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Due to security reasons and high intensity of fire MSF is unable to deliver operations in war-torn areas of Luhansk.Anton Skyba/The Globe and Mail

As Russia maintains its relentless siege of Sievierodonetsk and Lysychansk, the two Ukrainian cities have become too dangerous even for the front-line medics of Doctors Without Borders.

The international humanitarian medical organization, also known as Médecins sans frontières or MSF, is famed for the bravery of its staff and their willingness to work in war zones around the world. But while the Nobel Peace Prize-winning group has several teams of doctors and ambulances on standby in the battle-scarred Donbas region of eastern Ukraine, it is no longer operating in the cities taking the heaviest Russian fire.

“We decided not to go there because of the situation. We cannot guarantee the security of our teams,” Andrea Carlini, MSF’s project co-ordinator for the Donbas region, told The Globe and Mail on Wednesday. “The possibility of being caught in a strike or shelling is too high for the added value we’d provide. We are not a suicide organization.”

Serhiy Hayday, the governor of the Luhansk region, which includes both cities, said in a phone interview on Wednesday that while MSF’s help is needed in Sievierodonetsk and Lysychansk, he understands the organization’s decision. The fact that even MSF feels unsafe working in the region underscores the brutal nature of Russia’s war against Ukraine, he said.

“Bombs can land anywhere, at any moment, and with such large calibre shells you don’t have much chance to survive even if you’re travelling in an armoured car,” Mr. Hayday said. “We spoke with MSF today and they said they were willing to help Luhansk oblast, but only in the Bakhmut region. They said they can’t operate any farther than that. They say it’s too dangerous, and that’s the reality.”

Bakhmut, where Mr. Hayday keeps his office, is 50 kilometres southwest of Lysychansk, in the neighbouring Donetsk region.

He estimated that 15,000 civilians remain trapped in each of Sievierodonetsk and Lysychansk, which lie across the Siversky Donets river from each other. Each city had a prewar population of about 100,000.

Mr. Hayday said Lysychansk had been pounded with air strikes and heavy artillery throughout Wednesday. But teams of Ukrainian volunteers were still able to reach the city to deliver humanitarian supplies and evacuate some of the wounded, he said.

Sievierodonetsk, meanwhile, is now under near-complete Russian occupation, with only the city’s Azot chemical factory still under Ukrainian military control.

Mr. Hayday said there were still 568 civilians, including 38 children, hiding in shelters underneath the factory as of Wednesday. About 100 were staff at the factory, while the rest were family and friends of the Azot workers who had decided to wait out the battle for their hometown rather than be evacuated somewhere else.

“Some of them believe that they have nowhere to go and prefer to remain where they are, near their homes. Some consider themselves too old to move somewhere else. We spent a lot of effort convincing the people who are in the shelter to leave,” Mr. Hayday said.

Mr. Hayday said it is impossible to estimate how many people have died in the weeks-long siege of the two cities, but that the number is definitely in the thousands. Despite the growing risk of being surrounded, Mr. Hayday said Ukrainian troops would continue to defend the region for as long as possible, since doing so drains Russian military resources and prevents the Russians from pressing deeper into Ukrainian territory.

While the battles for Sievierodonetsk and Lysychansk raged on Wednesday, several teams of MSF doctors and ambulance drivers waited 80 kilometres away in the city of Kostyantynivka. Even there, the thunder of Russian artillery was audible throughout Wednesday. Air-raid sirens sounded repeatedly in the city, followed on several occasions by loud explosions.

To the south, a plume of dark smoke could be seen rising from the front-line town of Avdiivka, which is under Ukrainian control.

The Donbas region is dominated by quieted coal mines, disused metallurgical factories and golden-domed Orthodox churches. Most of the region’s residents are Russian-speaking Ukrainians, though most of the prewar population fled after Feb. 24, when Russian President Vladimir Putin ordered a full-scale invasion of Ukraine.

Mr. Carlini said MSF, which only deploys ambulances after Ukraine’s Ministry of Health requests its help, had seen a spike in demand over the past 10 days in the Bakhmut area, which is also increasingly coming under attack.

The main hospital in Bakhmut was struck by a Russian missile last week, blowing the roof off the oncology ward, but Mr. Carlini said it is nonetheless continuing to function to the best of its capabilities. “I’m not sure if they are coping or not, but they are doing their jobs and if they have needs, we help them.”

Ukraine’s General Staff said Wednesday that Russian forces were trying to advance toward Bakhmut and had launched air strikes on several nearby villages.

MSF helped evacuate 22 wounded patients from Donbas on Tuesday, including a woman in her 80s who had escaped Lysychansk and reached the hospital in Bakhmut with the help of local volunteers. She had a broken leg and was in shock, Mr. Carlini said, and MSF transported her by train to a hospital in the western Ukrainian city of Lviv.

MSF released a statement on Wednesday decrying what it said was the indiscriminate targeting of civilians in the nearly four-month-old conflict, which has killed tens of thousands of people and forced millions of others to flee their homes. MSF headquarters said that more than 40 per cent of the war-wounded patients it had evacuated aboard its medical trains since the start of the war were “elderly people and children with blast wounds, traumatic amputations, shrapnel and gunshot wounds.”

“The war in Ukraine is being conducted with an outrageous lack of care to distinguish and protect civilians,” the MSF statement said. “Most patients we talked to when designating who is responsible for their injuries pointed at Russian and Russian-backed military forces.”

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