MARIUPOL, Ukraine -- Standing in pale-blue scrubs in a darkened hallway of a Soviet-era hospital in Mariupol, Volodymyr Mykut looks too young to be out of medical school.
But Mykut's energetic, amiable air hides the sobering experience he has acquired in a hectic, bloodstained year at the Ukrainian city's Hospital No. 1, close to some of the fiercest fighting in the war between government forces and Russian-backed rebels.
At age 29, he has dealt with more catastrophic trauma and death than many surgeons will face in a lifetime.
Hospital No. 1 stands on a quiet block surrounded by greenery on the edge of Mariupol, a sprawling industrial port that is the biggest government-held city in the Donetsk region. Located on the road from Russia to the annexed Crimean peninsula, it is a glittering prize for the separatists, who have targeted it several times in a conflict that has killed more than 7,900 people since April 2014.
From the front lines to the north and east of the city, wounded Ukrainian soldiers are evacuated directly into the care of Mykut, his colleague Vitaliy Nahorne, or one of three other Ukrainian military doctors at this relic of a hospital -- a drab gray brick building with a cold, colorless interior. On a recent visit, nurses and wounded soldiers shuffled through the hospital's two hallways as a young blonde woman armed with a Kalashnikov stood guard outside.
After 16 months of fighting, a cease-fire has largely held since September 1, giving Mykut and his colleagues a reprieve.
Escorting a reporting team up to the second floor of the hospital, days before the truce took hold, Mykut said he could not recall the last time it had been so quiet.
Just 24 hours earlier, the doctors faced one of the worst nights of the war: A flood of soldiers, wounded in the heaviest round of shelling near Mariupol in over a month, streamed into the hospital. The Ukrainian forces suffered 20 casualties that night – seven men killed and 13 wounded in action -- and this hospital tended to nearly all of them.
Those evacuations can take anywhere from twenty minutes to one hour according to these doctors. One important reason for that is that Ukraine has been forced to refrain from using helicopters at the front after many of their aircraft were downed by antiaircraft weaponry Kyiv says was supplied by Russia. By then the drastic wounds these soldiers suffer, many of them from razor-sharp artillery shrapnel, may have taken their toll.
Once the wounded get there, Mykut and his colleagues do what they can.
Too often, he said, it's not enough.
"We can operate, but it's like Vietnam War standards in here, or even 1943," Mykut said.
"People talk about America giving us weapons, but we don't just need weapons from America, we need health care," he said. "Sometimes the lights just go out, we need things as basic as lamps."
Shortly before the cease-fire took hold, Ulana Suprun, an American physician who left New York and founded Patriot Defence, an organization that trains Ukrainian soldiers in combat first aid, spent a week visiting Ukrainian hospitals near the "line of contact," including Hospital No. 1 in Mariupol.
She compiled a report, based on a standard U.S hospital assessment, which tests a hospital's ability to deal with mass casualties in disaster situations.
"None of the hospitals are prepared for mass casualties," said Suprun. "The larger second-line military hospitals in Dnipropetrovsk and Kharkiv boast that only 1 percent of the soldiers they care for pass away, but that's because the critically wounded guys die before they can ever get to those hospitals."
Many of the ambulances used to transport badly wounded people from the front lack basic life-saving equipment.
Kharkiv and Dnipropetrovsk are big cities further from the front line – which is where Suprun said the problem starts.
Although Ukraine seems to have plenty of ambulances to transport the wounded from the front, she says, most of the vehicles lack basic lifesaving tools.
"They don't even have defibrillators, or if they do, they are pieces of ancient Soviet equipment," she said. "In one, the defibrillator just looked like two cattle prods."
Another shortcoming, at some of the hospitals close to the fighting, is staffing.
Since many of the hospitals are civilian clinics, some of them simply close for the night, and few of the doctors are capable of handling battlefield trauma. According to Suprun, some simply don't want to.
And despite the ethical standards doctors vow to uphold, there is also the question of loyalty.
"Soldiers told me they've driven into cities near their lines and had to ask locals where the hospital is and if they can even get a doctor. Then they'll have to wake up a doctor, and that doctor might be a latent separatist, so imagine how that goes," Suprun said. "They said there are some hospitals they don't even bother going to because they believe the doctors are all pro-Russian."
Life Is Cheap
Such concerns, Mykut and Nahorne said, were behind the decision to send military doctors like them to the hospital in Mariupol and other facilitiess.
"Half the town is pro-Russian, and so were the doctors working at this hospital. They were the ones treating Ukrainian soldiers at the beginning so the military had to ship military doctors like us here." said Mykut.
Nahorne looked at Mykut and added, "Well, some of those-pro Russians have changed sides, but not everyone."
Beyond shifting loyalties and inadequate equipment, Suprun says that a broader problem is the Ukrainian military's approach to combat medicine – which she suggests is, more even than Mariupol's Hospital No. 1, a relic of the Soviet era.
"The Ukrainian military's doctrine to medical care is carried over from Soviet days," Suprun said.
"They didn't care about the individual at all at the beginning, they just thought, in this war if they have 1 million, we'll send 2 million, so who cares if 1 million from each side die, we will have won. The individual soldier meant nothing and their lives didn't matter," she said. "We want to change that."
Volunteering on the Maidan in Kyiv during the protests that pushed President Viktor Yanukovych from power in February 2014, Suprun tried but failed to save the young victim of a gunshot when government snipers opened fire.
Since the conflict broke out in eastern Ukraine weeks after Yanukovych fled to Russia, Suprun has spent more than $1 million and worked tirelessly to try to ensure that Ukrainian soldiers are trained to deal with the worst possible wounds.
She has been granted Ukrainian citizenship by President Petro Poroshenko, but says she is facing an uphill climb in changing the attitude of the people in charge.
"I told them that they need to start training soldiers in combat lifesaver courses, which is a standard thing for Western armies, and they just sort of gave me a pat on the back and said, 'Well, you keep up the good work,'" Suprun said. "They have no interest in building this program themselves. They just don't care."