https://www.bbc.com/-Image source, BBC / Darren Conway
The front line field hospital team – led by Ruslan
By Quentin Sommerville in Donbas, eastern Ukraine-BBC News
In southern Ukraine, the city of Kherson has been liberated, but in the east, close to the Russian border, fighting still rages and casualties mount. In a trauma centre under daily Russian shelling, a dedicated team of medics – many of whom volunteered for service at the start of the war – are saving lives. The BBC spent almost a week with them.
Blood, iron, sweat and dirt are soaked into the walls and floors of the Ukrainian field hospital. No matter how hard the Ukrainian army medical staff scrub, a metallic smell haunts the place. It clings to the doctors’ clothes and in the ambulances its presence is overpowering.
“Even when you wash away the blood, and sprinkle with peroxide, there is always this smell. You never forget it,” says Valeria, 21, an anaesthetist’s assistant.
The trauma centre has been set up in an abandoned building, where more than a dozen doctors and nurses work and live together under fire. The roar of outgoing artillery fire is constant. In the five days I spend with them, Russian bombs fall around their clinic almost daily, while Ukrainian dead and injured arrive at their door.
The Brigade – its full name can’t be revealed for reasons of operational security – has already lost two medical stabilisation points to Russian fire, and five of their medics.
Before the war, Valeria worked in a hospital north of Kyiv. She is used to trauma, there is nothing harder than resuscitating a child who has died, she explained. Without a word to her family, she volunteered for military service, and has been saving lives in some of the most dangerous fronts since.
“I have the most amazing job in the world. I defend heroes,” she says. “They defend us and I’m here to defend them – and not to let them die.” As part of the anaesthetic team, she says she’s there to ease the pain of those who are wounded.
Valeria is petite with a wide, ready smile. Over her scrubs she wears a leopard-print fleeced hooded top. Her sleeping bag is in the corner of one room. On the bare wooden floor, a cartoon panda mat, and Baby Yoda doll are at her bedside. An adopted kitten, Maryssia, keeps her company while she sleeps.
This article contains some upsetting descriptions
While every day is unpredictable, it begins with the same routine. At 09:00, the radio plays the Last Post and the Ukrainian national anthem. The team stops what they are doing and stands for a moment of remembrance for those lost in this war.
Valeria and the team spring to work when a badly injured soldier is carried into their emergency room. He groans in pain and cries out, “My arm, my arm.” But his injuries are far more severe. He is semi-conscious but in a critical condition.
With his grey beard, he looks in his late 50s. His face is peppered with shrapnel, his right eye gone. At least one finger is missing from his right hand and there is heavy bleeding from the back of his head. As they begin to cut off his uniform, his marble white skin is exposed.
His name is Sasha, and I watch from the doorway as the medics speak to him, perhaps explaining his injuries. He cries out as another wound is found and treated. Work begins on stitching his face. One of the surgeons, Dima, 39, packs the bloody eye socket, his fingers going deep inside the man’s skull. The soldier is sedated, but even so, his left hand reaches out, and grasping one by one, he counts the four fingers remaining on his right hand.
The medical team have removed his clothes and placed on his feet a pair of hand-knitted green woolen socks to keep him warm; they receive them by the box load from Ukrainian civilians.
To one side, in body armour and uniform caked with mud from the trenches, stands the stout man who found him. He says the soldier could have been hit by a cluster bomb or mortar fire, but he wasn’t sure.
The chief medic, Ruslan, 39, is tall and bald with a thick red beard. We first met in the summer when I was here last. He is a commanding presence and barely needs to say a word as his medics work to keep the man alive. His team understands each other with just half a glance. Their immediate job is to stabilise that casualty and get him to the main hospital where he can undergo surgery.
To the side, Olia, a pharmacist who joined the army when the war started, goes through the man’s clothes, and bags up his personal possessions.
For Ruslan, a career soldier, this war started in 2014 when Russia invaded and illegally annexed Crimea. But he says the Ukrainian army used the time well, its battlefield treatment has improved greatly and is now at Western standards.
But they lack something that Western military views as essential – medevac helicopters. Instead, the man is put into an old UK ambulance, which the unit bought for $7500 (£6,378). They installed a new engine and began using it to transport their patients to the nearest main hospital 25km (16 miles) away. Getting the wounded there in time is the hardest part of the job, says Ruslan.
He and Olia accompany the injured soldier in the ambulance, Olia cradling his head as the vehicle bumps over unlit and potholed country roads, while flashes of artillery landed in the distance. Ruslan holds the man’s hand, pressing for responses while he watches his vital signs.
Roman is behind the wheel. Earlier in the day, the ambulance driver been hunting pheasant for the dinner table – the birds’ numbers have multiplied since people fled the area.
He says he had lost count of the number of times he has made the run to the main hospital. “Every trip is dangerous,” he explains. “We don’t know where the Russian occupiers will be firing. Our work is such that it must be done. Doesn’t matter if they are firing or not.”
On the dark road ahead, a building can be seen burning – a burst of fierce orange flame is the only light for miles.
The drive is slow, but the roads improve as we near town. Roman accelerates, the ambulance’s blue light speeding through checkpoints. Just over an hour after the injured soldier was brought into the field clinic, he is delivered to the main hospital. He survives.
Back at their base, a pause, a time to take stock. Equipment is replaced, blood and flesh cleaned up. Ruslan smokes, while Valeria washes blood from her arm and retires to her corner to watch cartoons on a laptop. Roman cleans out his ambulance.
The team often refer to themselves as a machine, links in a chain, or as Ruslan puts it, “a spinning mechanism”. But their work doesn’t seem purely mechanical to me – there is compassion and tenderness, too, when they treat their patients.
On the same front line, but on the opposite side, thousands of Russian conscripts have arrived. With little training, they are being thrown at Ukrainian positions and experiencing heavy losses. There are reports that the Russians even lack basics, such as tourniquets, for treating injured soldiers.
Neither Moscow nor Kyiv have revealed full casualty figures, but the US military, using satellite footage and other sources, estimates that both sides have sustained more than 100,000 killed or wounded since Russia invaded.
War isn’t just about armour and artillery, it’s also about maintaining morale and motivating soldiers. In this, Ukraine believes it has the advantage.
The arrival of those Russian recruits has brought a change too, the doctors and nurses now find they are treating more bullet wounds, the result of close quarter fighting. During the five days I spend with the team, I hear more sustained gunfire than I’ve heard during my time at the front in Ukraine’s war.
Olia, the former civilian pharmacist, is the quietest of the group. In a crowd of big personalities, she is the most self-contained, a slim fit woman usually swaddled in a puffer jacket, hat and large glasses.
What does she feel about the man whose life she had help save, I ask.
“I treat every patient with warmth, and I can pass at least a little piece of it on to him,” she replies. “A little piece of my warmth, of my soul, so he would be not so worried. To ease his condition a little.”
She goes running most mornings, along the muddy roads, as tanks and armoured vehicles pass her on their way to the front line. For her, the exercise is an escape, she says. “I always think of peaceful times. I know that this war will come to its end soon, and we will all return to our lives, to our families, to our jobs. I don’t want to focus on war.”
The team have been together the entire war. To see them around the table is to watch a family, and yet no-one knew each other before the fighting started.
They’ve endured a roll-call of atrocity, serving together in Bucha, Irpin, Bakhmut and now here. Olia and Valeria recall carrying dead or injured soldiers through the woods and fields for treatment or burial in the early chaotic days of the war,
“To get used to it is probably impossible,” says Olia. “It is very hard to see injured fighters, badly injured, there were a lot of them [in places like] Bucha and Irpin – destroyed cities, destroyed towns. It’s impossible to describe with words.”
The team come together for dinner, to mark the return from leave of Yuryi, the unit’s other surgeon. There is hardly room around the table, or on it. They eat pheasant cooked in butter with lemon, grilled liver and mashed potatoes. There is pumpkin cake for afters.
I first met silver haired Yuryi, 42, in the summer. Then, he would wear only grey camouflage shorts, and spent his downtime scouring the fields with a metal detector “hunting for treasure” – his haul included some old coins and a silver ring.
One of the defining aspects of this war has been Ukraine’s willingness to fight. Yuryi, unlike Ruslan, is not a career soldier. This is his first war, but he, like many others I’ve met, sees it as only natural that he would leave civilian life behind to fight for his country – and to protect his family.
“Someone has to fight, and someone has to live,” he tells me. “Because if everything becomes total war then we will become, if I may say, numb, hardened, emotionless.”
He describes going home to visit his boys aged 12 and 14. “Those days were so short,” he sighs.
The war, he says, was his generation’s responsibility, so that his children can live in peace. “I’m satisfied that my wife and kids do not experience all the emotional turmoil that we experience here. We are like a gasket that blocks all the hard times that the war brings,” he says.
On another day, a soldier arrives breathless at the field hospital. He holds up two fingers, two injured I wondered. But no, he needs two body bags. One for the corpse that lies next to an injured man inside the dark green army van and the other, I assume, for another casualty.
Ruslan and the others help in gently removing the stretcher with the body. There was a lull in the shelling, and birdsong – the days had been cold there, but that day felt almost like Spring.
I stand at a distance and look at the individual carnage. Half of the dead soldier’s body is gone, his chest and stomach is a mess of blood and bone. His vehicle had taken a direct hit from a Russian tank fire. Wordlessly, the medics around him carefully place his remains inside a thick black plastic body bag. The heavy-duty zip is pulled closed, and the van then leaves for the mortuary at the rear of the front lines. In the hand of one of the departing soldiers, four more neatly folded unused body bags.
The injuries the team treat are grisly, they show me on their phones, men with limbs blown away, strips of flesh hanging from bare bone, another with a cluster munition embedded in his stomach. In a video they recorded of one casualty, his leg is removed and placed in a black bag, still with his trousers and boot.
For Valeria, the worst part of the job is when a “construction set” arrives, soldiers’ body parts that must be matched and placed together for burial.
“When they bring parts of the person to you, I feel great pity,” she says. “Because when you tried [to save a casualty] and it didn’t work, that is one thing, but when you cannot do anything – to feel your own powerlessness. I think it’s the worst, and not only for me.”
And the youngest casualties are those she won’t forget. “When there is a date of birth of 2003, you realise that this person is 18 years old. This person saw very little in life, maybe never kissed and already sees death, sees, and endures such severe trials. It’s the young people I’m most sorry for. I remember the faces very much, the injuries.”
“I remember these boys who didn’t lose their fighting spirit, [who] lays down in front of you without a leg or an arm. He jokes with you. You can’t help admire the strength. Without weapons in their arms – such a powerful weapon they have in their heart.”
In war, courage becomes a matter of fact. Ruslan’s team have it in spades, and he only falters, he says, when he’s leaving home, and his two young daughters behind.
“I try to leave home quickly because the longer I take leaving the house, the more worried they will be,” he tells me. “So I always say, ‘Listen to mom, help her’ and I just leave, run away.”
I’m with him one evening, and even at the end of a long day, he still chops the wood and lights the fireplace. The rest of his team are on shift or have retired for the night. Ruslan is often the last to sleep. His wife, also a doctor, sends him pictures of bunk beds for him to choose for the girls.
Before I go, I ask him if he has any final thoughts.
“Only one message comes from here,” he says. “Peace. There is always a need for peace. Civilised society… and this is happening? Well, it means it is not civilised enough. I wish we’d learn that faster. All of us.”