Who protects the doctors? Inside Kyiv's hospitals as Russian attacks intensify

"Ten operations this morning, and I performed surgery myself today. We no longer pay attention to whether the alert level is yellow or red. We just keep operating," says Borys Todurov, a Ukrainian cardiac surgeon and director of Kyiv's Heart Institute.

As Russian attacks on the Ukrainian capital intensify, doctors across the city face a dilemma: when an air raid alert sounds, should they seek shelter or continue treating their patients?

For Todurov, the answer is often dictated by the patient's condition.

A substantial share of the Heart Institute's patients arrive by ambulance in urgent need of treatment. A heart attack may require immediate coronary angiography, stenting or surgery.

"We cannot stop and go to a bomb shelter, even during a red alert," he tells hromadske.

The hospital has a shelter capable of accommodating up to 500 people, but it has no operating room. Staff and patients not involved in emergency procedures can go downstairs, while doctors and nurses remain with those who cannot safely be moved.

Todurov says only 10–15% of patients use the shelter during alerts. The others choose to continue treatment.

"We have become fatalists over the past five years," he says. "We live expecting that anything can happen to anyone at any moment, and we simply continue doing our jobs and pray that we won't be hit."

Rules for treating patients under attack

Ukraine's government recently introduced guidelines for medical facilities during air raid alerts, distinguishing between two levels of threat.

Under a yellow alert, associated with drone attacks, medical facilities can continue operating while ensuring access to shelters.

Under a red alert, which covers missile threats and large-scale attacks, staff and patients are generally required to move to shelters. However, treatment that would be dangerous to interrupt, including surgery, must continue.

Emergency medical care remains available regardless of the alert level. Ambulance dispatch centers must operate continuously, including from shelters.

The Health Ministry says the aim is to protect patients and medical workers without interrupting lifesaving treatment.

In practice, however, the decisions are rarely straightforward.

"Medical workers are people too"

"On the one hand, we're medical workers, and we can't say, 'Sorry, there's an air raid alert, come back later.' Patients need help whether there's an alert or not," says physician Mariia Pereverzieva.

"But on the other hand, medical workers are people too. Why are our lives automatically less important than those of patients who can go to a shelter?"

Her colleague Tetiana, a family doctor who asked not to be identified by her surname for fear of problems with management, takes a different approach.

She admits that she continues seeing patients at a public clinic during alerts, even though the facility has no shelter.

"If a patient isn't frightened, and they've brought a vaccine in a cooler, or they're sick with a temperature of 39°C [102.2°F], I won't refuse to examine them, even at the risk of a reprimand," she says.

Tetiana estimates that she can resolve around 70% of patient requests online.

Private clinics follow different approaches.

The Lama Lu medical network says its facilities remain open during alerts, with patients and doctors jointly deciding whether to continue appointments or seek shelter. The network has installed backup batteries and inverters to protect vaccine storage during power outages.

The Dobrobut clinic network says it suspends operations during red alerts but continues working during yellow alerts, while monitoring threats to individual neighborhoods. Patients and staff move to shelters when necessary.

When the explosions come close

For patients, even a routine medical appointment can become an encounter with the war.

Maryna Yeroshkina recalls being in a doctor's office at a public clinic when an explosion struck nearby.

"I was sitting there telling the doctor about my symptoms when he suddenly jumped up, grabbed me by the shoulder and pushed me into the corridor," she says.

The doctor had been sitting with his back to an open window and felt the blast wave. Yeroshkina, who has impaired hearing, had barely registered what happened.

Another Kyiv resident, Uliana Yeshchenko, describes a friend giving birth during a Russian attack.

Women in labor remained in the delivery room, with staff explaining that it was on the ground floor and away from the building's more exposed areas. During the attack, patients were invited to move into a corridor away from windows.

Other disruptions are less dramatic but still affect access to healthcare.

Oksana Nesterenko says her public clinic continues functioning much as before, except when electricity cuts disrupt the internet connection.

Then Helsi, a digital healthcare platform used for appointments and medical records in Ukraine, becomes temporarily unusable.

"Information gets written down the old-fashioned way — on a sheet of paper," she says with a laugh.

Air raid alerts can also make it harder to arrange appointments. One patient seeking treatment for a jaw injury repeatedly encountered an automated message telling her to call back later. Unable to wait, she eventually paid for a consultation at another public hospital rather than accessing specialist care through a free referral.

A shelter beneath the clinic

During a yellow alert, a hromadske reporter visited a primary healthcare center in Kyiv.

Doctors were seeing patients, and elderly visitors queued at reception.

The shelter was in the basement: dark, with worn benches, fabric-wrapped pipes overhead and a mannequin dressed in a Soviet-era chemical protection suit and gas mask.

A handwritten sign held by the mannequin read, "Welcome."

The shelter was officially designated for 56 people. Only two women were inside, using flashlights to see.

It remained open around the clock and had two emergency exits.

Above ground, appointments continued.

For Kyiv's doctors and patients, this has become an everyday reality: the need for medical care does not disappear when an air raid siren sounds, but neither does the danger.

And the question of who protects those providing that care remains unresolved.