Civilians bear brunt of Ukraine-Russian war

MEDICAL data and accounts from patients evacuated on the Doctors Without Borders (MSF) medical referral train show that the war in Ukraine is being conducted with an outrageous lack of care to distinguish and protect civilians.

Over 40% of the war-wounded on the train have been elderly people and children with blast wounds, traumatic amputations, shrapnel and gunshot wounds.

This points to a lack of respect for civilian protection, which is a serious violation of international humanitarian law, said the medical humanitarian organisation.

Between March 31 and June 6, MSF medically evacuated 653 patients by train from war-affected areas in the east to hospitals in safer parts of the country.

On the 20- to 30-hour journey, nurses and doctors monitored patients and provided care to keep them stable. Many people shared their harrowing experiences with the MSF staff.

Christopher Stokes, MSF emergency coordinator, said: “Our patients' wounds and the stories they tell show unquestionably the shocking level of suffering the indiscriminate violence of this war is inflicting on civilians. Many patients on the MSF train were wounded by military strikes that hit civilian residential areas. Although we cannot specifically point to an intention to target civilians, the decision to use heavy weaponry en masse on densely populated areas means that civilians are inescapably, and are therefore knowingly, being killed and wounded.”

From the accounts of patients, several consistent and harrowing themes emerged:

• Civilians have been shot at while evacuating or attacked while trying to leave war zone

• Indiscriminate bombing and shelling has killed and maimed people living and sheltering in residential areas

• Elderly people have been brutalised, directly attacked, and their particularly vulnerable status completely overlooked by attacking forces

• The types of wounds are often extensive and appear to affect all, indiscriminately, whether male or female, young or old.

People referred on the train are

mostly either long-term hospitalised patients or recent war-wounded who need post-operative care.

Of more than 600 patients transported and cared for on MSF's medical train over two months, 355 were injured as a direct result of the war.

The overwhelming majority of these patients suffered blast injuries. And 11% of war-related trauma patients were younger than 18, and 30% older than 60.

A 92-year-old woman from Lyman, Donetsk region, recounted: “I was on my way to the toilet when an explosion

happened. I lost consciousness and fell.

“Once I came around, my face was covered in dry blood. I had an open arm fracture and must have also broken my nose when I fell. I was alone and in pain, screaming for help, but no one heard me. Later, a volunteer found me and spent two days trying to call an ambulance that would get me into a hospital.”

Blast injuries caused 73% of the war-related trauma cases, with 20% caused by shrapnel or gunshots and the rest by other violent incidents.

More than 10% of war-trauma patients had lost one or more limbs, the youngest just 6 years old.

MSF patients and their caretakers on the train tell unimaginable stories of children, men and women trapped in conflict, bombed in shelters, attacked during evacuations and seriously injured in explosions, by bombs, by gunshots, or by mines and shrapnel. Some patients report being injured in their homes. Others came under heavy weapons fire as they tried to travel to safer areas.

“As in all conflicts, MSF calls on all

armed groups to respect international humanitarian law and abide by their obligations to protect civilians and civilian infrastructure, allow people to flee to safety, and allow for the safe and timely evacuation of the sick and wounded.

In addition, we call for humanitarian access to be able to provide assistance to people no matter where they are. In Ukraine, we see, at a minimum, indiscriminate attacks on civilians, so our call is particularly urgent,” said Dr Bertrand Draguez, MSF president.