In Ukraine, overcrowded shelters and bombed-out ghost towns

As Russia’s full-scale invasion of Ukraine nears its fourth year, fighting is intensifying, leaving communities near the frontline in Dnipropetrovsk region with little or no access to healthcare. 

Roads used to evacuate are frequently targeted, towns are reduced to rubble, and civilian casualties have sharply increased in 2025. A strike in Pokrovske on 29 September illustrates the danger: MSF teams were treating patients in the nearest hospital’s intensive care unit when the building shook from the explosions. Eight wounded people arrived with shrapnel injuries, limb trauma, and traumatic brain injuries, and were stabilised on-site. “This is what people are fleeing,” said Dr Ivan Afanasiev.

As thousands of people continue to flee from frontline areas, the Dnipropetrovsk region has now become a critical transit hub, leaving displacement shelters overcrowded. When the numbers of displaced people began to surge in July and August, one of the largest transit shelters was sheltering around 500 people per day, despite having space for just 140. Médecins Sans Frontières (MSF) teams are working via mobile clinics in these shelters to provide medical consultations and psychological support, primarily to people who are elderly. 

Since April 2025, MSF teams have treated more than 1,400 patients, but we are witnessing a growing number of needs and increasing severity of cases. 

For this reason, we recently increased the frequency of visits and expanded medical assistance to additional locations where people are arriving.

“My city, Kostiantynivka, is in ruins. There is nothing left: no water, no gas, no police, no firefighters,” says 68-year-old Valerii Bureiko, who arrived with his wife and elderly and bedridden mother-in-law at an MSF-supported transit centre. “That’s why we decided to leave. It’s easier for younger people, but at our age, we won’t be able to build anything in a new place, so it was a very hard decision.” 

People are becoming displaced as cities and villages have turned into ghost towns; empty streets, trees blackened by explosions, buildings left damaged and uninhabitable, healthcare inaccessible. 

MSF teams refurbished hospitals in Dnipro, Dnipropetrovsk region and Donetsk region in 2022, enabling them to keep functioning even as the war advanced. Today, many of those hospitals are damaged, destroyed, or abandoned. Over the past three months, hospitals in cities such as Kostiantynivka, Mezhova, and Sviatohirsk have ceased to operate; since 2022, MSF teams have been forced to leave six hospitals and ambulance bases, and to withdraw from a number of mobile clinic locations due to the proximity or direct strikes from shelling and bombardments. 

“Many people are forced to evacuate on foot, walking 15–20 kilometres across rough terrain under drone strikes, often through fields which may have landmines, relying on sticks or crutches,” says Dr Ivan Afanasiev, an MSF doctor working in the shelters. “Most are people who are elderly, aged 60 to 70 and up, and already weakened by untreated chronic conditions such as hypertension, diabetes or asthma, as well as malnutrition and anaemia.”

Conditions in the shelters vary: some are set up in tents with rows of camp beds; others are housed in former schools, cultural centres, dormitories, or train stations.

Our teams see patients with fractures and shrapnel wounds that were left to heal untreated. Some arrive with open, infected wounds with maggots. 

Others reach transit centres experiencing chest pains or other symptoms due to the stress, which may indicate heart attacks. Many also have pneumonia and acute asthma symptoms. 

“Two bombs fell on my house. Everything was filled with smoke,” says Liubov Cherniakova, 72, from a village near Kurakhove, sitting on her bed in a crowded shelter. 

“I ran out, fell into a hole, and couldn’t get up. Hera – that’s the name of my dog – came back for me, pulled me by the collar, bit and licked me to bring me to my senses. When I opened my eyes, I saw how happy she was that I was alive.” 

Even after leaving frontline areas, people do not feel safe in these transit centres. 

Cities serving as evacuation hubs are themselves frequently targeted by drone and missile attacks. 

Pavlohrad, where the nearest large transit centres to the frontline are located, is repeatedly bombed. Most displaced people continue their journey further west, with brief stays in the centres.