Marc Robinson/ RN DTN MSc/ Advanced Nurse Practitioner
Marc Robinson is a highly experienced global health and expedition nurse. He started his global health nursing journey at the London School of Hygiene and Tropical Medicine, undertaking the Professional Diploma of Tropical Nursing. Alongside this, he worked in critical care, emergency medicine and was deployed by a number of global non-governmental organisations. After gaining the knowledge and experience required for nursing in humanitarian and austere environments Marc joined the UK-Med register in 2016. UK-Med is a frontline medical aid charity; born of the NHS, working worldwide to ensure everyone has access to healthcare during disasters or crises. Marc’s main previous deployment with UK-Med was supporting the healthcare response to the Samoan measles outbreak in 2019. Here he recounts his experience working as a UK-Med Nurse and Medical Team Leader in East Ukraine during the current conflict.
“All groups of people in Ukraine are vulnerable and in need”
The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Ukraine Situation Report: 19 May 2022 suggested that 12.1 million people in Ukraine needed health assistance, with 6.4 million reached thus far.1
The same report advised that the priorities for the conflict-affected population are non-communicable diseases, crisis-attributable injuries, sexual and gender-based violence, mental health and psychosocial health, and infectious diseases.1
Conflict-related physical trauma is placing pressure on hospitals. In addition, the low acuity hospitals and rehabilitation facilities are under pressure to take on more acute healthcare needs to support the larger hospitals across Ukraine. The pressure on the healthcare service and medicines is an unknown challenge due to the ongoing hostilities with unpredictable effects on the overall health status of Ukrainians in the coming weeks and months.
The Covid-19 pandemic had already led to an exacerbation of chronic mental health disorders, with the social perception of mental health across all age groups negatively impacting this further. A significant worry is the limited number of mental health care workers. Mental health is a taboo subject in Ukraine. Ukrainians have a “can-do attitude”, but the level of trauma they have experienced is now taking its toll. Ukrainian family doctors (GPs) typically manage basic mental health needs but many who are struggling have never been to their GP before.
To address this gap in healthcare provision, UK-Med is working towards a robust mental health and psychosocial support package. I was fortunate to be able to contribute to this. Identifying the start point of those most in need felt like an impossible task – all groups of people in Ukraine are vulnerable and in need.
The Realities of Working in a Conflict Zone
There are a very limited number of Non-governmental Organisations operating in Ukraine, primarily due to security fears. The frequent and chilling klaxon is a reminder of imminent attacks across the country. If that isn’t enough, the strong presence of uniformed military personnel everywhere and the multiple military checkpoints to navigate whilst traveling to deliver essential healthcare will trigger you.
Whilst working alongside the national staff, the physical and phycological scars of the current conflict alongside the 2014 conflict are very much apparent. Continual awareness and provision of psychological support to co-workers, ensuring their work isn’t re-traumatising them is essential. Many healthcare staff are internally displaced having fled from their homes for fear of losing their lives. They relive stories of losing loved ones and hiding in bunkers for days. Accounts like these reflect the enormity of their psychological health needs.
Connecting with some of those most in need in the East, where health systems have been devastated, remains near impossible. Our teams travel long distances to provide primary health care to occupied areas that have faced intense warfare. With national fuel shortages, there is an additional daily challenge and an extra level of difficulty in delivering and distributing medical help and supplies.
As a nurse and healthcare worker, nothing will ever prepare you for the feeling that you just can’t deliver care or aid to those most in need. Identifying the imminent challenges: psychological distress, moral injury, and the national staff’s mentality made it more manageable when starting out in Ukraine. In general, deploying with an open mind, clear brief, and working with established organisations like UK-Med assist with the obstacles faced by humanitarian workers.
Historical lessons of humanitarians, albeit with the best intentions, but delivering care that doesn’t meet the need or complicates an already complex situation play heavily on the minds of those in-country. It’s understandable for healthcare workers to think they will be delivering life-saving interventions on the frontline. However, this is far from reality. Instead, the benefit is gained by providing trauma first aid training to prehospital staff or phycological first aid to citizens who have lost everything. From the start of any humanitarian disaster, ensuring sustainability in the care and support that is provided means engaging with local staff to understand the want and needs of those we work for and with.
Globally, health care continually comes under attack. This includes health care facilities, supplies, transport systems, personnel, and patients. The World health organisation reported that there were 235 verified attacks on health care, resulting in 58 injuries and 75 deaths between 24 February and 18 May 2022.2 The direct impact of conflict in Ukraine on their healthcare system requires some extraordinary efforts by their national staff. A story of a local Ukrainian midwife, Tatiana Sokolova, was featured in the newspapers in Ukraine. She worked in Mariupol, the North coast of Ukraine, in the basement during the shelling attacks. Across six weeks she assisted in the births of 27 children, facing the everyday tragedies of war and watching as women breastfed other babies when milk formula ran out. It’s stories like these all over the country that I will stick with me forever.
UK Med has a robust security assessment, keeping their deployed staff a safe distance from the front line at all times. However, there is always a risk associated with such work. Reality checks occur as sounds of bombs fall and the ground shakes from targetted aerial attacks 14km from my workplace. Yet, every day, the Ukrainian nationals show exceptional resilience in getting up and working together for a common goal – peace.
It’s impossible not to admire the resilience of Ukrainians and their understanding of bringing the nation together in the face of adversity. This isn’t just limited to humans. Patron the dog was recently presented with an award and medal by Ukraine’s President Zelensky at a ceremony in Kyiv. He’s a terrier who works with minesweepers and has located more than 200 devices. He has become a national hero and a symbol of Ukraine’s resistance.
What is UK-Med providing?
The responses are ever-changing, and health needs are frequently reviewed to ensure the most impactful activities are undertaken.
Currently, UK med are undertaking work to devise a strategy for psychosocial and mental health support. But first, we must understand the needs and culture of countries looking to collaborate and the services already delivering programs.
A key focus of our work in Eastern Ukraine is supporting the healthcare system by providing primary care directly to internally displaced persons.
Two key capacity-building workstreams are also ongoing concurrently. Firstly, training national prehospital staff in trauma first aid and mass casualty management across eastern Ukraine.
We have also provided bespoke capacity-building education programs to the local community-style hospital to help promote safe and effective care. As a result, they can take more acute patients and reduce the burden on the larger hospitals across eastern Ukraine.
As I write, the construction of a tented field hospital is underway due to donations to the healthcare system to temporarily replace hospital damage from the shelling.
Final thought.
Understanding the needs of the Ukrainian people is complex and ongoing. The conflict has now passed its 100th day with little sign of an ending. Organisation committing to providing support and aid means, as my Ukrainian co-worker said while wishing me farewell, “whilst you and UK-Med are here we at least don’t feel alone”.
References
- Ukraine: Situation Report, 19 May 2022 [EN/RU/UK]. OCHA. 19 May 2022. https://reliefweb.int/report/ukraine/ukraine-situation-report-19-may-2022-enruuk
- Ukraine: Situation Report, 20 July 2022. OCHA. 20 July 2022. https://reports.unocha.org/en/country/ukraine/
