Dr Khassan El-Kafarna is a Ukrainian-Palestinian surgeon working at the MSF-supported hospital in Kostiantynivka, eastern Ukraine. He speaks about frontline medical care and living with both his homelands in states of war.

Zwischen zwei WeltenRight now I’m based at the main hospital in Kostiantynivka. The frontline moves and we’ve been close to it many times. Every day we hear the sound of artillery – both incoming and outgoing – and the sound of explosions on the outskirts of the city. 

We see a lot of different injuries, working here, and we treat all kinds of patients, from people requiring simple surgery through to blast trauma with multiple injuries

Mass casualty incidents

Last summer was the worst. We treated a lot of people with blast injuries and had a number of mass casualty incidents - when large numbers of injured people arrive at once. There were at least four incidents like that, possibly more – you lose track.

When a mass casualty incident happens, it’s very sudden. We never get any warning beforehand, as the areas where it happens have no mobile phone network.

The first sign we get is a vehicle arriving at the hospital full of injured people. They tell us what has happened and that we should expect more arrivals, and then the wounded come in waves.

We start unloading the wounded and rush them to the ER, where we begin triaging and giving medical aid. Often, we take multiple patients into the operating theatres at the same time.

It’s always messy. Everyone in the team is running around, fetching medicines and ordering blood components, red blood cells and plasma. Sometimes during an emergency we have to collect blood from donors at the hospital. There have even been times when our medical staff have given blood.

Father and daughter

Some of the patients you treat really stay with you. There was one 16-year-old girl from Toretsk who had been standing with her father at a bus stop. When the shelling started, he tried to cover her body and protect her. He was hit and killed instantly and she suffered a large wound to the thigh. She lost a lot of blood; by the time she was brought to us, she was clinically dead.

We couldn’t gain i.v. access so instead we had to gain interosseous access, where you drill a hole in the bone and give medication that way. We intubated her and gave her fluids and managed to get a pulse. That’s when we took her into theatre.

We operated, cleaned up the wound and stabilised her. But when she came out of theatre, her blood pressure was unstable, so we kept her in the intensive care unit and the emergency doctor and I stayed with her all night. She made it through to the morning, so we decided to transfer her to a hospital in Dnipro that could provide more advanced care. A few days later, we heard that she’d died in hospital.

Of course, it’s the nature of the job that you see people die, but it can still be very difficult, particularly when it involves kids.

Sometimes you just can’t predict who will survive.

A big surprise

One of my patients was a woman of around 55 years old who had been badly injured. We were never certain if it was a bullet or shrapnel, but it had passed through the right side of her chest, leaving a large exit wound around 20 cm in diameter. It had missed major vessels by millimetres, so in that sense she was very lucky.

When the woman was brought to us, we honestly thought she wouldn’t survive the operation. She had broken ribs, a punctured lung and blood in the chest cavity. Even after the operation she was unstable for a long time, her wound became infected and we thought she would die. But we kept on treating her, performing four more operations, and over the weeks she slowly improved. Just over a month after she arrived, we discharged her and she walked out of the hospital smiling. Her recovery was a massive surprise to us.

A Gaza schoolboy

I always wanted to become a surgeon because of where I grew up. I am half-Palestinian, half-Ukrainian; I was born in Kyiv but grew up in Beit Hanoun in Gaza. 

I saw a lot of violence in Gaza: I witnessed many invasions and knew many people who had been killed. I witnessed our house being damaged and soldiers enter our home.

I remember seeing MSF vehicles in Gaza when I was growing up. 

Although I was a schoolboy and didn’t know much about them, I knew they were doctors who provided people with medical care.


My parents are trapped in Gaza at the moment, trying to get out. The first thing I do when I wake up every morning is pick up my phone to see if I have any news from them. It is very difficult. They don’t have electricity, they don’t have much food, they’re in a house full of people. You wake up in the morning and open your eyes and just hope they are still alive. 

In a war you can never be completely safe. Things happen – it’s a war. This hospital could be hit.

But to work here you have to throw that idea in the trash every day and get on with your work, otherwise you would not be able to function.

MSF has good security supervisors, we have evacuation plans, so I leave all that to them and get on with my job.

The work that MSF is doing here is important. You can see its contribution in this hospital alone, in terms of the improvements in medical care and the additional support we provide. But for me, the most inspiring aspect is the difference we make to individual people. 

Patients come to us, we treat them, and many are able to walk away healthy and on the way to recovery. As a doctor, that is very motivating.


Update: Dr Khassan’s parents and brother managed to leave Gaza in late-2023 and are now living in Ukraine.