In the Hospitals of Ukraine

In June, my heart sank as our car joined a queue that extended at least two kilometres to the border between Poland and Ukraine. There were two lanes: one for ordinary vehicles, the other for commercial traffic in which many trailers bore damaged cars for repair in Ukraine, I later learned, to replace those destroyed in the war. All moved with glacial speed but then our driver’s brain suffered a seizure for self-protection that had been dormant while careening down the rainy highway from Poland: he would go to the post and proclaim the importance of his cargo of doctors to the maintenance of world peace or whatever. It worked! Through we went, if not waving as boldly as royalty, certainly with smiles untroubled by the embellishment of our ambitions. 

We (Lara Wieland, a family physician from Queensland, my wife Elsie and I) were actually going to Ukraine to report on the effect of the war on children as revealed by visits to hospitals, orphanages, refugee centres and medical “camps” on the invitation of the Ukrainian branch of the International Christian Medical and Dental Association, of whose Australian branch we were members.

This report appears in September’s Quadrant.
Click here to subscribe

Beyond the border, the road sliced through pine forests that opened to hills of pastoral beauty overlain by blue sky and cumulus clouds. The fields ranged from manicured patches of vegetables to panoplies of sunflowers straining for the lingering light of a summer’s evening. I recalled the bucolic scene on the cover of an old LP of Beethoven’s Sixth.

After an hour or so of this pastoral beauty, in which cupolas of village churches had reflected the sun in gold and silver shafts, we entered the medieval city of Lviv with its cobbled streets, “Ukrainian baroque” terraces, brocaded cathedrals and ancient walls. Lined with al fresco cafes and restaurants, the streets led to parks where crowds strolled under spreading trees to the music of buskers, past gentlemen locked in chess.

As for children, every evening many gather in front of the old Opera House, to await fountains of water emerging from outlets beneath their feet. With some in swimming gear, from toddlers to teenagers, tension rises with the minutes, to burst in excitement with the spoutings, now lit with various colours. On the edge of the array, gentle streams emerge for the tentative touch of toddlers: in the middle, columns rise four to five metres with enthusiasm to match that of teenagers cavorting underneath. Some children are soaked immediately. Others seek its delay by running, hand in hand, with much laughter, between the spattering columns. Parents and grandparents participate emotionally. Are they remembering their times?

Away from the fountains, clowns amuse, ice-creams and fairy floss are eaten, skateboards and scooters clatter, babies are wheeled in soothing prams, and the yet-to-be born relax within strolling mothers. What fun. What life. What Vivaldi!

Things changed that night. I slept through the warning sirens and woke with the first explosions. First there was a bifid crash followed by silence. Then a second that lit the night sky and was followed by sirens.

In the morning, we learned eleven missiles had been guided to Lviv from Russian vessels in the Black Sea. Three had penetrated defences, landing on residential apartments. The bifid character of the first explosion was due to two of them striking almost at once. People were still being excavated. Oh God, I thought, what about the children? Of those killed, none were children, but that did not assuage the emotions that had overtaken me: anger, disgust, revulsion … what inexpressible evil to direct missiles onto sleeping children!

The Russian invasion began in the east of Ukraine in 2014 but accelerated, dramatically, in February 2022, when people awoke to columns of Russian tanks advancing on Kyiv, the capital. In talking with people from the areas affected, two features of the invasion emerged: the first was its suddenness, the second was the disparity between the immediate violence in some areas, and the early peacefulness in others where invading troops expected to be welcomed as liberators from “Nazi” oppression.

In the first, people awoke to artillery barrages. In the second, as in the airport town of Hostomel, some fifteen kilometres from Kyiv, people awoke to news of war on the media, accompanied by some shelling of the airport, and then the arrival of paratroopers in advance of tanks from nearby Belarus.

Initially, violence was minimal. It set in when Russian soldiers were informed they were not wanted and should “go home” and when many were deprived of that opportunity by destruction in stranded queues of vehicles.

Whether the Russian hierarchy believed its own propaganda is, of course, unknown. What is clear is that Moscow underestimated the determination and capacity of Ukraine to resist its physical and cultural domination.

We saw something of this resistance on our way to a “We Care” centre, north of Kyiv, run by various churches for people who had refused to leave during Russian occupation or were now returning to what remained of their belongings. The village was about ten kilometres from the edge of the modern city of Kyiv and, as we left its confines, my mind returned to a frequent conundrum. I pondered upon Kyiv with its glass skyscrapers, huge sporting stadium, chic boutiques, ornate supermarkets, trams and trains, miles of modern apartments replacing the rabbit warrens of Soviet architecture, churches, cafes and restaurants, parks and its views over the Dnieper River on whose sandy beaches, crowds picnicked in the summer warmth and swam as if they were in Coogee. And, I thought of its children.

Who could imagine that, almost overnight, the Russian army had advanced to the very doors of this modern European-style city? Did Moscow believe it would fall like a ripe fruit from an undamaged tree? Or, how much of its destruction were they prepared to inflict? I remain flummoxed.

On our way north, our guide turned from the main road onto a tributary and stopped when it entered a forest. “This is as far as they got,” he declared solemnly and proudly as he led us to some trenches and firing posts which lay, camouflaged and reinforced by pine logs, about fifty metres from the road. He explained that a bridge on the main road, further out, had been destroyed by Ukrainians, forcing Russian tanks onto narrow, slower roads, on which they bunched in front of defenders. Their reinforcement had been similarly impeded by destruction of the nearby tarmac.

“How did you stop the big Russian tanks?” I asked, for this was no fortified Maginot line, merely connected holes in soft ground. Our guide refrained from answering, lest, I assume, they need to do it again. But the shattered Russian vehicles now on display in Kyiv confirm unpleasantness on their way to the capital.

I looked but could find little remaining from the habitation of the troops or the battle itself. There was a small collection of shell and rocket casings but everything else had been painstakingly removed, making it impossible to guess how many soldiers had held “the fort” and how they had pulled it off. Remembering the thousands of soldiers in the pro-Russian Wagner group that are now ensconced in nearby Belarus, from where the initial invasion had been launched, I concluded there were even more defensive positions further up the road, undisclosed but ready.

The cost of the defence was, however, not entirely hidden. Little Ukrainian flags and ribbons fluttered from the logs of trenches, and satin “angel” dolls rested on lower branches of the pines, all in memory of the fallen. Indeed, Ukraine is aware of its losses: little flags denoting individuals extend in a swathe across the grass in the central park in Kyiv, photographs and posters are prevalent, cemeteries are enlarging and, in Lviv’s central square, every time there is a funeral of a soldier in one of its churches, a haunting version of the Last Post is played on a trombone, upon which the square stops, stands, kneels and weeps in accord with its piercing refrain.

The town of Bucha was nearby but our guide was unable to talk about this village that has entered history as one site of Russian cruelty. He had stayed during its occupation and, as a member of his church, had evacuated a number of civilians through the Russian lines, and had managed to help others, including those in Bucha. His humble, matter-of-fact demeanour belied his bravery.  

It is now believed that more than 1400 people died in Bucha under Russian occupation, including over 400 civilians whose recovered bodies suggested torture before execution. The numbers include nine children under the age of eighteen. Many women and young girls are reported to have been gang raped. A young man remains traumatised by the scene of the naked dead, including that of a nine-year-old girl. After its liberation, a Ukrainian commander recalls talking to on older lady who witnessed a young Russian soldier complaining to an officer about this treatment of civilians. She declared, “The officer took out his pistol and shot him.” All our guide could say was, “When the Russians realised they were not wanted they turned nasty.”

The brutality of Russian soldiers was derided by the aforementioned commander, in charge of a brigade of foreigners on Ukraine’s eastern front until he was first shot in the neck, then blown into the air by a shell from a tank. He recalled, he said, “flying through the air as if some giant had grabbed my leg” and, though pain-free at the time, had concluded, “This is bad.” The pain came later: from a wound to the head which still clouds his memory of the event, from penetrating wounds to his abdomen, and a shredded leg that had to be amputated. I talked with him in a rehabilitation hospital, to which I had accompanied a chaplain.

In the same room, another foreign amputee agreed with the commander’s assertion that all the Russians want to do is “rape women, drink vodka and steal everything they can get their hands on”. Both declared that the ordinary Russian soldier had little idea of why he was fighting, let alone the order of battle. Both declared there was no place for initiative in Russian ranks, only obedience to predetermined orders, and the knowledge that soldiers in the second rank would shoot anyone trying to retire from the first. “Their tactics have not changed since the Second World War,” the commander explained. “They send in a first wave of ‘meat grinders’ in order to consume the ammunition of defenders and distract from encircling by more experienced soldiers on the sides.” When defence weakened, the second wave would advance over the bodies of the first. Thus, “thousands of Russians are dying”.

Both amputees were disgusted that Russians would abandon their wounded but not their personal belongings, including wrist-watches. “How can you know that?” I asked. Amused at my ignorance, the commander explained that cameras on drones recorded action on the front.

The commander explained that while abandoning the wounded is bad for morale, it also increases the prevalence of permanent incapacitation: if you “lie bleeding for hours you are more likely to lose your leg”. He then decried Russian medical equipment: “We came across one soldier who was bleeding badly because he could not tie his old-fashioned rubber tourniquet, so we put one of ours on him.”

Both men were reluctant to be identified, explaining that Moscow had put a price on the heads of foreign volunteers: $25,000 dead, $50,000 alive. Though they doubted Moscow would ever part with the money, they did not wish to encourage aspirants.

“Why are you here?” I asked. Decisively, they both replied, “For the freedom of Europe.” “What does your future hold?” I asked. “I am going back as an instructor,” replied the commander, whose above-knee amputation precluded actual fighting. The other replied that his below-knee amputation would not preclude such duties.

In an extraordinary coincidence, I met that man again on the steps of a Kyiv hotel. “Do you remember me and my leg?” he greeted me, as if we were lifelong friends. “Of course,” I replied, and bent to admire the prosthesis he was waggling. He was spending two days with his wife before returning to the front. He promised me he would not tread on another mine but failed to assuage my distress.

Depredations by Russian occupiers are but one of the expressed reasons for the massive exodus of Ukrainians from the war zones in the east to safer regions in the west, and abroad. Others include the proximate savagery of artillery, the more distant terror of missiles, the wreckage of homes and livelihoods by the destruction of the dam on the Dnieper, and fear of the destruction of the nuclear power station in Zaporizhia.

As of July 2022, at least 12 million of 43 million Ukrainians were reported to have left the country. As of May 2023, 5.1 million are reported to be “internally displaced”, down from the peak of 8 million in May 2022. These “internally displaced persons” do not live in camps as might be imagined, nor are they seen sleeping in the streets or in parks. They appear to be living in rented accommodation, with relatives, generous individuals or, as we observed, in the buildings of various churches.

One indication of their number is the record of attendance at St Nicholas Children’s Hospital in Lviv, a referral hospital for complex paediatric problems. When Russia attacked in February 2022, there was an influx of wounded and burned children, but that initial tsunami had abated as children were evacuated from the war zones. The evacuation, however, greatly increased the workload of the hospital because of the chronic and acute disorders the children brought with them.

St Nicholas reports 18,000 children were treated in 2022 (including war injuries) but in 2023 that number had reached 14,000 by June. Surgeries had increased from 2484 in the last half of 2022 to 5349 in the first half of 2023.

We visited “refugee centres” in a number of churches that had given themselves to that function with inspiring commitment. Doubtless it is easier for the unadorned, utilitarian buildings of “evangelical churches”, but many, in the early stage of the exodus of strangers from the east, had had all floor space covered with refugees and their meagre belongings. Mattresses, often donated by neighbours who had learned of the need, had been laid side by side in auditoria, adjoining rooms, corridors and on stages. Tables and chairs were organised for communal meals, kitchens for feeding the masses, running water for bathing and the thirsty, clothing for the needy, medicines for the sick, and playing ground for children imprisoned by stress. Given the wording of the twenty-fourth chapter of the Gospel of St Matthew, you could almost say it was biblical!

Seventy refugees were still residing in one church we visited, and more were on their way. All current space had been filled so, contrary to the biblical story in which a hole was made in a roof to gain entry for help, men of this church elevated the roof to provide an extra floor for refugees.

For one refugee in that church, the prospect of more space was not, however, viewed with unlimited enthusiasm. We had been introduced to an older lady whose living space comprised one double bunk. We chatted as she sat on the edge of the lower bunk, with whatever remained of her earthly belongings spread out on the upper. She could hang a thin cotton screen for privacy. Her neighbours slept inches away in adjacent bunks and some were boisterously occupied in a board game on the floor, only interrupted temporarily by introductions. The lady caught my eye appraising the teenagers and assured me with a smile, “I have become a grandmother again.”

Yet another church had been suddenly overwhelmed by hungry refugees. “How did you feed the five thousand?” I asked the pastor, intending humour. Without any, he replied, “I was very worried about that,” but to his astonishment, neighbours who had been traditionally sceptical of his brand of Christianity, ostracised as it had been by the Soviets, heard of the predicament and suddenly began to arrive with cooked food.

Similarly, another pastor had felt bound to visit the front lines to deliver the sacraments and other encouragement to men of his congregation fighting in the trenches. Women in the church decided spiritual support should be accompanied by physical support and began to cook. The idea spread to neighbours and, soon, the church had to buy a special car, diesel-powered to minimise conflagration from a mine, but stripped for food and other comforts.

That pastor has a bad knee and while undergoing rehabilitation learned of the need for an ambulance that could transport amputees, so the church bought one second-hand from Italy, and now provides a twenty-four-hour on-call service. One night, the pastor had to drive, alone, to a field hospital near the front and retrieve a soldier who had been shot in the neck and was having difficulty moving his limbs. The pastor still despairs at his inability to avoid potholes.

Of course, not all wounds are physical or restricted to adults: children are suffering psychologically, beyond the capacity of government services. Many of the “refugee” centres in churches provide therapy for disturbed children, including in outreach programs to other institutions or more distant towns. Often that therapy is provided by young people, including medical students.

I accompanied such a group on a Saturday afternoon visit (which complements those during the week) to an “orphanage” near Lviv. Such institutions are not only designed for children who have lost parents but, according to the Soviet model, for “wards of the state”, admitted because of neglect or abuse. The number of residents in the institution had swelled with the arrival of evacuees from similar places in war zones and, thus, we were visiting children to whose original damage was added the fears and uncertainties of war and dislocation. Not surprisingly, anxiety, depression, anger, cognitive regression and social withdrawal had worsened, as simple life skills receded.

When we arrived, about twenty-five children had gathered on the lawn and were already being divided into teams according to ages ranging from five to fifteen. Worryingly, some children had not emerged from their rooms, and there were no older teenagers whose “thousand-yard stares” had unnerved us in other places. However, under the encouragement of a physical therapist and accompanying music, the games soon began. Simple races of hopping and running progressed to more complicated routines with hoops and balls, then rhythmic dancing with music, then co-operation in teams including vigorous tugs of war, interspersed with “time out” for some children to play board and card games.

There were hugs, high-fives, clappings, shrieks, yells, and much laughter. The excitement was palpable. I found it difficult to take my eyes from one little girl of about eight years of age who, without exaggeration, bounced, clapped and laughed the entire time, only excepting her turn in a relay in which she had to run with a small ball between her knees. The damned thing kept escaping, to be replaced with increasing determination until she crossed the line to whoops of joy from her friends (and me).

But then it came time to leave. Stillness descended. My heart ached.

“Save Ukraine” is a faith-based organisation dedicated to the immediate care of the wounded, but also to the future of the country. Its program of “rescue, restore and rebuild” began after the Russian invasion in 2014, and now reports the rescue of some 102,400 children and families from war zones by means of its sixty strengthened vehicles manned by twelve rescue teams. Also, after tortuous negotiations and with incontrovertible proof of identity, it was recently able to retrieve 145 children from Russian abduction.

The organisation restores through its five “hope and healing centres”, which provide temporary housing, food, clothing and psychosocial support for refugee families, those who have suffered sexual abuse, and those who cannot care for themselves, including the abandoned elderly. It rebuilds by providing modular housing, and by strengthening families disrupted by the war.

When we visited its centre in Kyiv, it was housing some 200 refugees, consisting of thirty-five families, some of whose children were playing on the driveway. One little girl commanded attention by pelting downhill on her scooter; another by hooping, not merely at pace, but with a dexterity that permitted attack on an annoying brother. Nothing wrong here, I concluded.

Because Save Ukraine is deeply involved in their rescue, we discussed the dreadful business of the Russian abduction of Ukrainian children. Ukrainian estimates have reached 20,000, but statistics are limited by lack of original data of births and deaths, loss of school and other records during the war, and by unrecorded migration from war zones. Nevertheless, the fact if not the figure of widespread abduction is not disputed and human rights organisations are demanding the prosecution of Russian authorities, including President Putin, for this war crime.

Children have been abducted at roadblocks, from “orphanages”, and from so-called “summer camps”. One father from a Russian-occupied village told me how representatives of the mayor had visited all families with children in his village and offered transport to a special “camp” on the shores of the Black Sea where there would be peace, food, fellowship and education. The father rejected the offer, but other parents did not, especially those with older children and adolescents who were excited to go for a holiday with their friends. As Save Ukraine admits, what parents would not want their children to be free from bombing and hunger? But time has revealed that, ultimately, the buses were destined for Russia and the children for Russification.

“Why would Russia do this?” I asked evacuees and others, and though specifics varied there was the underlying concept of the subjugation of Ukraine to the Motherland, not merely of its geography but also its language, culture and history. Answers included “because they want to punish us”, “they want to turn us into Russians”, “they want to compensate for their loss of men on the battlefield”, “they want to compensate for their low birth rate”, “they want to brainwash the children and use them against us when they grow up”, “they want to blackmail us with the safety of our children”. Others emphasised Russian propaganda: “see how good we are, rescuing children from the war started by the Nazis in Ukraine”.

“Why are there not huge protests by parents?” I asked. “Would you expect to see your child again if you protested against Putin?” was the obvious answer.

Whatever the reason for the abductions, my brain struggled with the enormity of the crime. How could anyone do this? But no one seemed surprised by what was happening. The attitude was rather, “What did you expect?” Some understanding was provided by a youthful translator who had strongly objected to the concept of rebuilding Ukraine. “It is not about rebuilding, it is about creating a new Ukraine,” she insisted, “one that is freed from the Soviet mentality.”

“What is this Soviet mentality?” I asked. She carefully explained that, primarily, it aligned the identification of right and wrong with the interests of the Party which served the alleged “motherhood” of Russia. In this, she was paraphrasing Lenin, who insisted that “all morality is subordinate to the class struggle” and, thus, to the interests of the Party elected by history to lead to a perfected future.

Thus, the latter-day abduction of children, or their shredding by shrapnel, their maiming by little mines that could look like butterflies, their crushing by rubble or incineration in their beds might be perceived as justifiable, as much in the interests of the ruling party, as their starvation had been in the Great Famine of 1932-33 when Joseph Stalin had declared that opposition to collectivisation by their parents was a threat to the philosophy and power of Moscow.

My education continued, Under the Soviet mentality “people were led to believe the government was the source of everything you needed and, therefore, had to be obeyed and certainly not criticised”. There was no place for personal initiative or responsibility. Passive submission to Mother Russia was the way things worked, facilitated by bribes at every stage of life, from baptising an infant to passing examinations at school, to getting a driving licence, to getting a job, and to organising a funeral—under the knowledge that “if you did not obey, if you stood out, if you tried to do something yourself” you would fail or be punished.

Being a Christian, the young lady declared the need for recognition of a higher morality and a new worldview in a new Ukraine in which citizens went out of their way to serve others: not to bribe them for personal ambition. And, as a Ukrainian, she assured me she would fight to the death for its achievement.

Of the doctors I met, David’s story is representative. He is a neurosurgeon in a hospital that receives those grievously wounded from the artillery duels on the frontlines. The system of medical education in Ukraine has allowed him to pursue that single speciality before and since graduation, and so, at only twenty-seven years of age, he bears responsibility for the treatment of head and spine injuries on his almost ceaseless shifts.

We were attending a “retreat” organised by the Christian Medical Association and, perhaps because I am a much older and foreign colleague, he sought my company to go over some of his experiences. Thus, I viewed photographs of ghastly shrapnel wounds to heads, and listened how he had removed shrapnel, shattered bone and bits of brain, and tried to close leaking wounds. “This war is costing us dearly,” he repeated. He wonders if he could come to Australia to improve his spinal surgery.

Of the hospitals I visited, none is more illustrative than St Nicholas in Lviv. But its increase in workload has encouraged cross-infection with resistant organisms that has overwhelmed its capacity for diagnosis and direction of antibiotic therapy. Perhaps difficult bacteria were amplified in that early wave of children damaged in the war: shrapnel can carry a load of dirt and bacteria deep into the body, and they thrive on cooked skin and muscle. Whatever the cause, authorities relay the problem and are asking for help. Traditional diagnosis of sepsis begins with clinical signs which, however, may be difficult to distinguish from the effects of trauma. Then, the type of germ might be suggested by its microscopic appearance or the character of its growth on special media impregnated with various antibiotics. But this process takes time and personnel, both of which are limited in war. As a result, many deaths have occurred.

St Nicholas needs a machine that can quickly diagnose the presence of sepsis, its causative organisms and the most appropriate antibiotic. Machines exist which can perform these duties by analysis of the DNA in body secretions, using polymerase chain reactions. All major hospitals in Australia have these PCR machines and, in the realm of foreign aid, they are not expensive. One should be provided.

The hospital, indeed the whole of Europe, needs pressure to be exerted continually on Moscow to forget about destroying Ukraine’s nuclear reactor. It was sobering to view St Nicholas’s plans for that eventuality: maps revealed where ambulances would enter the complex, be hosed clean of nuclear contamination, and discharge their patients for triage of the severity of wounds and contamination. Windows and doors would be closed to reduce airborne radiation, and iodine solutions and tablets would be distributed from well-marked and accessible stores in every ward, to every child, to compete with absorption by the thyroid gland of the radioactive variety. If necessary, children could be accommodated in the ordinary bomb shelters which extend beneath the hospital. In permanent readiness, eerie subterranean corridors await with made-up cots and beds on which fluffy toys are poised for welcome.

In my final discussions with a young doctor who receives and distributes foreign aid gathered internationally by Christian Medical Fellowships and other organisations, and accounts for every pill and bit of equipment, I asked what the greatest need was. He agreed with the need for a PCR machine, and for a more durable source of the special biological scaffolding that encourages quicker repair of burns. Regrettably, China is now the main supplier of that therapy, and its affirmation of “undying friendship” with the county that is burning people in Ukraine has, not surprisingly, reduced confidence. He acknowledged the value of foreign education for young specialists carrying heavy loads. He also insisted: “We need ambulances. Lots more ambulances to replace those destroyed by bombs or rattled to pieces on difficult roads.” Limbs and lives were being lost by their lack.

In a final discussion with a young man in the rehabilitation hospital who sat with the stump of one leg propped over the arm of a wheelchair, with that of the other covered by short pyjamas, and who apologised for his poor script because he had also lost the arm with which he used to write, I asked what he would say in an open letter to Australia. His reply was immediate: “I would tell them we will fight to the death, and request help to do it.”

Dr John Whitehall is a professor of paediatrics at a university in Sydney. Donations for distribution by the Christian Medical Association of Ukraine can be given through this link: https://chuffed.org/project/voices-of-hope.