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A Hospital on Rails A glimpse of my journey on board MSF’s medical train

News & Events > News & Stories > A Hospital on Rails A glimpse of my journey on board MSF’s medical train

By Yasser Kamaleddine*

I began writing these thoughts one month after completing my mission and returning to Cairo. During this time, I managed to rearrange my thoughts and recall the events of the five weeks I spent in Ukraine. Out of the ten years I spent doing aid work, this mission was my shortest time in the field. Yet, it offered me some of the richest experiences ever.

On May 13, I made it to Lviv in western Ukraine after a long journey. I traveled from Cairo to the Belgian Capital Brussels, then to Poland, before completing the journey by road to western Ukraine. I spent the journey thinking of the medical train that I heard so much about during the few weeks preceding my mission. This train is one of a unique medical activity. It was unlike anything I’ve ever seen during my experience working in conflict zones and elsewhere. The medical train and its several denominations such as “hospital on rails” and “the escape capsule” spirited me to embark on the journey as if it was my first mission.

Lviv is a beautiful small city located near the western Ukrainian border with Poland. It was very calm and did not echo the seriousness of the war described by some as World War III. I saw people wandering the streets, moving between restaurants and shops as if the ongoing events had no impact whatsoever. I was suspicious of this deceptive calm, but before the end of the day, the alarms set off all over the city to warn of a possible Russian air strike. Restaurants closed their doors, some people went home quietly, while others wandered the streets and gave no caution to the alarm.

I had previously witnessed people’s resilience to the horrors of war in Afghanistan and Iraq. However, after only a few weeks of the outbreak of the war, I expected the situation to be more severe. It wasn’t long before I learned that the sound of the alarms was too familiar for the residents. It goes off daily to warn the residents of possible danger and get them to evacuate the streets and shelter from a possible raid. The alarms go off even though Lviv is located within a thousand kilometers of the clashes in the east of the country.

A journey of 40 to 60 hours on board the medical train

I spent one night in Lviv before joining the team to take the famous medical train. After each trip, the team spends the night in the city to rest and shower before setting off on a new evacuation journey. One trip takes about twenty hours from Lviv to the eastern frontline cities such as Kharkiv, Dnipro and Donetsk. While the total round trip takes between 40 to 60 hours, it may take longer if we send patients to more than one destination or shorter if the train is heading from the frontline cities to Lviv.

Before my arrival, I heard from my colleagues in Brussels that the country has one of the most complex and large train networks on the entire continent. The idea was simple and genius at the same time. From the outside, the train looked as usual as it could be with nothing out of the ordinary. It looked like a typical passenger train, but on the inside, it was equipped to cater to the needs of the medical team and transport about 30 patients from and to the eastern and western sides of the country.

The daily struggles of the “babushkas” during the war

The team on board consists of doctors, nurses, a logistician, and a translator. I was the field coordinator on board. Part of the team rests in Lviv, while 18 to 21 team members work on board during each trip.

The train served as a small mobile hospital equipped with 30 beds prepared for the care of the patients during the long journey. The MSF logistics team turned a full cabin into an intensive care unit with a bed capacity for five critically ill patients. This unit had most of what exists in hospital care units, such as two respirators and an entire network to produce and deliver oxygen.

Preparations for the trip begin upon receiving a notification from the Ukrainian Ministry of Health and the hospitals around the front line. One of our fellow doctors residing in a city nearby conducts an exploratory visit. We determine the approximate number of patients who need to be transferred to Western Ukraine with a full description of their medical state and needs. The number of patients may decrease or increase during the trip. Once this information is collected, the team is notified to prepare for a new journey. We’d meet at the train station half an hour before the trip to take the medical train as soon as it arrives. When the train heads to pick up the patients, the team prepares the train to receive patients in all five cabins designated for this purpose. On the first night of the trip, two or three MSF staff members share the same cabin, knowing that the next night would be restless as the medical staff shares nighttime shifts to monitor the patients. In short, sleeping was hard throughout the trip.

I have not met a team this wonderful during my career. Most of the members had other jobs that they suspended to work on the medical train and save the lives of people fleeing the war. Based on the conversations I had with the team members, I realized that their decision stems from their belief that everyone has a role to play in times of disaster. The team feels so much pride in what they’re doing despite the challenges and dangers of the war. The members met people from their hometowns while being evacuated by the medical train. It also turned out that some members and some patients share mutual acquaintances and friends. Most of the team members were affected by the war on different levels. They or their families had to flee their cities and villages to safer places. The train was an art scene displaying the human stories shared by doctors, nurses, and patients throughout the evacuation journey.

During my time on the train, we managed to evacuate around 200 patients. Most patients suffer from war wounds caused by explosions or shrapnel. The team called most of our patients “babushka”, which means “grandmother” in Russian and Ukrainian. We often set off on a train full of babushkas. These grandmothers were struggling to fight the daily repercussions of this war. Most of them had refused to leave their homes when the war began but had to leave them as patients after being injured. During that period, most of the residents of the villages around the frontlines fled their homes. Only those who did not have enough money to flee or relatives to host them stayed. Most of the Babushkas refused to leave their birth towns. “I will go home as soon as possible. I never wanted to leave my house in the first place, but now I have to,” one of the babushkas told me.

A rabbit that costs an arm and a “leg”

Some patients told me how the war changed their lives and stole their loved ones. We met a patient who used to work as a construction worker. He is in his late forties and comes from a village in eastern Kharkiv. He had lost his father and mother before the war and was left alone in his home. He did not plan to leave his small house even as clashes approached and rockets roared. With no wife or children to fear for, his house and the little land around it were everything he had. One day, he heard a bang, then a closer one, before an explosion drove him several meters away and broke his arms. He recounted what happened in detail as if it were the story of another person.

“I didn’t know what to do to shelter from the shells,” he said. “I had seen what happened to my neighbors. A father, a mother, and their four children had died in the basement of their house. The shells had buried them under the rubble. I did not know if I was safe in the open, but I was sure I don’t want the same ending.”

Another war-wounded patient was joking about what happened as she sat on the bed with one leg amputated and the other injured by an explosion and shrapnel. “I was bringing a rabbit from the barn to prepare dinner for my friends,” she joked, “that was the most expensive rabbit I had in my life. It cost me a leg.” She smiled even though she was in obvious pain even after taking painkillers. Her seventy-year-old dad accompanied her on the journey. He looked at her with a mixture of sadness and pride as she described how she ended up on this train. “We’ll pass through this crisis. She is a strong woman, she got her toughness from me,” he told us as we moved away from her bed.

Neutrality and Impartiality

Neutrality and impartiality fall under the fundamental principles of the humanitarian work established by the battle of Solferino in 1859. This battle is considered an inspiration to international and humanitarian organizations active nowadays, even though the reality today is more complicated and less ideal.

As an aid worker, I constantly think about the living conditions of the people in need on both sides of the frontlines anywhere in the world. It has always been challenging for workers in the humanitarian field to deliver crucial humanitarian aid to the people in need regardless of their ethnicity, religion, or political affiliation during the wars.

In the context of the Russian-Ukrainian war, and despite the presence of MSF in Russia since 1992, to date, MSF teams are unable to reach people in areas controlled by Russia and groups supporting it in Ukraine. The scope of aid work during wars is constantly narrowing all around the world. Accessing people in need and saving the lives of those affected by armed conflicts without discrimination is becoming more and more challenging.

I spent five weeks in Ukraine before packing my things to return to Cairo. On the night of my travel, I attended a small party prepared by the team to bid me farewell. That night, I shared my feelings with them and told them how each of them has impacted how I see the reality of suffering during wars. I expressed my fascination with the wonderful souls of all the team members on board the train.

Despite the distance between Egypt and Ukraine, the war was the focus of all media attention. Therefore, many questions came to my mind as I was packing. How can the geopolitical analysis and the breakdown of the causes and repercussions of the war (from the NATO membership and the oil trade to the loaf of bread) ever explain the suffering of the people I met on the train? I could not come up with an answer. I will content myself with the good memories, the rich experience, and the relationships I made. These will never leave my mind. And now, here I am, saying goodbye to the team and returning home, while I wait for my next mission.

*Yasser Kamaleddine is a pharmacist and aid worker from Egypt. He joined MSF in 2012 and assumed managerial roles in aid operations such as project coordinator and head of mission. He worked in several missions in Egypt, Lebanon, Iraq, Afghanistan, Syria, Greece, Kenya, and Ukraine. Yasser is currently the head of mission in Egypt. He holds a master’s degree in pharmacy from the University of Cairo and a master’s degree in anthropology from University College London.

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