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  • One Surgeon’s Experience During Armed Conflict in Ukraine
  • Artem Riga

Shortly before the war, I completed my postgraduate studies for my PhD degree and became a young teacher at a medical university, gaining academic experience. And I carried out my surgical clinical practice on duty in the 2nd level district hospital for the civilian people in the city, which is located not far from Kharkov. My story begins at 5 a.m. on February 24, 2022. A terrible and awful morning found me on duty in this hospital near Kharkov—the sounds of explosions, shock waves, and the smell of burning—all at the same time. My thoughts turned into a swarm of bees. This is a war.

There had been anxiety in society for several days before, that Russia would attack Ukraine. Now, within a short time after the explosions, adults and children with numerous injuries and wounds began to enter the hospital. There were many. How to help so many wounded at the same time? It was a challenge. What will happen next? The hospital was dramatically unprepared to receive such a large number of victims. It turned out that there was an acute shortage of medical personnel, medical materials, and painkillers. It was difficult for me to sort the patients according to the severity of their injuries, since I was the only surgeon on duty. In the first hours of the beginning of the aggression, the management of the hospital was paralyzed. I could not leave the victims alone and leave my post. I felt that my strength was slowly leaving me but I stayed to provide medical care to people. I was stunned by the children’s injuries and their damaged faces. There was fear and alertness that the shelling of the hospital would begin. I was in fear for my life. At the same time, there was fear for my patients and loved ones. Oh! What about my relatives? I called my relatives, and told them about everything I was seeing. I asked them to leave Kharkov for a safe place. I still remember the words I said to them: “I see hell.”

From the first day of the war, the logistics of vertical hospital management were disrupted. The main principles of medical care—availability, accessibility, acceptability, and quality—were violated. The city became a front line and was under occupation for several months. Transportation of patients to a hospital of the 3rd level of care was impossible, as all roads and highways were shelled. Most of the medical personnel became refugees, a certain part of the medical personnel did not have the opportunity to get to the workplace. A few colleagues who remained in the hospital and I began to organize horizontally. It was important to me that I was not alone. Still, I had to rely only on my [End Page 174] own strength and sometimes the help of colleagues. Starting in February and for the next two to three months after, we worked independently without staff rotation and with meager medical support. I had to stay on duty for a long time, and knew I would most likely have to live in the hospital. Two months after the end of the occupation, the shelling of the city intensified. In the conditions of constant shelling and threats to life, medical assistance to people who remained living in the city and the countryside was provided only in stationary conditions. A lot of the population left, and the rest hid in shelters. The city was a ghost town. There were no lights on the streets; no people, no cars, no signs of life. My personal transport was damaged in one of the shelling attacks and I had to get to the hospital on foot or by bicycle. During the fighting, it was dangerous to move around the city and get to the hospital, because there was always a threat to life. At the same time, I was always certain that the colleague whom I had to replace on duty would not leave the post if I suddenly did not arrive—I myself had to arrange shelter when I was outside the hospital. For...