Beginning of October 2022, Rachel Clarke rushed into kyiv bomb shelters with hundreds of Ukrainians. The UK-based National Health Service (NHS) doctor and author was traveling to Ukraine to provide support and training to doctors caring for the dying in hospices across the country. However, the visit to the capital came just as Russia was bombarding the city’s electrical infrastructure with missiles.
“You didn’t just hear the missiles land, you felt them echoing in your chest,” Clarke explained to WIRED Health in London in March. Above ground, windows have been blown out. Shards of glass lined the streets. “I was terrified,” Clarke says. “The Ukrainian people endured this for months.”
Since the start of the full-scale invasion of Russia in February 2022, all life in Ukraine was impacted, including its health system. Hospitals were destroyed and damaged, medical facilities were looted and landmines were discovered inside functioning Ukrainian hospitals that Russian forces had briefly occupied. according to the charity Médecins Sans Frontières. Those living in the occupied areas had essential medicines and treatments restricted, according to the charity.
Throughout the war, millions of people have been displaced from eastern Ukraine, and the continued fighting has strained the country’s medical infrastructure at all levels. Surgeons who operate on patients have learned to continue the process when the air raid sirens start, Clarke says. Ambulances carrying people were dug into mud and snow after being blocked.
Among the widespread disruptions, the war has limited the care that can be provided to the terminally ill, including wounded soldiers on the front lines. Clarke, a palliative care doctor with the NHS, says patients and those caring for them need more support. One hospice she visited, a three-story building that can accommodate up to 30 patients, couldn’t afford an elevator, so those who couldn’t go down the stairs were stuck inside. Similar scenes are repeated in the hospices of the country. A patient who lives with terminal lung disease and cannot afford to donate to hospice is knitting socks for the doctors and nurses caring for her, Clarke says.
An increased supply of morphine and anti-compression mattresses are two “low-tech interventions” that could help support people, she says. Clarke and neurosurgeon Henry Marsh have now started a new charity, Hospice Ukraine, to provide additional staff training and finance other supplies. It will work with “trusted local partners” to improve care, Clarke says. The aim is to help relieve people facing the deadly consequences of war. “Health care in Ukraine is deliberately targeted as a weapon of war”, Clarke said as the charity launched. “If you maim a doctor, you also harm all the other people that doctor might have treated.”
