Ukraine, 2022. The world is going to remember this for a long time. As I am writing I am laying on a makeshift bed built out of cardboard, coats and blankets scavenged and donated to me for the night by the people living here.
"Here" is an underground metro station in the heavily damaged city of Kharkiv. The public transport system has completely collapsed, and the network of underground subway stations have become refuges for people whose homes have been destroyed by airstrikes and shelling — or who are too scared to stay above the surface.
I'm working here as a doctor in a mobile health clinic run by Médecins Sans Frontières, supporting locals who have been displaced by the war. MSF has set up clinics in several stations on the three Kharkiv underground lines. Despite the curfew in the city, the teams can move from station to station through the tunnels, doing consultations even at night, mainly for respiratory tract infections and hypertension — consequences of the living conditions in the underground system but also of the stress.
Being on the surface now feels so strange, eerie. A few people hurry down the streets in ones or twos, clutching bags of supplies, trying to get to safety before the next air raid alarm sounds. Which is often, at least four or five times a day.
After only a few days here, the sound of outgoing and incoming shelling has become background noise, the constant thudding fading into the distance. It's too exhausting to spend much time thinking about what it means — another building destroyed, more lives lost and homes razed.
Today, during one of my too-brief visits to the surface, I could see smoke rising from a building that had just been hit, in a part of the city that is already destroyed and suffering more damage every day.
The hits from above force the buildings' contents to spew out onto the streets. Books, clothes, shredded insulation, bricks, curtains and cooking pots mingling together in bedraggled heaps trailing out of the buildings and down to the ground, like intestines hanging out of a disembowelled body.
Living in a state of emergency
The whole country is in a state of emergency. The few remaining inhabitants of this city are huddled underground, crammed in to the subways or makeshift basement shelters, just trying to survive.
Most people with the means have left, leaving behind the elderly, the disabled, those with chronic mental health condition — the most vulnerable.
During the day some people venture out, squinting against the bright lights and shuffling down the streets, terrified and waiting for the next impact. Some people are too scared to surface at all and have been underground for weeks.
As always with Médecins Sans Frontières projects, we follow the people in need and bring care to them however we can, tailoring our programs to best meet the community's needs. And so here we are with these people, in crumbling Kharkiv, once the second-biggest city in Ukraine and a source of pride for its inhabitants. It was renowned in this part of the world for its beautiful buildings, parks and monuments.
Down here in the metro stations, we sleep on whatever we can find. With the sudden flood of displaced people from Ukraine, more than 6 million nationally, there is no camping gear left anywhere in the country so we sleep on the cold tiles on yoga mats with cheap nylon sleeping bags designed for 20 degrees. Sometimes the people provide better for us, even setting us up a corner of a carriage, a piece of foam on the ground, a spare pillow.
The nights are cold; people wrap themselves in coats and blankets, trying to stay warm. As we finished our clinic tonight and packed up, picking our way through the crowded platform, a woman I had treated called out to me — "Doctor!" — and handed me a shiny red apple with a grin. I took it gratefully, holding her hand for a second, touched that she was willing to share what little she had with me.
She looked me in the eyes, thanking me profusely for being here. She lost her home in the shelling and has nowhere else to go. She is suffering panic attacks and insomnia, and has been unable to access her regular medication for high blood pressure.
Finding hope in the devastation
Earlier this evening I spoke to an elderly woman whose home was hit and destroyed yesterday. She and her husband were at home, she inside the apartment and he on the stairs. They heard the first explosion and had no time to react before their block was hit.
They were pulled from the rubble by emergency services and through some miracle the only injury between them was a ruptured eardrum. She was distraught.
With nowhere else to go she has joined the thousands like her now living a subterranean life, with no privacy or washing facilities, relying on volunteers for everything.
Stories like this are everywhere. So many of the patients we see present to us for a problem which initially seems fairly simple, like a top-up of their blood pressure medication or a check-up for a sore throat. But once we start talking to them they often break down, words spilling out of them of the horrors they have endured.
Two nights ago I treated an 11-year old boy. Initially he was complaining of difficulty breathing, and when I asked some more questions it became clear that this only happens when he has to go up to the surface.
Panic attacks are frighteningly common among the people living underground here; they are terrified of surfacing and many are experiencing severe anxiety.
Something inspiring and positive amongst all this suffering is the popping up of local volunteer networks across the city — people organising and working together to help those most in need. Locals who have decided to stay here are taking requests from people stuck in their homes, and coordinating donations of food, hygiene items and medications. Local drivers travel around the city, taking huge risks to get these supplies to the most vulnerable.
Every day I meet people whose compassion and determination to help the most vulnerable brings tears to my eyes and forces me to see the hope that lives on in this devastated place.
Lisa Searle is an Australian doctor currently working in a mobile clinic run by Médecins Sans Frontières in Kharkiv.
