Saturday, February 24

The train where the innocents of Putin’s war travel

“There is no mercy for civilians.” It is not the title of any film, although it is clear that Raquel González, coordinator of Doctors Without Borders (MSF) Spain, and the 600 people of this organization that operate on Ukrainian soil live every day stuck in a horror film. And despite the many reports that come out of the front line of combat – laments González – “it is not being counted enough that most of the wounded are civilians massacred, bombed while fleeing, in their own homes, heavy weapons are used in crowded residential areas, they are shot in open corridors where the Russians are positioned to finish them off.” She repeats: “The attacks are indiscriminate. A very serious violation of international humanitarian law is being committed. Russia is showing no mercy to civilians.” There are 5 of the 27 MSF divisions in the world with operational capacity in war zones. Spain is one of them. The organization is saving lives right now in “the worst holes on the planet: Syria, Yemen…”, describes the coordinator. But in Ukraine, unlike the Central African Republic or South Sudan, where deaths and injuries number in the hundreds, they discovered two good allies: the railway network resisted with the stoicism of Volodymyr Zelensky’s battalion and the surgeons and nurses of the system Health officials did not abandon their posts and stayed inside the hospitals as if they were any other soldiers. «The train never leaves if there is risk in the analysis carried out by the three institutions in cooperation. We are not heroes or martyrs, we cannot leave if there is no certainty of reaching the destination» Raquel González Coordinator of MSF Spain They wanted to save their own, so MSF gave them basic training that they did not have for treating shrapnel wounds and bombing. Just after the first month of war, on March 31 and at the initiative of MSF Belgium, the medical-humanitarian entity launched the first medicalized train to operate in a war context on the Ukrainian rails. He was not the first employee in the service of medicine. There was a precedent, in a pandemic. In the worst of the Covid-19 onslaught, France had required this transport service to move sick people, minimizing the risk of contagion. In Ukraine things are worse. Before starting the locomotive, Médecins Sans Frontières verified, in collaboration with the national railway services in Ukraine and its Ministry of Health, that the system remained solid, resisting the rain of Russian missiles. So the train started moving to move the first 56 patients from the eastern part of the country to the west and center. «It never leaves if there is risk in the analysis carried out by the three institutions in cooperation. We are not heroes or martyrs, we cannot go out if there is no certainty of reaching the destination,” says González, who this week received the Mapfre award for the most innovative project for its social impact. It is not very common for a medical organization to receive a distinction of this type and claim its ability to “innovate in war” . But here the key lies in the revolutionary nature of applying emergency medicine in convoys and doing so using a new method, which has become one more weapon in favor of the Ukrainian resistance. 1,811 patients transferred from March to the end of September You just have to check their figures: 1,811 patients transferred from March to the end of September and cured (“no one has died”, admits González) in the 59 trips completed from the front to areas away from the fight. Added to them are 78 orphans evacuated from orphanages and another 200 patients with serious neurological and psychological conditions such as Alzheimer’s and Parkinson’s who did not expect a flattering outcome. He cloned it for another with ICU When this first railway hospital was opened, it was used to transfer patients (and companions) who required low levels of medical care to Lviv, to the west of the conflict, to admit them to different hospitals much more decongested than those of the cities from the east, where they receive 650 people in one day. The injured travel with a state of health strong enough to endure the entire journey without the need for major interventions: they usually have traumatic injuries to the arms or legs, for example. They are assisted by a team of 8-9 professionals, including medical, nursing and psychological staff. Medications such as hemostatics, antibiotics and analgesics are administered to relieve pain, transfusions are performed and bandages are replaced… It could be said that they are given basic medicine. A bedridden ICU patient, with ventilators and AFP oxygen/ PROVIDED BY DOCTORS WITHOUT BORDERS But such was the successful medical journey of this first train that on April 24 the organization had already cloned it; this time the lifesaver was for seriously injured patients, with oncological and chronic diseases, heart attacks and other cardiovascular problems. This second convoy runs along the rails of Zelensky’s country with a medical team on board of fifteen people and eight wagons, one of them an Intensive Care Unit (ICU) with capacity for five patients, which applies more specific assistance to the sick. bedridden. It is also equipped with all kinds of essential material for life, including a ventilator with an oxygen flow of 60 liters per minute. Monitors, defibrillators and perfusion pumps. This second ambulance on rails -with more than 200 meters in length- transfers 26 patients on journeys that have lasted from 24 to 30 hours, up to 48 and 60 round trip. “We have been very lucky so far, because we have arrived either just after an attack or we have left just before,” Ukrainian doctor Albina Zharkova tells ABC from inside the train. KRAMATORSK 52 civilians burned Among them were two children. It was the result of the double bombing of the city’s train station. Dozens of people suffered serious mutilations The trips have not been without shocks, some have not left due to the crossfire. The personnel on board remember well the day of the massacre in Kramatorsk, where they arrived, stopped at the station and helped dozens of wounded who had been blown up by the explosions. Zharkova’s story is overwhelming. “I am worried about the children. In that attack on Kramatorsk many lost their parents, siblings and themselves were seriously injured. It’s very sad to see.” Nurse Denys Babity added: “When I fed nine patients in the car, they asked for two plates. They were hungry, their bones and ribs showing. It seemed that they had been malnourished for a long time. As the staff inside this long-term ambulance explains, the selection of patients is not done by MSF. It is developed by the Ukrainian Ministry of Health so that, in evictions that last a maximum of 40 minutes, the patient is stuck on the train. The wounded are screened with an emergency triage typical of war scenarios. Logistical muscle MSF’s mission also focused on the interior of the convoy: to adapt it to the space of warfare where it was to circulate. Windows covered with protective materials to withstand the mortars, the width of the doors modified to allow stretchers to enter, the floor of the two hospitalization cars, as well as that of the ICU, lined with linoleum, a material that controls infections. And a gasoline generator installed in the convoy, weighing more than two tons, to ensure the constant flow of electricity throughout the journey. It is a work of medical goldsmithing and logistical muscle to achieve the goal: save civilians. They are more than 40% of the evacuees. 10% were not 18 years old; 30% were over 60. Raquel González and the Ukrainian doctor return to the starting point: «Many do not want to be evacuated, they just want to continue living in their homes. Winter is coming and they are without food, with electricity and gas cuts, without hygiene conditions. “Unfortunately in the eastern area we continue to have many unexpected attacks,” confirms Zharkova. And despite everything, the train remains the safest transport and will continue to travel from Kharkov, Luhansk, Donetsk and Mariupol. “We have no forecast that this is going to end soon,” says the MSF Spain coordinator.

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