Life in Emergistan: Ukraine’s healthcare splintering : Emergency Medicine News

Ukraine, war, international MS:

kyiv, Ukraine, February 28, 2022.


I was sitting in my rural ER, the sun was shining, and my streak of shifts was coming to an end. The past few days had been hectic and a little weird, with ER work more complicated than usual due to a drug bust and associated heroin withdrawal among those arrested.

We sedated patients, ventilated them, and airlifted them to other hospitals. Yet I realized that our hospital is, by international standards, an oasis of calm and normalcy. As weird or chaotic as our changes are, we never see any incoming rockets or missiles. There are never any barricades or idle tanks on the local mountain roads, no anti-aircraft batteries scanning the skies. We never worry about troops coming out of the woods or gunshots breaking out. We never see attack planes cross the sky, and the helicopters we call for patients are never troubled by ground fire.

It is remarkable to sit in peace and quiet, to give patients our very best, which, by all historical standards, we do with decadent ease. Yes, COVID has been tough in unprecedented ways, but we are well connected and well supplied. We have enough medicine, bandages and blood, and generally enough staff, and the pandemic seems to be calming down for the time being.

We have generators when thunderstorms affect electricity, and cellular signals and phone lines are repaired almost immediately when they occasionally fail. Our water supply is clean and constant, and the hospital freezers are full of food. Patients can come here at any time of the day or night: the lights are on, the staff are present and we have plenty, for lack of a better word. Most of the time, we can give people what they need most of the time, even though the pandemic has given us endless problems. We have this largesse to offer.

I thought of these facts when seeing images of the war in Ukraine. I saw burning buildings, shattered airplane fuselages, and citizens bleeding and crying outside destroyed apartments. I saw men and women carrying stretchers on which the wounded lay.

Cameras focused on the anxious faces of young and old soldiers and volunteers, clutching guns in the hope that death was beyond them for now. I have read about those who did not escape madness and fell defending their homes and others who died away from their families after being sent to invade another country through the pride of their boss. All the things I can do, even in my little hospital, are slowly fading in Ukraine as violence and destruction erupt in this beleaguered country that has seen so much suffering over the past century.

Only devastation is certain

Heart attack and stroke patients in Ukraine may not receive the treatment they need, and those with severe strokes may even die. Children with life-threatening infections may not be referred to necessary specialists as it would be too dangerous. Surgeries needed for serious, acute and chronic medical conditions will be delayed, temporarily or permanently, as operating rooms fill with the injured and their floors bear the thick, smooth veneer of spilled blood.


Ukrainians fleeing Irpin’ to Kyiv where they were evacuated by the Kyiv Territorial Defense Battalion.

Who knows what will become of the wounded and captured, the patients whose hospitals are overrun by the invaders? Hopefully a sense of decency will prevail, but again, a sufficient amount of decency could have prevented the whole affair in the first place. Surgeons, doctors, nurses and firefighters will use their best, but young combatants and victims of bombs, rockets and artillery will take priority over many other things in these dire circumstances. .

What do I know of the war? Nothing. I have never been to war. But I know what I read and see. I know emergencies and tragedies. I know death and blood, cries and loss. I also know how precious lives and resources are at the best of times. The COVID-19 pandemic has been a stark reminder of what it means to give limited care to people when there is nothing to offer them, when there are not enough medical specialists, nurses, technicians and doctors, when there are not enough beds, oxygen tanks, ventilators and intensive care beds, when even pillows are in short supply.

Limited resources are particularly difficult for those in crisis: the patient in cardiac arrest, the clinging cancer patient, the pregnant woman without care, the hopeless overdose patient.

Things are terrible in Ukraine. Tasks normally handled easily will not be handled at all. Unnecessary deaths will become inevitable. The reaper will stalk the earth and bodies will pile up from things as gruesome as automatic weapons and as mundane as infected kidney stones. Even those providing care will not be immune. White coats are not bulletproof or bombproof, any more than medical care is bullyproof. Every country is coping with the crisis in its own way, and it’s hard for us because of the pandemic, but it’s much worse for Ukrainians right now.

I can leave my job and return to my safe house without expecting devastation or loss. I will be celebrating my darling wife’s birthday this weekend. But in Ukraine, where death rains and enemies surround, the good, the normal and the hope are shattered. War and rumors of war shape so much: we study them, we prepare for them, we mourn them, and some celebrate them too easily, but people and little things, daily necessities and the gifts of modernity and civilization are destroyed in the end.

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Dr Leappractices emergency medicine in rural South Carolina and is the author of the Life and Limb column ( and a blog ( read his past REM columns to

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