Humanitarian access disintegrating in Ukraine: MSF

Maternity and children’s hospitals in ruins. Patients receiving treatment in bunkers and subway stations. Reports of soldiers firing on civilians and sexually assaulting those too frail to flee their homes. Millions displaced. Thousands dead. Food and critical medical supplies dwindling.

More than a month into Russia’s invasion of Ukraine, humanitarian needs are escalating, but access to the hardest-hit areas of the country has become impossible.

Alex Wade of Médecins Sans Frontières (MSF) says respect for international humanitarian law appears to be disintegrating. CMAJ reached him in Dnipro, where is he is working with local health systems to maintain medical supply chains.

“We work in conflict zones all over the world and, usually, through our principles of neutrality and impartiality, we are able to negotiate with all parties in a conflict for safe access for humanitarian services and noncombatants who need access to medical care,” Wade says.

Not so in Ukraine. “For now, we have not managed to have that access.”

The situation is most dire in the besieged southern port city of Mariupol. Repeated attempts to arrange safe passage for the thousands trapped in the city have failed. The United Nations’ human rights team has reported evidence of mass graves and is investigating claims that Russian forces have killed fleeing citizens in their cars.

In the first week of the war, MSF was able to deliver some medical supplies to the city, including “material for trauma surgeries to treat up to 50 war-wounded,” Wade says. “But then before we could get them more supply the town was encircled and it became too dangerous to access.”

Staff in the city have witnessed increasing shelling on residential areas and civilian buildings. As many as 300 people were recently killed in a Russian bombing of a theatre.

“We cannot say if it’s direct targeting or if it’s just sloppy aiming, right? It could be either,” says Wade. “But, either way, for us it doesn’t matter… and the incidence of this happening seems to have increased.”

Médecins Sans Frontières has lost contact with the city’s hospitals. “The last communication we had was them informing us that they were receiving a high number of wounded. They were worried about their supply. And we haven’t been able to communicate with them since. We’re incredibly worried about the situation there.”

Supply issues are the most pressing concern across the country.

In terms of human resources, “Ukraine has a very advanced health system, very, very competent doctors and nurses, and a lot of them. Even in places of conflict, we’re seeing medical staff staying to treat patients,” Wade says. However, “the medical supply system throughout the entire country has been massively disrupted.”

Certain roads and warehouses are no longer accessible, meanwhile, hospitals in or near conflicts zones are receiving “hugely increased numbers of wounded requiring emergency medical interventions,” he says. “Many are in danger of having ruptures of essential medicine and no longer being able to treat their patients.”

Médecins Sans Frontières is in touch with hospitals across the country — in Kyiv, Zaporizhzhia, Donetsk, and Luhansk. The organization has its own supply system based in Europe and has been shipping supplies by truck into Lviv from Poland.

“From there, we have a major ware-house where we can split stuff up and dispatch it” around the country, Wade explains. The organization is prioritizing cities that are receiving the most wounded “to get them as many supplies as possible as quickly as possible.”

In cities where MSF still has access, the organization is preparing health systems for “the worst” — a protracted, violent siege like in Mariupol.

In some cases that means preparing to move health care services underground. “If hospitals are not accessible, or God forbid continue to be hit, do we have the supplies, tools and expertise to transform a bunker into a fully running hospital? These are the discussions ongoing right now,” Wade says.

While millions of people have fled the country, hundreds of thousands more have been displaced within Ukraine, primarily to major cities in the west like Lviv and Dnipro.

Among them are people with chronic conditions, those who need ongoing access to treatments like insulin and hemodialysis, pregnant people who need birthing services, “and now, of course, a huge burden of people with new mental health conditions such as posttraumatic stress disorder,” Wade says.

Health systems and mental health services particularly have been “over-whelmed” by the massive surge in demand.

The global medical community can help by “keeping attention on what’s happening,” Wade says. “There are huge needs and they’re still increasing, and I worry over time people become normalized to seeing it on the news.”