DOOR TO DOORTHE DOCTORS OF DEBALTSEVE

MSF driver, Aleksi, plans the MSF team's home visit appointments on a map of the town of Debaltseve.

This is a story about two doctors: one from Armenia who took leave of his practice and family back home; the other a local who chose to stay during the conflict that devastated her country. Together they and the MSF teams that support them are knocking on doors bringing hope and healthcare to the residents of Debaltseve.

During months of conflict, particularly fierce in February 2015, the city of Debaltseve in eastern Ukraine suffered massive damage. After the Minsk agreement on 12 February, the separatists took control of this strategic city. Since then, many residents have gradually returned home. Living conditions, however, remain precarious: many homes were damaged by the fighting, food is scarce, and those health facilities that still function offer little in the way of medical care, due to damaged buildings, a lack of drugs and a shortage of medical staff.

Against this backdrop, MSF doctors Khachatur Malakyan and Svetlana Niekurasa, each accompanied by a nurse and a driver, carry out home consultations for the most vulnerable. Following up on appointments booked in the MSF mobile clinic that pulls into town five days a week, the doctors go house to house, seeking out the elderly and fragile residents of Debaltseve. For conditions ranging from debilitating hypertension to chronic cardiac disease, the doctors consult, diagnose, prescribe and offer free medicines to housebound residents cut off from the outside world and left to care for themselves.

Not only do Katchatur and Svetlana prescribe medicines, they also provide a much needed lifeline of hope and reassurance for the isolated and elderly, many of whom also suffer psychological trauma from weeks of subsisting without external help whilst fighting raged around them. Since then, they have clung on to life in the city in the face of electricity and water shortages, and freezing temperatures.

DOOR TO DOORTHE DOCTORS OF DEBALTSEVE

Photographs and Text by Jon Levy

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Driving through an abandoned roadside checkpoint between Luhansk and Debaltseve.

The approach to Debaltseve from Luhansk in the east, along the newly finished motorway, bears the scars of the fierce battles fought here in February 2015. The road is pitted with holes from explosions and debris.

Dr. Kachatur Malakyan enters a building in Debalseve to visit a bed-ridden elderly patient. A

lack of resources and building materials due to the conflict in Ukraine has left many homes without

windows and in a state of dangerous ruin.

The MSF mobile clinic van parks in a neighbourhood of Debaltseve and prepares to receive residents for medical consultations.

Dr. Khachatur Malakyan (l) and nurse Andrei Bogma (2nd l) consult with

Lydia who has Parkinson’s disease. Lydia lives in a small apartment with

her daughter Lina and two granddaughters.

Lydia Momarova, 80, suffers from chronic hypertension and is unable to walk far from her home. Her small apartment still bears the broken windows and scars of the fierce battles that were fought in the city in February and she suffers terribly from the cold. She was grateful for the visit of the MSF team, who checked on her on her health and delivered greatly needed medicines that are unavailable in the town.

Dr. Khachatur Malakyan and Lydia Momarov, 80, discuss the dosage of her prescription for hypertension in her home in Debalseve.

Lydia Momarov, 80, recounts her experience of the battle between Ukrainian and separatist forces in Debaltseve that raged outside her apartment and across the city in February. Like many elderly residents, Lydia had nowhere to flee to and remained in her apartment without electricity, water or medicine for her hypertension.

Antonina Barbushkina is 83 years old and lives alone in a bomb-damaged apartment in Debalseve. She is veteran of the Second World War but is unable to draw her Ukranian state pension since the Ukranian government stopped paying out to residents in the breakaway territories in the east. Dr Khachatur Malakyan visits her once a week to check up on her and to deliver medicines.

Dr. Malakyan visits Nikolai Shevchuck, 77, at his home in Debalseve. Nikolai suffers from chronic cardiac disease and is bedridden. He relies on his wife, Valentina, to take care of him. MSF provides vital home care to patients who are housebound and have stopped receiving medical care in the embattled eastern Ukranian town.

Dr. Kachatur Malakyan checks Nikolai’s heartbeat.

Nikolai’s wife Valentina, 76, helps her husband take his medicine at their home in Debalseve.

Dr. Malakyan talks to Valentina about the medecines that her husband Nikolai requires for his heart condition.

Having reassured Valentina that he will pay her and her husband a visit again next week, Dr. Malakyan heads off to visit more patients in Debaltseve.

Many residential buildings that were damaged by shelling and fire during the February battles in Debaltseve are still occupied.

Pavlo Virienko, 86, is alone in caring for his frail wife, Lydia, 86. He is scared to venture far from his home due to the recent fighting in the town. On a recent foray into town to collect food he fell and cut his face. One of their daughters is able to visit them once a week but their other daughter, who lives on the other side of the frontline in Ukraine is unable to make the crossing to see her parents.

Dr. Kachatur Malakyan and nurse Andrei Bogma of MSF make a follow up visit to the home of Pavlo and Lydia Virienko, both 86, in Debaltseve.

Many families in Debaltseve have survived the winter using food stocks they stored for the

freezing inhospitable months. For the elderly residents breakfast, lunch, and dinner is often made up of a diet of beetroot, bread and tea.

Dr. Kachatur Malakyan and his colleague nurse Andrei Bogma exchange a concerned look during a home visit to Pavlo and Lydia Virienko.

An elderly resident of Debaltseve walks in the nearly deserted streets as life

slowly returns after months of heavy fighting between Ukranian and separtist

forces for control of the city.

MSF doctor Svetlana Niekurasa checks on 91-year-old Varvara

Tutunik in her home in Debaltseve. Two MSF home visit teams are

visiting elderly and sick patients across the city following fierce

fighting that has left them without medical care or access to

Many of the older apartments inhabited by Dabaltseve's elderly

residents contain the ubiquitous cast iron gas hob. This solid metal range is

used to provide heat to the entire apartment as well as to dry washed

clothes and prepare food.

Nina Morozova, 84, lives alone in an apartment that was damaged by the

recent fighting in Debaltseve. She recently received a donation of plastic

sheeting from an international aid charity to cover the windows in her

apartment that were shattered by bomb blasts during the fighting.

A photograph of Nina Morozova's son takes

pride of place in her apartment. Her son,

serving in the Russian army, is unable to visit

her since the conflict in Ukraine began.

Nina Morozova, 84, discusses her diabetes with MSF nurse Ksinia Tsvierkornova during a home visit by the MSF medical team to her apartment in Debaltseve.

Dr. Svetlana Niekurasa greets a woman, who had asked the MSF team to visit, at the gate of her home in Debaltseve.

Doctor Svetlana Niekurasa consults with Svetlana Vorobyeva, 74, who suffers from hypertension and has become

immobile in her home in Debaltseve.

Svetlana Vorobyeva, 74, suffers from hypertension and has become immobile in her home in Debaltseve. Her husband Ivan, 74, looks after her and they been visited three times by the MSF team providing care and medicines to some of Debaltseve’s hardest to reach and most vulnerable residents.

Doctor Svetlana Niekurasa checks over Ivan Vorobyeva, 74, who looks after his frail wife alone at the home in Debaltseve.

Ivan Vorobyeva, 74, bids a cheerful farewell to the MSF home visits medical team at the door of his apartment in Debaltseve. He laughs his dog, hiding in his kennel from the MSF doctor.

Bombed out and detroyed buildings that bear the scars of the fierce fighting the city saw in February are all around Debaltseve. Despite evidence in recent months that many residents are returning to the damaged city following a ceasefire food, medicine and building supplies - with which to repair homes - are in short supply. MSF has started a programme of mobile clinics and home visits to provide medical care to the most vulnerable residents.

Nina Prokopenko and her husband live in this apartment block in Debaltseve,

in eastern Ukraine. In February their neighbourhood was the scene of

fierce fighting and they struggled to survive, trapped in their apartment

during four days of continuous shelling that destroyed the roof and

set fire to parts of the building.

MSF nurse Ksinia Tsvierkornova waits outside the apartment

block as she prepares to enter the home of Nina and Ivan

Prokopenko in Debaltseve.

Ivan Prokopenko sits on the edge of his bed in his apartment in Debaltseve. Trapped inside

their apartment during fierce fighting in February they are both traumatised and Ivan is

depressed to the point of being unable to go outside or take care of himself.

Dr. Svetlana Niekurasa, working with the MSF home visits team has returned to visit Nina and

Ivan for a second time to check up on his condition and to bring medication which is

unavailable in the city since the conflict began.

As the building they live in was badly damaged, Nina and Ivan Prokopenko eat and sleep in the one room of their apartment, in Debaltseve, that has heat from a wood burning stove, two beds and a table to prepare food.

Nina Prokopenko smiles as she says goodbye to the MSF doctor, Svetlana

Niekurasa and the MSF home visit team after they visited her and her husband, Ivan, in their apartment in Debaltseve.