Working 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 help out.
Many doctors had fled the fighting, his friend said, and conditions at the hospital resembled a bygone era of warfare, with surgeons chopping off limbs rather than trying to repair them to save badly wounded soldiers.
“He called me and said he could no longer chop off the arms of young people,” said Dr. Bohak, while standing in an operating room of a hospital in Kramatorsk. “When I came here, I had surgery on the first day.”
As Russian forces harass eastern Ukraine with a mix of artillery, air strikes and rocket attacks, frontline hospitals, many in poorer, rural areas, have been overwhelmed. They are seriously understaffed or have been completely abandoned as doctors and nurses have fled the violence.
All day long, the walls of the hospital shook from the thunder of fighting near Kramatorsk, an industrial city in the Donbas region, where Russian troops are conducting a bloody offensive. A steady stream of ambulances arrive at the sandbag-fortified emergency room, carrying soldiers and civilians, many with life-threatening wounds.
But the hospital is manned by a skeleton crew. Only two of the 10 doctors are left, helped by six nurses who work 24 hours a day and have only one day off to rest, said Tatyana Bakaeva, the chief nurse. (Hospital officials asked for the name not to be published for security reasons).
“Only the most stoic remain,” said Mrs. Bakaeva. “People are scared, what can you do?”
It’s a similar story throughout Donbas: As the toll of the injured rises, the need for more doctors and nurses becomes even more dire.
In Avdiivka, right on the front lines, the only remaining surgeon and the hospital’s medical director described spending months in the emergency room and never leaving, except to rush to the supermarket amid shelling. In Sloviansk, a town just north of Kramatorsk where smoke plumes from battle can be seen on the horizon, only about a third of hospital staff remain.
The city of Bakhmut lies at a crossroads between Russian troops advancing from the east and the north. There, ambulances block 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 handle so many wounded,” said Svitlana Druzenko, who is coordinating emergency evacuations of wounded soldiers and civilians from the combat areas. “The wounds are the same for civilians and soldiers, because missiles don’t choose where to fall.”
Many wounded from the East are taken to Dnipro, a city of one million inhabitants and six major hospitals. But it is a four hour drive from many frontline positions. And the hospitals there are also depleted of nursing staff, said Dr. Pavlo Badiul, a surgeon at the Burns and Plastic Surgery Center in Dnipro.
The center was full of war casualties and the staff worked uninterrupted without a break, he said.
As a member of the American Society of Plastic Surgeons, Dr. Badiul received an appeal through the Association’s Equipment and Medical Supplies Association newsletter after training in California. “Although we are getting targeted aid, a lot is still lost, diverted or misplaced,” he said.
Volunteers mobilized to clear up some of the backlash. Ms. Druzeko works for a voluntary emergency medical organization known by the Ukrainian initials PDMSh. The ambulances and staff are ubiquitous in hospitals and at so-called yellow zone transfer points, locations on the edge of the battlefield where wounded soldiers are picked up by ambulances and rushed to the nearest hospital.
It’s dangerous work. Last week, a yellow zone base holding Ms. Druzeko had been bombed north of Bakhmut by Russian troops.
“Not only drones, but also aviation is working in that area,” said Ms. Druzeko.
Most surgeons operating from the hospital in Kramatorsk, including Dr. Bohak, his volunteers. Since he arrived, the hospital has had almost no amputations.
dr. Bohak showed cellphone videos of his operations last week. He dug into scorched and shredded flesh, ripped out severed arteries and painstakingly stitched them back together, restoring circulation to the damaged limbs, saving her and the soldiers they were attached to.
“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. That is why my arrival was very important.”
However, not all limbs can be saved. Eduard Antanovskyy, deputy commander of the military unit at the hospital, said a Russian soldier was recently brought in with a serious leg wound. While he was in the hospital, he said, the soldier was given guards for protection.
“We had to take the leg because the tourniquet was on too long,” he said. “Even if we wanted to, we couldn’t have saved his leg. We treated him humanely, not the way he deserved to be treated.”
Despite months of warnings from the White House and others that Russia was planning to invade, many in Ukraine, including much of the political establishment and even some in the military, refused to believe it. When Russian missiles started hitting Ukrainian cities on February 24, it sparked a struggle. Hospitals, in particular, were unprepared for the sudden surge in patients suffering from the cruel and difficult wounds inflicted by war.
In the first week, Dr. Maksim Kozhemyaka, a civilian trauma surgeon, volunteered to assist at the military hospital in Zaporizhzhya, one of the main centers for the treatment of soldiers in eastern and southern Ukraine. Almost immediately, he said, the hospital was overrun with 30 to 40 patients a day and lacked sufficient supplies to treat gunshot wounds or other serious injuries.
“We didn’t believe this could happen because we understood there would be huge losses on their side as well,” said Dr. Kozhemyaka in an interview at the hospital emergency room. “And of course we thought no rational leader of any country would do this.”
For the hospital workers who persist in the grim routine, the losses can feel personal, and sometimes so profound.
On a recent morning, ambulances rushed to the small hospital in Sloviansk with soldiers injured in an air raid, just a few kilometers away. One of them was carrying the battered body of Ihor Ihoryuk, 33, the only child of the hospital’s chief nurse. Many 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 slept, had ripped his arm off and his blood was streaming on the asphalt in front of the hospital as he was rushed inside.
A few hours later, a nurse named Anna came out of the hospital, her green eyeliner was running down her face. Ihor couldn’t be saved, she said.
“He grew up before our eyes,” she said, fighting back the tears.
She was holding a box of Ihor’s black army boots. “He won’t need them anymore,” she said.
She took them to a spot a short distance from the hospital entrance and placed them next to a pair of black tennis shoes drenched in blood. They belonged to a soldier who had died the day before.
Carlotta Gall contributed from Dnipro, Ukraine.