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In Ukraine, horrific injuries and not enough doctors to treat them

Operating with skeletal crews, doctors and nurses race to save limbs and lives. It’s a grim routine for medical staff who often work around the clock. And not all limbs can be saved.

KRAMATORSK, Ukraine – Days after Russian forces invaded, Yaroslav Bohak, a young cardiovascular surgeon, was at home with his family in the relative safety of western Ukraine when a colleague made a desperate call from the east, begging him to come and help her.

Many medics had fled the fighting, his friend said, and conditions at the hospital resembled a bygone war era, with the remaining surgeons cutting limbs, instead of trying to repair them, to save seriously injured soldiers .

“He called me and told me he couldn’t cut off young people’s arms anymore,” Dr Bohak said, as he stood in an operating room at a hospital in Kramatorsk. “When I arrived here, I had surgery on the first day.”

As Russian forces pound eastern Ukraine with a mix of artillery, airstrikes and rocket attacks, frontline hospitals, many of them in poorer rural areas, are overwhelmed . They are either severely understaffed or completely abandoned as doctors and nurses fled the violence.

All day, the walls of the hospital tremble under the thunder of the fighting raging near Kramatorsk, an industrial city in the Donbass region, where Russian forces are leading a bloody offensive. A steady stream of ambulances arrive at the sandbag-reinforced emergency room, carrying soldiers and civilians, many with life-threatening injuries.

But the hospital has a small team. Only two of its 10 doctors remain, aided by six nurses working around the clock with only one day off, said Tatyana Bakaeva, the head nurse. (Hospital officials asked that his name not be released for security reasons).

“Only the most stoic remain,” Ms Bakaeva said. “People are scared, what can you do?”

It’s a similar story all over the Donbass: as the number of injured increases, the need for more doctors and nurses becomes even more acute.

In Avdiivka, right on the front line, the only remaining surgeon and the hospital’s medical director described spending months in the emergency room, never leaving except for a quick trip to the grocery store amid shelling. In Sloviansk, a town just north of Kramatorsk where plumes of battle smoke can be seen on the horizon, only about a third of the hospital staff remain.

The town of Bakhmut lies at a crossroads between Russian forces pushing from the east and the north. There, ambulances clog a small courtyard of the military hospital and the emergency room is almost always full.

“No one ever prepares for war, and this region is not so densely populated to be able to deal with so many wounded,” said Svitlana Druzenko, who coordinates emergency evacuations of wounded soldiers and civilians from areas of fight. “Injuries are the same for civilians and military because rockets don’t choose where to fall.”

Many of the wounded from the east are brought to Dnipro, a city of a million people with six major hospitals. But it is a four-hour drive from many frontline positions. And the hospitals there have also been exhausted of nursing staff, said Dr Pavlo Badiul, a surgeon at Dnipro’s Burn and Plastic Surgery Center.

The center was jam-packed with war wounded and staff were working non-stop, he said.

A member of the American Society of Plastic Surgeons, after training in California, Dr. Badiul appealed via the society’s newsletter for medical equipment and supplies. “Although we receive targeted aid, much of it is still lost, diverted or taken to the wrong place,” he said.

Volunteers stepped in to make up for some of the delay. Ms Druzenko works for a voluntary emergency medical organization known by its Ukrainian initials PDMSh. Its ambulances and staff are ubiquitous in hospitals and at so-called yellow zone transfer points, places on the edge of the battlefield where wounded soldiers are picked up by ambulances and rushed to hospital on closer.

It is dangerous work. Last week, a Yellow Zone base that Druzenko’s organization established north of Bakhmut was shelled by Russian forces.

“Not only drones, but aviation is working in this area,” Druzenko said.

Most of the surgeons operating at Kramatorsk Hospital, including Dr. Bohak, are volunteers. Since his arrival, the hospital has had virtually no amputations.

Dr. Bohak showed videos on his mobile phone of his operations last week. Digging into the scorched and shredded flesh, he extracted the severed arteries and painstakingly stitched them back together, restoring circulation to the damaged limbs, allowing them and the soldiers to whom they are attached to be saved.

“The nearest serious clinic is in Dnipro, 280 kilometers from here,” he said. “It takes time to get there, and it may be too late to save the limb. This is why my arrival was very important.

However, not all members can be saved. Eduard Antanovskyy, deputy commander of the hospital’s military unit, said a Russian soldier had recently been brought in with a serious leg injury. While in the hospital, he said, the soldier received security guards for his protection.

“We had to take the leg because the tourniquet lasted too long,” he said. “Even if we wanted to, we couldn’t have saved his leg. We treated him humanely, not as he deserved to be treated.

Despite months of warnings from the White House and others that Russia planned to invade, many in Ukraine, including much of the political establishment and even some in the military, refused to believe him. When Russian rockets started hitting Ukrainian cities on February 24, it sparked a stampede. Hospitals, in particular, were unprepared to deal with the sudden influx of patients suffering from the vicious and difficult wounds inflicted by the war.

During the first week, Dr. Maksim Kozhemyaka, a civilian trauma surgeon, volunteered to help at the Zaporizhzhia Military Hospital, one of the main treatment centers for soldiers in the east and south of Ukraine. Almost immediately, he said, the hospital was inundated with 30 to 40 patients a day and did not have enough supplies to treat gunshot wounds or other serious injuries.

“We didn’t think it could happen because we understood that in any case there would also be huge casualties on their side,” Dr Kozhemyaka said in an interview at the hospital emergency room. “And of course, we thought no rational leader of a country would do that.”

For hospital workers who persist in the grim routine, the losses can feel personal, and sometimes are deeply so.

On a recent morning, ambulances rushed to the small hospital in Sloviansk carrying soldiers injured in an airstrike a few miles away. One carried the battered body of Ihor Ihoryuk, 33, the only child of the hospital’s head nurse. Much of the hospital staff had known him since he was a boy.

The force of the explosion, outside a room in a seed factory where he and his comrades were sleeping, ripped his arm off and his blood spilled onto the asphalt outside the hospital as he was running inside.

Hours later, a nurse named Anna walked out of the hospital, her green eyeliner streaming down her face. Ihor could not be saved, she said.

“He grew up before our eyes,” she said, holding back tears.

She held a box containing Ihor’s black military boots. “He won’t need it anymore,” she said.

She took them a short distance from the hospital entrance and placed them next to a pair of blood-soaked black tennis shoes. They belonged to a soldier killed the day before.

Carlotta Gall contributed reporting for Dnipro, Ukraine.

nytimes Gt

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