Stephen Cornish is executive director of Médecins sans frontières (Doctors Without Borders) Canada.
The crisis in eastern Ukraine has become a staple of daily news feeds. But behind the headlines about proxy wars and abstract political strategies lies a very real humanitarian catastrophe, in which at least 5,000 people have died and more than a million others have been displaced from their homes. As efforts to secure a lasting ceasefire between the Ukrainian army and rebel forces struggle to succeed, civilians on both sides bear the brunt of the suffering.
Indiscriminate shelling by both parties has affected everything from homes to health-care facilities. Dr. Michael Roesch, a surgeon with Médecins sans frontières (Doctors Without Borders) in the contested city of Gorlovka says that even the infrastructure that hasn't yet been levelled is scarred. "All the buildings have shattered windows," he recently wrote, "which is an issue when the temperature goes down to 10 below zero at night. Yesterday, we passed a children's playground with scorch marks on the ground from where a shell had exploded. And there are bomb craters everywhere, including right in front of the children's hospital."
This destruction is borne out by casualty figures: In addition to the thousands killed, more than 13,000 have been wounded. When an MSF team first arrived at Gorlovka hospital in late January, there were more than 100 wounded patients in the surgical wards. The deputy director of the hospital reported that between 30 and 100 emergency cases were arriving every day.
But physical trauma isn't the only effect on the people of eastern Ukraine. The psychological impact of living in close proximity to death, destruction and fear leaves lasting emotional damage, especially for children. A young woman named Alyona recently fled with her family from the intense violence that has overtaken her home town of Debaltseve. She found shelter at a sanatorium in the forest near Svyatogorsk, where, along with about 350 others, she has been able to receive basic care from an MSF team. She told a psychologist that her greatest worries were for her two-year-old son.
"I noticed he doesn't want to be away from me," she said. "He's still scared. I hope my child won't have scars from these events, but time will tell."
Alyona's flight from Debaltseve was unlike anything a parent would ever want a child to experience. After hiding with 25 others in a dark, powerless basement with no heating for 10 days, she and her family were finally able to evacuate the building. Due to shelling, however, they had to wait outside for hours as more bombardments came. "Waiting there all together, I thought it could become a mass grave," she said. "A shell hit, and a woman lost her leg. By the time the ambulance arrived five hours later, she had bled to death."
Such stories are common in a conflict where medical facilities have come under shelling – a shameful violation of international humanitarian law. Hospitals should be safe havens for those affected by violence. Several facilities supported by MSF have been hit, forcing medical staff to flee and depriving thousands of access to care. MSF has routinely called upon all parties to halt the shelling of hospitals and ensure that civilians can reach safety, but even as we try to scale up a medical response to the violence, health facilities are being damaged or destroyed, and deteriorating security conditions are making it harder for aid organizations to help those who need it most.
Amid this escalating human tragedy, attempts to find a political solution continue. While there is hope that a lasting ceasefire will prevail, much of what we have been hearing from people on the ground remains filled with uncertainty and worries about the future. Moreover, even an immediate resolution to this conflict will do nothing to diminish the deep and urgent need for humanitarian aid in parts of eastern Ukraine. Many will already need assistance simply to survive the winter: Some of MSF's patients have spent days and weeks hiding in caves and have exhausted their means of subsistence.
It is essential that humanitarian organizations be able to reach the suffering. This has been made more difficult by administrative barriers. Unless the delivery of emergency aid is better facilitated, the human devastation will only worsen, and people like Alyona and her family will continue to despair.
"We don't have plans for the future," she told MSF in Svyatogorsk. "It is difficult to have hope. Everybody has been affected, mentally or physically. People had everything, but now my child is homeless. It's impossible to turn back the clock."