Harrowing journey aboard medical train in Ukraine takes injured to safer areas

As a retrofitted medical train pulled out of Zaporizhzhia, Ukraine, carrying nine badly injured patients to a safer location last week, Canadian American physician Dr. Daniel Schnorr could finally exhale.  

"After all the patients were on board, we were getting ready to leave and we did have an air raid … so the train was stuck for a little while," said Schnorr, who led the first mission of its kind for Médecins Sans Frontières (MSF), also known as Doctors Without Borders.

"But then, eventually, the air raid was lifted, and the train started moving, and everyone breathed a sigh of relief — and you're on your way. And once the train starts moving, it feels like you're already halfway there," he told White Coat, Black Art host Dr. Brian Goldman.

Schnorr is among a number of Canadian health-care workers going to great lengths to care for Ukrainians on and near the front lines of the war that started when Russia invaded Ukraine on Feb. 24.

"The idea of the medical train kind of arose because we noted that the trains have, remarkably, been able to run throughout the war from the beginning," he said.

After a security analysis, the group concluded that the trains are the safest mode of travel right now, despite the fact that the station the group departed from was bombed a few weeks earlier.

On March 31, the train departed with the group of patients — all suffering from blast injuries, and ranging in age from three to 84 — from Zaporizhzhia, in the country's southeastern region, and transported them about 1,000 kilometres west to the relative safety of Lviv.  

"When we first entered into the country, MSF was kind of fanning out, trying to figure out where we could have the most effect, where we could help the most people, where we could alleviate stress on the medical system," said Schnorr, who runs a small emergency department in eastern Arizona when he's not dispatched to a crisis zone. This was Schnorr's fifth mission with MSF. 

The city of Zaporizhzhia has been receiving people who have fled Mariupol, which has been under siege for weeks. As a result, hospitals there have many patients with grievous injuries that will require prolonged hospital stays, said Schnorr.

"They were anxious to try to move patients out of their hospitals because they're anticipating a lot more patients coming in the next few days to weeks."

WATCH | Dr. Dan Schnorr explains the medical train evacuation:

The railway staff modified the railcars so there's space for patients to lay down, as well as for things like oxygen concentrators, IVs and other medical equipment, said Schnorr. Parts just inside the entryway to the train were cut away to make room to manoeuvre stretchers so the sickest patients could remain lying down while transferred from ambulances. 

"We don't have the ability to take ventilated patients, or patients that are on medications to support your blood pressure. But we can take most other patients," he said.

Though the train will be able to take many more patients at a time in future journeys, for its inaugural medical evacuation, Schnorr said they selected a small number of patients who would need to be in a hospital for a long time, but were stable enough to survive a train ride that could be up to 24 hours, given checkpoints along the way.