No access to medical care in Kurakhove, Eastern Ukraine.

The working day at the Médecins Sans Frontières (MSF) mobile clinic in Pavlohrad, eastern Ukraine, is almost over. Dr Oleksandr Hontariev is counting the boxes of medicines, packing up for the evening, when a volunteer runs into the room.

"We have wounded. Can you please help them?" they say.

Dr Hontariev pulls on new medical gloves and quickly goes outside.

MSF’s mobile clinic is running out of a community centre, now turned into a transit centre for people who have been forcibly displaced from Donetsk region, the neighbouring oblast. Several large buses have arrived outside the centre, each with a sign reading ‘Evacuation’. On the buses are people from Kurakhove, who have just made the more than four-hour journey to reach the relative safety of Pavlohrad.

An elderly woman sits in a wheelchair next to her husband. Her face is covered with small scratches and she is crying. Her husband leans over and whispers something in her ear, trying to comfort her.

"My brother is under the rubble," she says, over and over again.

Dr Hontariev treats a wound on her arm with initial trauma care before moving on to others. Two wounded men, a father and son, are waiting inside a vehicle.

"The older man has burns and shrapnel wounds to his back and shin,” says Dr Hontariev. “He was injured four days ago, and only now he was able to get help. Burns like this can only happen when hot metal comes into contact with the body. The debris burned through his clothes and injured his back."

MSF teams frequently encounter patients with similar mine and blast injuries from four or five days earlier. Delays in evacuation caused by constant bombardment mean that people are unable to access life-saving care right after they are injured. In the past two weeks, 25 per cent of patients treated at the Pavlohrad centre by MSF teams, had injuries from blasts that struck their homes.

Dr Hontariev finishes treating the new arrivals’ wounds. An ambulance arrives and its crew continue to treat the wounded while volunteers help people to settle down.

Evacuation

In the former assembly hall of the community centre, the chairs in the audience rows have been removed. Dozens of beds line the hall, including on the stage. Most of them are occupied. The room is dimly lit, with only infrared heaters burning brightly in the corners. Some residents are listening to music on their phones, barely audible in this large room with its high ceilings. ​

Here, at the transit centre in Pavlohrad, people from Donetsk region stay for a few days before moving westward in Ukraine or abroad. Many come from Kurakhove and its nearby towns and villages. As the frontline moves with the continuing offensive of Russian troops, and as living conditions deteriorate, people have no choice but to leave their homes. In these towns, the shops, pharmacies, and hospitals are closed. But even so, the constant bombardment makes evacuation incredibly difficult.

Mrs Yelyzaveta, 83, is resting on her bed at the transit centre. She came from the village of Dachne, near Kurakhove. All her documents and money burned along with her house.

She recalls that during the constant shelling she was looking for something to distract herself.

"I was sitting with my neighbour under an apple tree, shells were flying over us. And I said, 'Why are we sitting there like we're waiting to die?'” says Mrs Yelyzaveta. “We have to do something, so I went to sweep the leaves from the yard."

Soon after, an explosion happened near her house, starting a fire. She and her son managed to get away from their burning home.

"The house was on fire, so we couldn't go back in,” says Mrs Yelyzaveta. “The neighbours' houses were cut in half by the bombing, but ours caught fire."

Mrs Yelyzaveta’s son refused to evacuate so she came to the transit centre alone. She hopes to move on soon and reach her relatives in Poltava, central Ukraine.

Medical assistance

At the mobile clinic operating out of the centre, Mrs Yelyzaveta had her blood pressure and blood sugar level checked by MSF staff and was given medicine. MSF doctors and psychologists work here every week and can see up to 50 patients a day.

"First of all, these are elderly people and people with disabilities, so they often have underlying conditions or complications," says Dr Hontariev. "They have hypertension, heart disease, diabetes. Many of them come to us with respiratory diseases, because they were in basements for a long time during the shelling. People with minor injuries are also often brought here." ​ 

One patient’s story has stuck in Dr Hontariev’s mind.

"The man was on the street when the attack started,” he says. “He ran into the basement of someone else's house and had to spend two weeks there before he could evacuate. All this time he ate only the canned vegetables that were in the basement. He came to us with bilateral pneumonia."

Psychological support

One of the patients tells the doctor that his son is missing. After his medical examination, Dr Violieta Kozhukhovska, a psychologist working with MSF’s mobile clinic team, came to talk with him. They find a quiet place in the transit centre to sit together. ​

"This man has a sister, but he can't contact her,” says Dr Kozhukhovska. “His phone burned in the explosion in his house, and he doesn't remember her number. I advised him to try to find her through social media."

Most of the evacuated patients, she says, are now in a state of acute stress. ​

"The task of a psychologist at this stage is to carry out a crisis intervention, that is, to listen without asking unnecessary questions so as not to traumatise them again,” says Dr Kozhukhovska. “It is important for people to speak out."

The people arriving at the transit centre have suffered the loss of their loved ones and they miss their homes. But they can find solace in the centre. Back in their besieged towns and villages they spent most of their time sheltering in cold basements with limited food supplies. ​

"They are now enjoying warmth and hot lunches, enjoying the electricity. It's a blessing for them right now," says Dr Kozhukhovska.

The transit centre in Pavlohrad has been operating since August 2024, when the frontline approached Pokrovsk. Various humanitarian organisations host people fleeing from Donetsk region in the centre and provide them with legal, medical, and social services. The MSF mobile clinic comes to the transit centre every week. Patients are offered examinations from MSF doctors and psychologists and are provided with needed medications.