Mobile gynaecologists treat women in Ukraine's medical desert

On an empty village square next to a brick building with boarded-up windows, a group of women were waiting to climb into the back of a large medical truck for a gynaecology check-up.

It has become a familiar scene across eastern Ukraine, where brick-and-mortar hospitals and clinics have been flattened, destroyed and bombed in more than two years of relentless Russian aerial attacks.

The World Health Organization has recorded more than 1,600 attacks on Ukrainian health facilities since Russia invaded in February 2022, and Kyiv says at least 194 civilian medics have been killed.

The Donetsk region, where the fiercest fighting along the entire frontline is currently underway, has become a medical desert.

"Many doctors have left," Mykola Papin, a 63-year-old gynaecologist and obstetrician, told AFP.

Of the 18 specialists employed at the regional perinatal centre in the nearby city of Kramatorsk, only Papin and one other doctor remain.

Across the country, medics have departed for safer areas, while others have been wounded themselves or joined the armed forces to treat injured soldiers.

Papin, who also left the region when Russia first invaded, now tours isolated villages and towns in a specially kitted-out medical truck, performing examinations and providing medical care to the thousands of Ukrainians who still live close to the front lines.

"Life goes on. Yes, it is difficult, yes there is shelling, but people need medical care," he told AFP.

- 'No transport' -

When the mobile clinic pulled up in the village of Novomykolaivka earlier this month, a dozen women were already waiting.

Papin and his team received them one by one, enquiring about their medical history, including any pregnancies or abortions.

The village is only around 20 kilometres (12 miles) from the cities of Sloviansk and Kramatorsk, which Ukraine controls and where there were plenty of medical facilities before the war.

"There's no transport" to the city, said Anna Odnovol, 39, who in any case said her long-time gynaecologist had left town. As did her father's psychologist.

The villagers had depended on buses, but they had become a rare sight. Car ownership was a luxury.

Before the mobile clinic, "there was no one to turn to", said 48-year-old Iryna Yefremenko.

"We need doctors, even in a forgotten village like ours," she added.

- Giving birth under bombs -

Papin's team follows an itinerary set out in advance, even making stops as close as a dozen kilometres from the frontline.

"There is a danger of shelling on the way to work, and while providing help. But despite this, we continue to work," he said.

He has gotten used to the risks.

"We delivered babies during shelling" in the first weeks of the war, he recalled.

Now, there are fewer deliveries, as "the birth rate has fallen sharply", he said.

The stress brought on by the war has prevented some women from becoming pregnant, he said. Many have seen their menstrual cycles thrown off.

And the war has ravaged healthcare in a myriad of ways.

Without access to regular check-ups, some cases of cancer have not been detected until "more advanced stages", Papin said.

- Damaged infrastructure -

The mobile clinic -- financed by the United Nations Population Fund, Sweden and Norway -- is equipped with an ultrasound machine and "all the necessary tools", he said.

While proud of the set-up, Papin regrets that he has to work alone.

Were he at a regular clinic, he would have any number of specialists just down the corridor. Now if he wants a second opinion, he has to cover "50 to 70 kilometres".

The travelling clinic is also a way to offer support to women who may be suffering in other ways.

He makes sure to distribute brochures on domestic violence and looks out for any sign of abuse when examining the women.

"This is our task: not only to consult, but also to relieve the psycho-emotional state" of his patients, he said.

For one of the patients waiting in line for a check-up, keeping positive was a vital part of being able to carry on living in the area.

"If we choose to cry, instead of keep going, then we will need a mobile psychologist," she said.

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