she said. 

While Ukrainian troops have pushed Russian forces nearly entirely from the Kharkiv region, Butova said there was still uncertainty over what would happen next. 

“The fear is still there,” she said. 

Cardiologist Oksana Yanchuk and neurologist Ilona Butova (right) speak with a patient at the hospital in Zolochiv.  Photo: Natalie Vikhrov

Near the Border 

Artillery isn’t the only risk this hospital has faced throughout more than six months of war. Located about 15 kilometres from the Russian border, Butova said staff here also feared the facility could be seized by Russian forces. 

Zolochiv remained in Ukrainian hands but in the early days of the war Butova’s team decided to take precautions, only allowing those with milder conditions – those who could be discharged quickly if need be – to recover at the hospital. Others, who were in a serious condition, would be stabilised at the hospital before being transferred to another facility. 

At times, the hospital has been inundated with casualties but these days there are fewer doctors to treat them. The war has forced many to flee Zolochiv, including medical personnel.  

Until 24 February, the facility had more than 120 people on staff. Just over a third of them stayed. Of the 27 doctors who worked at the hospital prior to the invasion, only five remain.

Butova briefly considered leaving too. But then she sent her family to a safer city and moved into the hospital with cardiologist Oksana Yanchuk.

“I stayed because I understood someone had to,” Butova said. 

“At first, it was very scary… Now, we have rules about how to behave, what to do, where to go, so you understand everything.”

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Reforms and Repairs

The World Health Organisation earlier warned that “the war has increased the need for health care while reducing the system’s ability to provide services.”

Pavlo Kovtoniuk, former deputy health minister and co-founder of Kyiv-based think tank Ukrainian Healthcare Center, said the destruction of medical facilities has disproportionately affected smaller towns around the country, some of which had been left without any medical infrastructure. 

“If you look at specific communities, especially small towns or villages where a single hospital or a single primary care facility… was destroyed and not operational, it means those communities were cut off from the medical care in general,” he said. 

While Ukraine’s health ministry has been tallying the damage to the country’s medical infrastructure, Kovtoniuk’s team at the Ukrainian Healthcare Centre has been documenting attacks on health care facilities. So far, they have collected data on 189 attacks. 

“We are interested not in what is damaged but in the attacks themselves so that this information can be used in legal proceedings later on and also advocacy,” he said. 

Kovtoniuk hopes their work will help hold the perpetrators accountable although he concedes that justice will be a long-term process.

Recovery of Ukraine’s health care system will take time and money too. Ukraine’s health ministry has estimated that it would cost more than 38 billion hryvnia (around £880 million) to restore the country’s medical infrastructure.

Repairs on facilities that suffered minor damage are already underway but more than 120 of them would need to be completely rebuilt. 

Kovtoniuk said rebuilding the country’s health care system wasn’t just a matter of reconstructing what was there before the invasion. 

“Ukraine was in the process of transforming its health care system,” he said. “After the war ends, the task would be not only to reconstruct but also to redesign and revisit, rethink the system and to modernise the system.” 

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