March 16th felt like spring in Chernihiv, a city in northern Ukraine. "The sky was cloudless," says Vladyslav Kukhar. "It was cold, yes, but the sky was so blue."
Then, near City Hospital No. 2, multiple shells exploded. One detonated inside. Kukhar, a surgeon and the hospital's director, was there.
"These explosions, it all seemed so unreal," he says. "We realized that we were the target."
Russia's attacks on Ukraine's health facilities are part of a tragic global trend in conflict zones. It's happened in Syria, Yemen, Ethiopia and Chechnya as well. The result is to cripple health care, scaring people from coming to a clinic if they need help.
Shells fell: 'It was like an apocalypse'
In Chernihiv, Kukhar says that the Emergency Department of City Hospital No. 2, located on the ground floor, was instantly destroyed. In addition, the shock wave shattered windows across all nine floors of the building, showering everything with broken glass. Beds spun. Doors sailed down hallways.
"It was like an apocalypse," Kukhar says. "There was a white fog of cement and dust in the building, in the hallways and rooms. There was alarms sounding. The screams of patients ... the medical personnel."
Kukhar remembers a girl crying in the hallway as if it were a photograph seared into his memory. He raced to the operating rooms. His colleagues were still alive. Next he ran to what little remained of the Emergency Department. "We were trying to find all the wounded to prioritize them," he says, "to render them necessary aid" — including sedatives.
Within an hour of the attack, Dr. Tetiana Lebedieva, deputy director of the Chernihiv Health Department, stepped into what had become City Hospital No. 2. "It was a very, very difficult emotional moment," she recalls. It's become Lebedieva's job to document the drumbeat of assaults on the health facilities in her city. "My job requires me to drive around the city and check every hospital," she says.
The scene was overwhelming. This place of healing, she says, had employed over 300 physicians of more than 30 specialties, including an especially strong cardiac surgery department. The hospital had developed a strong COVID response unit. In seconds, this building was devastated.
And the staff feared a further attack.
"The decision was taken very quickly," Lebedieva says, "to move all the patients who were able to walk, to move them to the underground floors," which had sustained less damage from the shelling. Those who'd been recovering post-op were brought into the hallways since their rooms, now without windows, had grown cold with wintry air.
"Everyone was very scared," Lebedieva recounts. "The patients — everything that has been done to help them to live their life longer is being destroyed in seconds or minutes. It's such a pain in your heart and hopelessness in your soul."
This is what Tetiana Lebedieva had come to document, with her eyes and her phone — the latest in a string of attacks on health infrastructure. "We need to have the evidence that this happened," she says. "It is a breach of all military conventions."
Medical care: 'Hanging on by our fingernails'
At the time, this was the sixth report of a hospital attack in Chernihiv alone. Within city limits, all seven municipal hospitals are now damaged and only three remain partially open, including City Hospital No. 2. Every private clinic in Chernihiv has closed due to a combination of destruction and patients evacuating outside of the city.
Medical personnel across the city describe the difficulties they've witnessed. Dennis Matsko headed up a multidrug resistant tuberculosis ward in Chernihiv, but it was destroyed by shelling. He's now working out of the district hospital and says, "We are hanging on by our fingernails."
Oksana Lohvinchuk, medical director of that same district hospital, says that a nurse in a nearby village called her to say farewell. "There's very heavy bombing tonight," the nurse said into the phone. But Lohvinchuk reassured her that she would be okay. Fortunately, the nurse survived the night and is continuing to care for patients.
While other health facilities in Ukraine have been spared, Chernihiv isn't alone. Health infrastructure in the regions of Kyiv, Luhansk, Kharkiv, Mariupol, and elsewhere have all been hit hard. From the start of the war until the publication of this article on April 7, the World Health Organization has reported 103 assaults on Ukrainian health facilities.
Tarik Jašarević, a WHO spokesperson who was based in Ukraine until early April, says the attacks terrorize communities, showing "there are no humanitarian boundaries to the conflict" and "really put the very existence of the health care into question."
Pavlo Kovtonyuk is the former deputy minister of health in Ukraine, and he's now working with the Ukrainian Healthcare Center, a group he co-founded, to document attacks on health facilities as possible evidence of war crimes. "We believe that Russia one day or the other will be taken responsible for what they did," he says. He hopes that Ukraine will be victorious, adding that such an outcome is "not only about [a] military result but also about holding evil accountable after it all ends."
Life after the shelling: 'We were there to help under any circumstances'
At Chernihiv City Hospital No. 2, the staff repaired the building the best they could, but supplies were limited. It took four days to cover the blown-out windows with plywood and tarps. The hospital moved all of its work to the ground floor, transforming it into an emergency triage center, mostly for the wounded.
"There was no alternative," says director Vladyslav Kukhar. "We were there to help under any circumstances. That's what we did. That's what we had to do. Fate has made this choice for us."
More than half of Chernihiv's population of not quite 300,000 people has fled, but numerous medical personnel have stayed behind to help at City Hospital No. 2, like Oleksandr Ryzhenko.
Before the war, he was a pediatric surgeon elsewhere in Chernihiv. Lebedieva observed that Ryzhenko has hands that are "capable of big miracles." But once the war broke out, the pediatric surgeon became a full-time volunteer trauma surgeon. He shows up to the hospital on his bike to tend the wounds of war. Often, he extracts shrapnel and bullets from the bodies of his patients.
For the moment, shellings have ceased and Ukrainians have regained control of the city. But until recently, Ryzhenko's days followed a cycle, pinned to the sounds of fresh bombs. He says when the explosions paused, staff — holed up in the basement — streamed out of the hospital with gurneys and tourniquets, ferrying new patients inside where the triage begins anew.
"You need to understand whom you should help first," Ryzhenko explains, "whom you should help second turn, and whom there is no sense to help anymore. And that's part of this new reality."
Ryzhenko and the other surgeons have done the best they can, running their operating equipment on generators. But fuel is scarce, a situation that grew increasingly dire as the Russian forces established a near chokehold on the city.
"In the night, the temperature was minus," he says. "So you could imagine what are the conditions in the hospital without windows." The staff has routinely huddled outside around makeshift stoves to cook food for their patients.
Even in these grim times, Vladyslav Kukhar, the director of City Hospital No. 2, says he's filled with gratitude — for the people who helped repair his building the best they could and for his colleagues who've stayed to help others heal.
"It demands more effort these days, but the patients get better," he says. "They leave the hospital, and they get their health back. And it brings us joy, it brings us pride. And it's the greatest honor in this situation."
Sergiy But, Maria Dolynska, Sergey Kupriienko, Anna Lebedieva and Oleksandr Stadnyk served as interpreters for interviews conducted for this story.
Copyright 2022 NPR. To see more, visit https://www.npr.org.
