The call is deferred once, then twice. At the end of the wire, the sound sizzles, the line is regularly cut. Dr. Jean-Clément Cabrol is hard to reach – and unavailable. For the past few days, this humanitarian doctor has been crisscrossing Ukraine on board a medical train set up in a few weeks by the teams of Doctors Without Borders (MSF), in partnership with the Ukrainian railway company Ukrainian Railways. “We are at the level of a very good ambulance, with good doctors. But for the moment, we can only transport stabilized patients”, says Dr. Cabrol, responsible for this evacuation program. The goal ? Relieve hospitals in the east of the country, in which “the tension is likely to rise more and more”, by transferring certain patients to reference structures in the city of Lviv, to the west.
On April 1, the MSF teams made their first trip, welcoming nine “serious but stable” patients from the Zaporijia hospital, heading for Lviv, on their medical train. The majority of them were injured directly in Mariupol, more than 200 kilometers away, or while trying to flee the Russian attacks which destroyed much of the city. “They were war wounded”, summarizes Dr. Cabrol, who recounts the impressive wounds and traumas of these travelers. On the train, its teams take care of “heavy” patients, such as a mother “disfigured by an explosion”, who has lost an eye and whose arm is stabilized by an external fixator. “We also had a very brave 14-year-old boy, whose four limbs had been split and were immobilized, with an abdominal wound… Fortunately, he had been well taken care of”, describes the doctor. Some patients still bear the scars of their weeks spent in basements avoiding explosions. “We had an old man who had stayed for a month with a fractured femur, probably due to a fall,” recalls Jean-Clément Cabrol, who even took the patient’s cats with him. “His wife didn’t want to leave them. So we took them with us.”
After almost 30 years with MSF, nothing really surprises the humanitarian doctor. The emergency doctor, who began his career in 1994 in Rwanda, modestly admits having “seen a lot of things”, and frequented “several countries at war”. When the first bombs exploded in Ukraine, Dr. Cabrol himself volunteered to bring his expertise to the field. “I was told ‘Oh, great’, and I left three minutes later. It seemed obvious to me”. At 59, he is one of the handful of French doctors or paramedics who have chosen to get involved in the field. From one day to the next, he and his colleagues must learn to deal with the wounds of war. “However, we do not go from conventional surgery to war surgery just like that. Especially when we must at the same time try to maintain traditional medical interventions and their safety”, recalls Jean-Clément Cabrol, one of whose missions is to transmit some of its techniques to Ukrainian surgeons. Their level, he assures, would already be “very good”.
Unstable situation
“Ukraine has a fairly strong health system, with an incredible hospital network and a large number of doctors,” confirms Guillaume Barreau, a member of MSF. The 30-year-old, currently specializing in emergency medicine, has been present in the city of Dnipro for several days. For the moment, its teams do not provide direct medical care to patients, but take the time to train local teams in “triage” of the wounded in the event of a massive influx of victims. “We train them on an algorithm that allows them to quickly recognize critical clinical signs, to focus on the most serious patients and on those who can still be saved”, develops the humanitarian, who ensures that this training is ” much appreciated” by Ukrainian doctors. “Some hospitals are already in this situation on the front, especially in Zaporizhia. It goes quickly: it is enough for several ambulances to arrive at the same time for them to find themselves in this configuration.”
For surgeons, the work is enormous. “It is rare for a war wounded person to arrive with a single injury”, explains Guillaume Barreau. Patients who have been victims of an explosion or a bombardment are “almost always” polytraumatized, injured in the legs, stomach or torso. “The blast ripped off part of a limb or caused severe chest or abdominal injuries, the body is riddled with glass, stone, concrete”, describes the doctor. To ensure continuity of care in this type of situation, its teams are also trying to assess the need for materials and medicines from the various hospitals in the region, while ensuring the safety of patients in the event of bombing or Russian attacks. “We are working on the preparation of certain structures, on their ability to perform support in underground conditions, if ever”.
Especially in the east, the situation can change very quickly. A few days after our exchange, Guillaume Barreau would like to remind us, to specify that certain hospitals with which he works are in the process of “emptying their staff”. “Near Donetsk, for example, there are structures where nurses and doctors are fleeing en masse: the staff is shrinking,” he regrets. While the biggest hospitals continue to operate, his teams are trying to reorganize the system “as best as possible”. Former holder at the University Hospital of Poitiers and resuscitator anesthesiologist for MSF, Elsa Carisé confirms. “The needs are constantly changing, the situation is very unstable”, explains the doctor, recently deployed in the city of Mykolaiv, a hundred kilometers from Odessa. “The war wounded are there, with penetrating trauma, bullets or shrapnel lodged in the body, lesions with risk of infection, lesions due to the blast of explosions…”, she lists.
“We know how to cash in”
Elsa Carisé’s daily life is intense: her round trips between the different cities of Ukraine can be canceled overnight for security reasons, while her teams can be direct witnesses or victims of Russian attacks. On April 4, some of his colleagues witnessed the bombardment of the surroundings of the Mykolaiv oncological hospital, in which they were preparing to meet the city’s health authorities. “Several explosions took place near our staff in the space of ten minutes,” explains MSF head of mission Michel-Olivier Lacharité in a press release published on April 5. “As we left the area, the MSF team saw injured people and at least one corpse. (…) Our staff were able to take cover and were not injured. The windows of their vehicle, parked in front of the entrance to the hospital, were blown up by the explosions”, it is specified.
Elsa Carisé, who was not present on the scene, is categorical: “Security is always taken into consideration. We feel that we are surrounded by the MSF teams, there is a certain moral support”, explains. -she. A member of the organization for five years, the doctor has already had the opportunity to work in several countries at war. “We all have our personal defense mechanisms. We try to keep in touch with our families, our friends, and that’s also how we hold on.”
“Degraded mode”
For the doctors who left “alone” to help in Ukraine, the weeks were just as busy. Arsène Sabanieev, an anesthesiologist in Lille, is thus on his second trip to kyiv: with the help of a colleague in the emergency room, he is responsible for delivering medical equipment to hospitals in the Ukrainian capital. “When I left, I had no reservations, no restraint. For me, it’s a patriotic duty to be there”, justifies this Franco-Ukrainian, who arrived in France more than twenty years ago. Accustomed to working in emergency treatment at Samu, the doctor “naively” expected, during his first trip, to be quickly integrated into one of the city’s hospitals. “But even if they are working in degraded mode, the doctors do not need us for the moment. What is needed is equipment, medicines, and armored ambulances”, insists-t- he. On the way, the emergency doctor could only see, annoyed, that certain medical vehicles had indeed been riddled with bullets – just like civilian cars or buses on which the word “children” was nevertheless written.
Shocked by the treatment inflicted on civilians or medical personnel, Arsène and his colleague are now considering joining a group of volunteer paramedics met on site, specializing in medical support on the front. “They recover the wounded and stabilize them directly on the spot, before sending them back to hospitals”, explains the resuscitator. “But on the front line, real doctors can be counted on the fingers of one hand… Paramedics have told me that they find themselves taking care of polytraumatized patients, when they are not trained to do so”, he specifies. Currently in kyiv, Arsene Sabanieev is witnessing a “certain lull”, and a “hollow phase” in the arrival of war wounded. But he says he is already ready to go to the east, even if it means going through “unofficial” bodies of volunteer doctors.