Over 200 patients with neurological and psychiatric conditions have been evacuated from an overcrowded hospital in Kharkiv city, eastern Ukraine, to facilities in Kyiv on the Médecins Sans Frontières (MSF) medical train. Before their evacuation, patients had faced extremely challenging conditions, with insufficient access to quality care and hygiene, and some having to sleep on the floor.

Healthcare facilities and care institutions on the frontlines in the east and southeast of Ukraine face serious challenges to continue to care for their patients. Many have faced cuts to water and electricity, have trouble meeting basic needs such as food, difficultly accessing the medication their patients need, and extreme danger as fighting rages near their locations. Because of the fighting, vulnerable patients such as people with psychiatric and neurological conditions are very much at risk.

Denys Babiy, MSF nurse, describes feeding patients on board the train, “I worked in a carriage where we had nine bedridden patients,” he says. “When I fed them, they asked for two dishes.”

“People were hungry, we could see their bones and ribs. They looked like they had been malnourished for a long time. It was hard to see,” says Babiy.

In early September, over 600 patients had been in a facility right on the frontline in Kharkiv oblast (province). An evacuation process was underway when reportedly the facility was shelled, killing four medical staff and two patients. Later the patients were transferred to a hospital in Kharkiv city, increasing the number of patients in the hospital from 400 to over 1,000.

“After receiving so many patients, despite the best efforts of the staff, the conditions in the hospital became really difficult,” says Borys Potapov, an MSF doctor who accompanied the patients from Kharkiv to Kyiv. “They didn't have enough beds, medication, or staff to take care of everyone.”

MSF was asked by the Ministry of Health to help ease the pressure on the hospital by transferring over 200 patients to facilities in Kyiv. The Ministry of Health selected which patients were to be transferred and informed MSF of their medical conditions. MSF donated hygiene items such as soap, shampoo and toiletries to the hospital before arranging the evacuation.

Buses and a Ministry of Health ambulance transported the patients to the Kharkiv train station where they boarded the MSF medical train. The first train departed on 23 September, with regular MSF medical staff supported by nurses and a psychiatrist from the Ministry of Health to assist the patients during the journey.

“We made two trips in 36 hours, transporting patients with a range of pathologies,” says, Emilie Fourrey, MSF project coordinator, speaking from the train platform in Kyiv. “Some were elderly people with neurological diseases such as Parkinson’s or Alzheimer’s. We also had a lot of patients with acute psychotic disorders, especially today on the final journey.”

“Some of the patients were understandably quite agitated but it went smoothly during the journey to Kyiv,” she says. “The patients will be transferred to two different facilities here, where MSF will follow up to check on their condition.”

MSF operates an ambulance referral service from 11 hospitals near the frontlines in the east and southeast of Ukraine. In the first three weeks of September, 277 patients were transferred to facilities slightly further from the fighting. The vast majority of these patients had suffered violent trauma and were able to receive a good standard of care.

However, as the experience of the patients with psychiatric and neurological disorders shows, being transferred from hospitals right on frontlines is no guarantee of receiving adequate healthcare if the hospitals that receive them are overcrowded because of the war. This is especially so if patients have complex, chronic health needs. Evacuating patients to hospitals in the west of the country far away from frontlines can alleviate pressure on healthcare facilities.

On 27 September, we visited some of the evacuated patients in a psychiatric hospital in Kyiv oblast. A Ministry of Health worker explained that some patients had thanked them, grateful to be in an environment far better than the hospital on the frontlines.

Despite these improvements, the patients still have significant health needs, with one nurse remarking that, in their many years of caring for patients in psychiatric facilities, they had never seen patients in such poor mental and physical condition.