MSF UKRAINE: What’s Left After the Flames: Four Years of Full-Scale War in Ukraine

After the war began in 2014, until the full-scale invasion in February 2022, MSF maintained medical activities in Donetsk Oblast, providing general healthcare to people living in villages and towns along the line of contact. Since February 2022, intensified fighting has forced MSF teams to withdraw from these areas, as well as seven hospitals and multiple mobile clinic locations across Donetsk, Kharkiv, Kherson, and Dnipropetrovsk regions that MSF has been working in.

Today, even cities far from the frontline remain exposed. Across the country, damage to energy infrastructure leaves communities facing repeated power, heating, and water outages throughout winter. Homes, hospitals, pharmacies, schools and shops have been destroyed or closed. Entire communities have become uninhabitable. As fighting continues, displacement has risen — and the humanitarian needs grow more complex and prolonged.

MSF continues to provide medical and psychological care across Ukraine: supporting hospitals near the frontline, running ambulances for war-wounded patients, operating mobile clinics in shelters and communities hosting displaced people and providing specialised mental healthcare.

Since 2022, MSF has been forced to leave seven hospitals and more than 40 other mobile medical clinic (based in medical facilities) locations due to insecurity. Four of those hospitals have been confirmed as completely destroyed. According to the WHO, more than 2,800 health facilities across Ukraine have been damaged or destroyed since the start of full-scale war. For many communities, life as it once existed is gone. Cities are no longer places where people can live — only ruins marking what once stood.

What’s Left After the Flames: Four Years of Full-Scale War in Ukraine

Damir is two months old. His mother, Kateryna Murashkina, is 17. Since his birth, he has been bathed twice — once in the hospital, and once on a rare day when electricity briefly returned.

“We use wipes now because it’s very cold,” she says. “The room doesn’t warm up in time to bathe him. I’m afraid of giving my child a cold.”

Kateryna and Damir live in a former scientific institute in Dnipro, repurposed as a shelter in 2022, where MSF teams now provide medical consultations for residents. Around 270 people displaced from occupied areas or cities reduced to ruins now live there. Repeated strikes by Russian forces on energy infrastructure mean residents endure days without heating, water, or electricity — in temperatures that fall to minus 20°C.

MSF’s increased presence in shelters like this one through mobile medical clinics, reflects the growing needs for displaced people as fighting continues to empty towns and villages. Consultations provided through mobile medical clinics more than doubled in 2025 compared to 2024 — increasing from 4,327 to 9,500.

For many people living near the front line, the decision to leave home takes a long time, and is extremely difficult – despite the extreme danger posed by the encroaching front line. With limited financial means and few alternatives, elderly people and those with chronic illnesses often remain in their homes until sustained bombardment and the collapse of infrastructure and essential services, including medical services, leave them no choice but to flee.

The scale of destruction in Ukraine is enormous and has only grown since Russian forces invaded in 2022. The nature of front-line warfare encompassing artillery, drones and missiles, means that nothing and no-one is spared as it shifts. MSF teams have also been forced to adapt – leaving seven hospitals and over 40 locations where they were running mobile clinics – when the situation becomes too dangerous.

Lyman, in Donetsk region, is one district where MSF was running mobile medical clinics before insecurity made operations impossible. In June 2024, activities were suspended entirely. Today, approximately 2,000 residents remain in the frontline town, which faces daily shelling.

Lyman was also 67-year-old Zinaida Babisheva’s home, who now lives in the Dnipro displacement shelter. She recalls life before the full-scale invasion. She remembers pulling tables into the street on public holidays to eat with neighbours. She remembers her garden.

“We had apples, plums, cherries, pears, peaches. So many roses and lilies,” she says. “Now my daughter grows flowers, but I no longer feel like doing anything.”

Liubov Kuzmenko, 65, from Siverskodonetsk also lives in the shelter with Zinaida, Kateryna and Damir. She says her apartment was looted after Russian forces took control. But what weighs most heavily on her is separation from her family.

“My parents stayed under occupation. My father died in 2024, and I couldn’t return to bury him. I send my mother video messages — it hurts that I cannot be there.”

As the war grinds on, hospitals, pharmacies, schools and shops have been destroyed or closed. Entire communities have become uninhabitable. As fighting continues, displacement has risen — and the humanitarian needs grow more complex and prolonged.

MSF continues to provide medical and psychological care across Ukraine: supporting hospitals near the frontline, running ambulances for war-wounded patients, and operating mobile clinics in shelters and communities hosting displaced people and in locations where people are trying to remain despite collapsing services and encroaching frontlines.

“Is the situation in Ukraine worrying, frightening, and deeply depressing? It is — and it’s getting worse.”

Robin Meldrum, MSF Country Director

Ukrainians call them ‘mopeds’ (small scooter motorbikes). The sound is higher-pitched, but similar. These are the long-range attack drones, usually equipped with around 100kg of explosive warhead and capable of destroying two floors of a solidly-built concrete apartment block or house. In the larger attacks, upwards of 600 of them are sent into Ukraine on just one night.

I first heard one in close proximity in late 2024, in the southern city of Mykolaiv. We were in the “2-wall-space” safe room in our international staff house. We knew some Shahed drones were approaching the city, because the alert systems are extremely well developed in Ukraine. We heard a couple flying past, maybe a few hundred metres distant. And then that whining sound got louder, and closer, until it was directly overhead, just above the rooftops. Nobody said anything. Muscles involuntarily tightened in a fight-or-flight reaction. The sound reached peak intensity, followed less than a second later by a shattering explosion that shook the walls throughout the house. It had hit a building around 300m from us. It was not a direct hit, and luckily nobody was hurt on that occasion; but almost every day now I read of people injured or killed in their homes somewhere in Ukraine by these attack drones. And this is just the drones – the ballistic and cruise missiles are capable of much greater destruction.

It was around this time that we had an incident in the frontline city of Kherson, in the hospital where we have an embedded medical team. Russian forces control the other bank of the wide Dnipro river, and the city is attacked on a daily basis with hundreds of artillery shells and short-range quadcopter attack drones. That day there was particularly wide-spread artillery shelling throughout the city, and several mortar rounds landed in the hospital compound, fortunately not directly hitting any of the buildings. Our team is well drilled in how to react, and they go to the safe basement shelter whenever there is an increased risk. I went to the hospital the following week to meet the director. We had a few topics to discuss, including some measures to increase the security of our MSF team. His reaction will be forever etched in my memory. His tension when he thought we were meeting to say we would no longer be able to work in that hospital was clear from the moment we walked in the door. And his relief when we said we intended to stay was palpable. He explained that he would struggle to maintain the Emergency Department and Intensive Care Units of the hospital without MSF’s additional support, and said the idea that the MSF team would leave had been worrying him for the past week.

This is what we see everywhere we go along the 600km of so of near-frontline areas where MSF teams are working. Hospitals and primary healthcare centres struggling to cope with enormously depleted staff numbers. One general hospital we were supporting near the frontline in the east had no surgeon, until the MSF team proposed to embed a medical team. During 12 months our team performed or assisted 452 surgeries in this hospital, until the frontline got too close and we had to withdraw and start supporting another hospital a bit further back from the active combat area.

The patients we treat, and transport by ambulance, are an indicator of how civilians are impacted. Pretty much every village you go to in the 50km zone from the frontlines has some civilians who have remained, usually older people who have lived there all their lives, not wealthy and with deep anxiety about leaving – where will they go? What will they do for food and shelter? What will happen to their home while they are gone? Many of these people have chronic medical conditions, and the primary healthcare options that they would normally rely on have reduced or sometimes completely disappeared. We try to reach as many of these communities as possible with mobile clinics, but our hospital teams see far too many elderly patients arriving in a critically sick condition, after missing out on their regular treatment plans for hypertension, diabetes or other conditions that ought to be easily manageable. The average age of patients admitted into the Intensive Care Unit we support in Kherson is 63, and many are much older – they often arrive in a critically urgent condition, and sometimes too late.

Over the past two months we have been surviving a very difficult winter, the coldest Ukraine has experienced for several years. Russian attacks have been targeting electricity and heating infrastructure, and the consequences have been brutal. I had to move into a colleague’s apartment after a month with no running water, no flushing toilet, very intermittent heating, and sometimes only 2 or 3 hours of electricity per day. I would often wake up in a room that was 3 or 4 degrees Celsius, which is the recommended temperature inside a fridge. Many of my Ukrainian colleagues have had the same experience, having to leave their homes to move in with friends or colleagues, because when temperatures drop to 20 degrees sub-zero, just surviving becomes a struggle if you have no heating.

A potential attack is never more than 10 or 15 minutes away, and this threat is ever-present, 24 hours a day, seven days a week. Everybody has their own ways of coping. I try to appreciate little moments of beauty and normality: the rooks circling and calling at sunset over the Dnipro river in Kyiv, while the imposing 300-foot tall statue of “Mother Ukraine” fixes an indomitable stare over the river to the east; the two lesser-spotted woodpeckers that would come every morning to the old walnut tree outside our house in Mykolaiv; good chats with friends over a beer or coffee in one of the many excellent bars or cafes in Kyiv or Dnipro; a memorable summer barbeque on the sandy beach on the shore of the Pivdenny Buh river in Mykolaiv (I copied some of the locals and went for a quick swim, and it was lovely)…

But above all, I find motivation and inspiration in our 320 Ukrainian colleagues. They have endured this for four years, and the energy-sapping fatigue is clear. Some, who originally come from the eastern region of Ukraine, have lived this war for 12 years now. Nobody I know is free of mental and emotional scars. But the determination and commitment they show, every day, arriving in the morning mustering all their energy to do their job as well as possible – it is an extraordinary source of inspiration.

We all know why we are here; there are some very vulnerable people in very high need of medical care, and they deserve all our efforts. And each passing week the needs grow as the machine of war grinds on.

“Death and . . . life have become part of the same day”

Ainur Absemetova, MSF Country director in Ukraine (2024–2025)

Death and the celebration of life have become part of the same day—and sometimes I still don’t know how to process that.

It has been almost nine months since I stepped away from my role in Ukraine, yet I am still trying to understand how war and ordinary life coexist: How people continue living while surrounded by fear, uncertainty, and loss.

I have worked in humanitarian response for more than 25 years, including in Afghanistan, South Sudan, Sudan, Yemen, and Haiti. I have been working for MSF since 2019 and have held various humanitarian positions in different contexts for about seven years. From summer 2024 to summer 2025, I served as MSF Country Director in Ukraine. I supported multiple medical and humanitarian activities, including the opening of the Vidnovlennia (Ukrainian for “Recovery”) mental health centre in Vinnytsia, which specialises in the treatment of post-traumatic stress disorder (PTSD) among people affected by war.

Ukraine is a vast country—the largest that lies fully within Europe—covering more than 600,000 square kilometres. The front line stretches over 1,200 kilometres, and the impact of the war reaches far beyond it. Some cities may appear calm at first glance, but air strikes and missile attacks affect the entire country. In recent years, attacks on energy infrastructure have left millions without stable electricity or heating, deepening both the humanitarian and psychological strain, particularly during winter.

According to the UN Human Rights Monitoring Mission in Ukraine, 2025 became the deadliest year for civilians since 2022, with 2,514 civilians killed and 12,142 injured by conflict-related violence. These figures reflect not only the scale of suffering but also the growing risks for people living far from the front lines.

The MSF project I coordinated is based in Vinnytsia, a city in central-western Ukraine that remains relatively safer than frontline regions. This relative stability makes it possible to provide longer-term, specialised mental health treatment—something that is extremely difficult in areas under constant bombardment. At the Vidnovlennia centre, MSF provides psychological care for people affected by war, including veterans, internally displaced people, survivors of captivity, and civilians who have experienced trauma, loss, or prolonged stress.

Although my role did not involve direct clinical work with patients, I often observed people in the waiting areas—children, young women, men, and older adults. Seeing them left a strong impression on me. I felt a constant awareness of how limited our capacity is as an organisation, and how much suffering remains beyond those we can reach. I often wondered what these individuals were facing once they left the clinic—what fears, losses, and uncertainties they carried back into their daily lives. War leaves many wounds that are invisible. You cannot always recognise trauma just by looking at someone on the street. People may appear to be coping, working, laughing, yet carry deep psychological scars from bombardment, displacement, bereavement, captivity, or prolonged fear.

Some of the moments that stay with me most vividly are mornings in Kyiv after heavy shelling. I would wake up thinking first about children and how they cope with growing up under constant air raid sirens. As a mother, I understand the deep helplessness that comes with being unable to fully protect your child from such fear and instability. These thoughts stayed with me throughout my day.

The morning after heavy shelling, people still commuted to work, children went to school, neighbours carried on with their lives. At times, it felt like everyone had learned to move forward by pretending nothing had happened. I found this understandable but deeply unsettling. The pressure to maintain normality can become a survival strategy, but it can also hide unresolved trauma.

What struck me most in Ukraine is how life continues despite everything. People still visit theatres, cinemas, cafés, gyms, and celebrate small everyday moments. At the same time, war has become woven into ordinary life. Air raid sirens, explosions, power cuts, and grief have started to feel routine. This normalisation of war is one of the most disturbing aspects of the conflict, because when violence becomes familiar, it reshapes how people think, feel, and perceive safety, loss, and the future.

It is difficult to describe what it feels like to live in a place where air strikes and celebrations, fear and resilience, grief and ordinary routines exist side by side. Even now, I am still trying to make sense of it. The coexistence of life and death, hope and despair, continues to challenge how I understand both war and humanity.

“I’ve seen incredible solidarity in how people support each other and keep going, despite the difficult times”

Christine Mwongera, MSF medical coordinator in Ukraine

Christine Mwongera has worked in many different projects and countries with Médecins Sans Frontières (MSF), such as Trauma hospital in Afganistan; Paediatrics, Nutrition and Maternity project in Sierra Leone; projects on primary and secondary health care including surgery, nutrition, maternity, community malaria program, and vaccination in South Sudan; projects providing primary & secondary health care for children and reproductive health, including hospital in refugee camp, supporting MoH hospital in paediatrics & nutrition in Sudan ; HIV/TB & Sexual violence project for migrant workers in South Africa.

For the past two and a half years, I have been working in Ukraine, supporting people affected by the war. My impression of the international armed conflict here is that it has deeply disrupted people’s lives—their families, their homes—and has taken away their sense of safety. This winter has felt particularly intense compared to the two previous winters I spent in Ukraine. Russian forces have systematically targeted energy, heating, and water infrastructure with missiles and drones during periods of severe frost. The cold and unpredictable electricity have made daily life feel heavier and have required constant adjustment such as to create ways how to stay warm inside the apartment around 7 °C, to adapt to the light schedule (some days there may only be 2 hours of light per day) . Many people have suffered from the harsh winter and power shortages—I feel it myself, I hear it from my colleagues, and I see it across Kyiv.

But people in Ukraine are truly remarkable. I’ve seen incredible solidarity in how people organise themselves to support one another and keep going, despite the difficult times. Through MSF’s Vidnovlennia mental health centre in Vinnytsia, where we support people who have experienced trauma, I have met patients whose courage and determination deeply impressed me. I remember individuals who had been through extremely difficult experiences—losing their homes, losing family members, being forced to relocate—yet they spoke about their families, their neighbours, and their future plans for themselves and their children. The hope they carried has stayed with me for a long time.

I am Kenyan, and when I first arrived in Ukraine, I found the social distance between people noticeable. Kenyans tend to be very expressive and quick to socialise, while Ukrainians seemed reserved at first. But once they opened up to me, the connection was sincere and meaningful—especially now, when they know you share the experience of war. And I do share that experience.

I am often based in Kyiv, and like many residents of the capital, I experience nights of heavy attacks on the city and its energy infrastructure. Monitoring channels such as phone application and telegram channels often warn of incoming shelling, and there are certain safety rules to follow, such as going to shelters or following the “two walls” rule, there should be at least two solid walls between you and the street. This means that the “safest” places to be are the bathroom, hallway, closet, or dressing room. Those nights can feel very long. Even after it becomes quiet, the body still holds tension and fear about what could have happened — mixed with the relief of being safe. One habit I have developed to cope after shelling is to limit news consumption and focus on positive thoughts. Sleep is often disrupted, and it can take time to recover and return to a normal routine.

I have always wanted to work where people need support the most. For me, this work is meaningful. Even the smallest action we take can have a real impact on someone at a very difficult moment in their life.

“The war is not always visible”: Vidnovlennia (translation in English - Recovery) Centre

Elena Butta, MSF medical manager in Ukraine

MSF runs the Recovery mental health centre in Vinnytsia. Our medical team provides psychological counselling and treatment for people experiencing symptoms of war-related post-traumatic stress disorder (PTSD). We started providing specialised psychotherapeutic services here in September 2023. Our doctors, psychiatrists, health promoters and psychologists work with patients who are experiencing traumatic disorders related to war. PTSD often appears alongside anxiety, depression, insomnia, and physical symptoms, as well as trauma linked to experiences such as torture, imprisonment, or bereavement. To help with recovery, the team conducts both individual therapy sessions and group creative activities. Here, Dr Elena Butter, a medical manager from Italy, talks about her experience working at the Vidnovlennia clinic from April 2025 until January 2026. My name is Elena Butta, and I worked in an Doctors Without Borders/Médecins Sans Frontières (MSF) project in central Ukraine. I have previously worked in conflict and crisis settings—including Afghanistan, South Sudan, and Haiti—and served as a medical manager supporting frontline teams.

I arrived in Vinnytsia in April 2025 after a long train journey from Poland. The region appears largely untouched by heavy fighting, yet the impact of war is still present in less visible ways. Many displaced people have settled here, and community hubs have emerged to support those arriving from affected regions. Rehabilitation and physiotherapy services for war-wounded patients have also expanded in the area.

My daily work focuses on the Vidnovlennia clinic—a name that means recovery or rebirth. Our activities are centred on three main pillars: psychotherapy for people living with PTSD; psychoeducation, mental health promotion, and stigma reduction at community level; and training local partners to strengthen sustainable capacity beyond MSF’s presence.

We collaborate closely with community-led initiatives, such as veterans creating peer-support groups, volunteers supporting war-affected children and families, small organisations advocating for survivors of torture or civilian detention, and safe spaces for marginalised groups. By supporting these local efforts with training, psychoeducation and therapeutic outreach, we help extend care beyond the clinic and strengthen community resilience.

What we are doing in Vinnytsia is a pilot approach to deliver specialised PTSD treatment in the context where trauma occurs. In many conflict settings, mental health support is limited to short-term or basic interventions. Here, MSF provides longer-term, evidence-based care that enables people to receive treatment in their own country, without waiting years or needing to travel abroad. With armed conflicts ongoing worldwide, and millions affected by psychological trauma, this model has the potential to inform future humanitarian responses.

PTSD is one of the most disabling consequences of war, yet it often remains neglected. It can disrupt daily functioning, strain family and social relationships, limit a person’s ability to work, and increase the risk of depression or substance misuse. Addressing PTSD is therefore not only about individual recovery, but about supporting families and communities over the long term. In Ukraine, where millions have experienced violence, loss or displacement, mental health needs are profound and will likely continue for generations.

On a personal level, I am constantly aware of the scale of unmet needs and the limits of what we can provide. At the same time, working alongside Ukrainian colleagues and witnessing the resilience of patients and communities has been deeply meaningful. Contributing—even in a small way—to recovery and dignity in this context is both humbling and a privilege.

Being present for others: An MSF project coordinator reflects on his experience in Ukraine

Jorge Castro Armijo, MSF Project Coordinator

Jorge Castro Armijo is a project coordinator for Doctors Without Borders/Médecins Sans Frontières (MSF) in Vinnytsia, western Ukraine. Jorge works at MSF’s Vidnovlennia centre, where psychologists, psychiatrists, doctors, health promoters and social workers support patients suffering from post-traumatic stress disorder (PTSD) caused by the war. The centre is named after the Ukrainian word Відновлення, meaning recovery. Here, Jorge reflects on the invisible wounds war leaves on people’s lives—and whether it is possible to heal them.

Since 2013, I have worked with MSF as a psychologist in Honduras, Guatemala, and Mexico. My experience has been diverse, from supporting people on the move to responding to a hurricane-related emergency in Mexico. However, Ukraine is the first time I have worked in an active war context.

I had wanted to come here since 2022, but I only had the opportunity seven months ago. When I arrived, MSF’s PTSD treatment centre in Vinnytsia was undergoing major changes. The space had moved to a larger building, which was more comfortable and better suited to patients’ needs. We held the grand opening during my first week, and I felt quite nervous. Thankfully, everything went smoothly. After the official ceremony, we had a small celebration with the team. That was when I realised how much people in Ukraine love to sing: when one person began, everyone else seemed to know the song and joined in. It was beautiful. Later, once I became more familiar with the team, I played the guitar for them, and they enjoyed it. We rely heavily on this kind of bonding in our daily work.

My main role as a project coordinator is to align the efforts of the team towards our shared objectives. I am also responsible for security management, which is crucial in a war setting. Vinnytsia is located further from the front line, but nowhere in Ukraine is truly safe. During my first week, the city was struck after almost two years without direct attacks. It was an extremely stressful experience. I am constantly aware that MSF operates in other parts of the country much closer to active hostilities. It is concerning to know that colleagues and communities elsewhere live under constant threat.

In Ukraine, the war affects every aspect of life. Many people remain in survival mode, meaning that some mental health consequences are not yet fully visible. I remember one of my first outings in the city when I spoke with a man who had come from the front line. As he recalled what he had experienced, his expression changed, as though he was staring into infinity. He asked a woman passing by to help translate into English. She agreed, but soon began to cry, explaining that her husband is currently fighting on the front line. It feels as though everyone carries a story, and you never know when you will encounter someone else’s pain.

Despite everything, I am continually amazed by people’s resilience and their determination to care for one another and move forward. Surveys indicate that PTSD rates in conflict-affected settings are significantly higher than in other regions. Depression and anxiety disorders are also widespread. However, because the war continues, many people delay seeking mental health care while focusing on basic survival needs. I am certain that once the war ends, the demand for mental health support will be even greater than it is now.

At weekends, I try to stay connected with my son in Honduras, despite the eight-hour time difference. Naturally, my family worries about me. I have realised that information about Ukraine reaching Latin America is often limited—sometimes, even major attacks go unreported there.

The logo of our mental health centre is shaped like a heart. To me, it symbolises recovery: one human supporting another on the path to healing. I am convinced that building community and staying connected are among the most important forces that have allowed humanity to endure and overcome adversity.

“To be ‘alive’ is the lowest bar and the highest achievement for everyone”

Katsa Juliana Shea, MSF health promotion manager in Ukraine

Katsa Juliana Shea joined MSF in January 2022 and has since worked in South Sudan, Bangladesh, and Haiti. In Ukraine, Katsa is based in the coordination office in Kyiv, but works in MSF projects in Dnipropetrovsk, Cherkasy, Donetsk, Mykolaiv, and Kherson regions. Katsa manages three teams of health promoters across these regions. Health promoters (HPs) are the link between MSF’s medical staff and people in the community. They are truly “on the ground,” meeting with community leaders and local medical staff, engaging meaningfully with beneficiaries, collecting real feedback and life stories, and using data and first hand accounts to shape MSF’s programs. HPs are two-way conduits, emphasising the need for adaptation, listening, and building trust with the community.

Managing HP teams is an endlessly varied and meaningful job where no two days look alike. In the past few months, the teams have worked on a variety of projects: a new model for a transparent, systematic needs assessment using digital mapping tools; a “Babusya [grandmother] Newsletter” of everyday stories from across Ukraine and beyond to help older women on the front line feel less alone; and identifying other actors and care pathways so those who fall out of medical care can receive care again. The HPs also teach about topics like healthy sleep, hypertension, tuberculosis, and antibiotic resistance using games, quizzes, and stories. These –tools are referred to as “HP Peppers”, which are creative ways to “spice up” health information.

The world of health promotion is about finding ways to co-create concepts of health with communities that live beyond lecture. Their work is a profound way to reject narratives of destruction and carry forward physical, mental, and social well-being hand-in-hand with their communities.

The absurdity of this war lies in its contradictions: the way life keeps going in parallel with the unbelievable destruction. There is the bravery and the sureness of the Ukrainian will, but also the grief, the fatigue of my friends, and the weight of patients’ stories. There is the number of times you pass young men every single day, canes in hand and missing limbs. It’s impossible to get your mind around the scale and toll of it all. And yet, somehow, amid this absurdity—the alarms, the shelling, the drones menacing the sky—people still go to parks, children play, and restaurants stay open. The horror and beauty coexist. You can’t help but carry that tension around with you like a small stone in your pocket, all day, every day, trying to understand how it can all be this way, how all of this fits together.

These contradictions don't exist in the abstract, they manifest in real harm. Last summer, more than 300 drones and several dozen long-range missiles were launched at Kyiv in a single night. Rockets and unmanned aerial vehicles (UAVs) struck residential buildings, hospitals, public transport, schools, and kindergartens. According to the UN Human Rights Monitoring Mission in Ukraine, in July 2025 alone, 286 civilians were killed and 1,388 injured—the deadliest month since May 2022.

Even so, the impact is uneven, filtered through different lives. The truth is, I feel it, but not in the same way as my dear friends and colleagues in Ukraine. I’m here, I’m under the same sky, I hear the same blasts, I see the same windows shake. I carry some of the adrenaline and some of the fatigue. But it’s not my brother on the front line, not my house reduced to rubble, not my whole village and childhood, upbringing, and family wealth erased. It’s not my history or my culture being fought for.

And so, there’s this constant doubling—where on the one hand I’m walking through it with them, drinking the same four cups of coffee the morning after, caring for the same patients, and on the other hand I know there’s a kind of a barrier between their grief and mine, their risk and mine. Which leaves me feeling deeply part of this experience and also,very much outside of it—like I’m inhabiting someone else’s tragedy, but only as a guest, never with full ownership of the pain or the legacy of this war.

One place where this tragedy meets the hand of arithmetic is the count of nights, alarms, explosions. Since the beginning of the full-scale invasion on February 22, 2022 and the end of August 2025, more than 64,000 air alerts have been recorded in Ukraine, of which 44,685 were threatened by artillery shelling, according to air-alarms.in.ua. Most of the shelling occurs in the early morning, between 1 a.m. and 5 a.m., when people are most vulnerable, tired, sleepy, and disoriented.

The shelling is at once terrifying and oddly banal. Your night is restless because of the scary hum of UAVs followed by loud explosions that jerk you awake, not to mention the way your phone pings every few minutes with some air alert or security information. Yet the next morning, there’s this strange return-to-form, almost a defiance disguised as routine. As you walk to work the next morning, everyone you pass is tired like you; it’s written on all our faces. You feel a sort of solidarity with everyone knowing none of you has slept the night before. And when you see your Ukrainian colleagues and ask them how they are, they will often say, “I’m alive,” and it’s not said in an ironic or even melodramatic way, it’s just the blunt, data-like truth of the situation. And you realize that “alive” is both minimal and maximal, the lowest bar and the highest achievement now for everyone who lives in Ukraine.

These experiences reflect a broader reality faced by many. The front line in Ukraine changes rapidly—recently by 10km in one night. As such, there’s been an increased influx of people arriving at evacuation centres set up some distance back from the front line. As you walk past the hundreds of beds side by side in an old school gymnasium, you see so many older couples in their 80s and 90s, sitting quietly under the dim lights, forced to finish out their lives in these extreme circumstances. Recently, I spoke with one man who had walked kilometres to reach the evacuation centre with two dogs and two cats by his side. As we talked, he stood there with the dogs at his feet sleeping, the cat missing half its face. “These animals saved my life,” he tells us. “There were drones above my head, but they didn’t attack me because they saw I had animals with me.”

The fact is, there are so many stories that could just tear your heart out in the quiet moments of the day when you let yourself feel it, but sometimes it’s the deceitfully ordinary moments that really hit me, the ones that feel small until you realize they carry the weight of everything.

One afternoon, as I stepped out of my flat, I glanced upward and noticed my neighbours, this young and ridiculously cute couple, standing at their window. I waved, and the man motions for me to wait. He disappeared briefly, then returned with the tiniest little newborn baby. He held the infant up to the window for me to see, beaming with such unguarded pride. I waved back. This image cements itself into my mind: a family, living under drones circling above, so deserving of peace. It’s just one of the countless small miracles that persist. My friend told me that the Ukrainian phrase “бути у надії” used to say someone is pregnant, literally translates to “be in hope.” And for sure, this hope, this investment in the future, is the resilience carried forward.