"Between life and death" was how a heroic Ukrainian nurse describes her life serving in the midst of war

The municipal hospital in Kostiantynivka, Donetsk region, sits just about 10 miles from the ever-shifting frontlines. Inside the four-story building, the air is heavy with the scent of antiseptics.

Anastasiia, her uniform stained with blood, moves with practiced efficiency as she assesses the injuries of the patients brought to the emergency room last night. She has worked as a nurse in the hospital’s emergency and trauma departments for over two years now.

Her medical specialization is otolaryngology, but she frequently needs to provide triage assistance since there’s a shortage of doctors and nurses. She is not the only nurse who, in the past 24 months, has been compelled to shift to the emergency department and assist with several amputations.

Twenty doctors and nurses make up the hospital’s current medical crew, which offers cross-disciplinary medical support. “Everyone had to shift to emergency care. This is the only way we can meet the demand,” shares Anastasiia.

She is about to check on one of her last patients, when a loud blast resonates through the air. Shockwaves ripple through windows as the ground quivers under the weight of each explosion.

Minutes later, about thirty more people are brought in. Some lie still, their eyes closed in silent prayer, while others scream for help. Panic sweeps through the hospital halls as the sound of sirens pierces the air.

Anastasiia assists a young girl in her twenties who was stranded beneath the debris. She requires a leg amputation. There is no time to ponder. She acts on instinct and acts fast. “In a hospital with limited resources and thirty injured patients arriving at the same time, the pace of your response must be increased three times more,” says the nurse.

“And sometimes it’s between life and death,” she adds on.

“It breaks my heart, especially when every day I have to perform an amputation on a child whose hand or leg has been heavily injured in the rubble pile following an attack.”

According to the Health Cluster, led by the World Health Organization (WHO), 7.8 million people require humanitarian health assistance in 2024, of whom 3.8 million are anticipated to need life-saving medical treatment in areas most severely impacted by the ongoing war.

“It breaks my heart, especially when every day I have to perform an amputation on a child whose hand or leg has been heavily injured in the rubble pile following an attack,” shares Anastasiia.

“You go through moments that you can’t put into words,” she says. The nurse goes on, “In an ocean of dread, you must be their safety, ensuring that you will do whatever it takes to save them.”

The Donetsk region has seen the highest damage to health infrastructure, with more than half of all health facilities, 119 in total, of which 8% are completely destroyed and 51% are partially destroyed.

Overall, more than 1,125 confirmed attacks have affected medical workers, medical transportation, supplies, patients, and infrastructure in the health care sector.

Recent reports indicate that the Ukrainian healthcare system experiences on average two attacks each day.

Every morning Anastasiia wakes up and finds out more and more civilian buildings are targeted – schools, kindergartens, supermarkets, theaters, pharmacies.

She kisses her eight-year-old daughter and husband goodbye every day before going to the hospital like it would be the last time. She realizes she might not return this time. “I love you so much,” she tells her daughter as she cradles her in her arms, her pale cheeks dripping with tears.

“Many times, when I travel to the hospital, the scene on the road looks surreal,” says Anastasiia.

Kostiantynivka becomes a ghost city after 2pm, as it’s subjected to widespread bombardment. Explosions create an unbearable sound. There are structures without shelter, and it is sometimes too late to locate one. “You have nowhere to hide while everything around you is bursting. Everything in the path gets destroyed.”

The typical interval between a series of missile attacks would be one to two hours.

The city lacked running water for three months in a row in the summer of 2023. Its citizens also reported issues with the heating system throughout the winter, with indoor temperatures reaching a maximum of 8 degrees Celsius.

Given that most of the city has been destroyed, relatively few people still hold their jobs. Most of the time, doctors are the only ones who still have steady employment.

Despite this, approximately 3.3 million people continue to live in frontline areas. “The main reason people are not fleeing cities near the frontlines is because they lack the resources to start over and over,” explains Anastasiia.

The collective centers for internally displaced people, which provide temporary shelter, have a limited number of available spots. “People can’t afford to pay rent once they have lost everything,” she adds.

Starting anew

After working in the emergency room of a war-torn city for more than two years, Anastasiia and her family relocated to Dnipro, Ukraine in March 2024. They are currently living in a collective center, sharing a room with seven other people.

Life has a different cadence today than it did in the ER. Although she would prefer to support hundreds of injured, she knows that her daughter needs her the most at this time.

Anastasiia lives in the collective center where the Health Right mobile team, World Vision’s local partner, goes once a month to offer legal, social, and psychological support. The multidisciplinary mobile team for internally displaced families is made up of a psychologist, a lawyer, and a social worker.

Funded by USAID’s Bureau for Humanitarian Assistance, ACTED Ukraine and the Ukraine Response Consortium, they assist around thirty families per day, covering 22 collective centers in Dnipro each month. “In a war zone, the imperative for psychosocial support is not a luxury but a lifeline. Amidst displacement, children bear the unseen burdens of distress and post-traumatic stress disorder,” shares Yuliya Teslya, mobile team’s psychologist.

“They react to sounds such as a slamming door. They don’t engage with other children. We are working to restore their sense of security by listening and intervening with psychological first aid techniques,” she adds.

Apart from providing legal and psychological support, the mobile team offers packages that include essentials like food and hygiene items. “In circumstances when you lack a reliable source of income, the assurance of having food on a daily basis is very relative,” says Anastasiia.

After an hour of art therapy led by the mobile team’s psychologist, Dasha, Anastasiia’s daughter, runs frolicking into the room with the eight bunk beds, surrounded by the few things the displaced families managed to take when they left their homes: a few clothes, stuffed toys, books, and the containers for their pets.

Leaping onto the bed covered in freshly laundered gray linens, Dasha hugs Bunny tightly. “My favorite toy, Bunny, is what I brought with me when I left my home in Kostiantynivka. I love Bunny. I have had him since I was little. It brings back memories of my home and our happy times together as a family,” shares Dasha smiling gently.

World Vision Ukraine Crisis Response has established and supported 157 service hubs for IDPs and Ukrainian refugees. More than 129,000 children like Dasha have benefited from mental health and psychosocial support services.

Story and photos by Laurentia Jora, UCR Communications Manager