As a freezing dusk descends over Mykolaivka in eastern Ukraine, Oleksandr Bilanov leans forward and reaches into a desk drawer.
“These landed here in my office,” he says, holding jagged shards of shrapnel in his palm, and recalling his toughest days as surgeon and chief doctor of this hospital where he has worked for 26 years.
“From May to July 2014 we treated about 360 people for gunshot wounds – civilians, military and separatists,” he says. “Of more than 300 staff, only about 100 were still here. When the worst fighting took place in early July, we were the only hospital in the area still operating. On one single day we performed 67 operations – not just removing shrapnel, but major operations like amputations. There was no time to be scared.”
Mykolaivka and neighbouring Semenivka saw some of the fiercest fighting in Ukraine’s war with Russian-backed separatists, as government troops drove the militia from their stronghold in the nearby city of Sloviansk.
“We could see what was coming and stocked up on medicine, water and fuel for the generators. We treated patients in the basement, and during artillery fire it felt like an earthquake – it almost knocked you off your feet,” recalls Bilanov.
“Thankfully, the building didn’t take any direct hits, even though the separatists were on the roof. But several shells landed in the grounds, the windows were blown out, and there were bullet holes everywhere.”
Sons at the front
Ukraine’s liberation of Mykolaivka was a huge relief for the doctor, both of whose sons were then serving in the nation’s military. Still, the battle compounded decades of neglect that his hospital had suffered.
Rain came through holes in the roof and shattered windows, and the X-ray room and operating theatres were in urgent need of renovation. But war, economic crisis and endemic corruption left Ukraine’s government with little cash for such projects.
The repairs were funded by Japan through the United Nations Development Programme, one of the many international agencies helping patch up eastern Ukraine as the conflict rumbles on into its third bitter winter.
In a humanitarian response plan for 2017, which was released on Monday, UN agencies and other aid groups said that 3.7 million eastern Ukrainians require some form of help, from protection to food aid to water and sanitation needs.
In appealing for $127 million (€118 million) in funding for “critical priority” programmes, the agencies said that “the number of people in need has actually increased by 700,000” since the plan for 2016 was drawn up.
“People have exhausted their savings, their ability to cope is stretched too far after more than 30 months of conflict,” the plan states. “The human suffering triggered by the ongoing conflict in eastern Ukraine must remain a priority.”
However, the war in Syria, Europe's struggle to cope with refugees and the election of Donald Trump – who has questioned the value of US engagement abroad – have all cast doubt on how much effort and money the world is willing to commit to Ukraine.
As international attention wanes, people in places such as Mykolaivka attempt to rebuild lives shattered by a war that has killed 10,000 and displaced well over one million – and which was unimaginable even three years ago.
"I only realised how close war was when I visited my grandma's village of Drobysheve in April 2014," says Artyom Butov (32), whose father is another doctor in Mykolaivka hospital.
“She said there was a checkpoint nearby, so I went to say hello to the guys there, thinking they were our soldiers,” he says. “But when I saw the rag of a flag they were flying, I realised they were separatists. Then I knew it was time to hide or join the fight.”
Butov became a drone operator for the Donbas Battalion, a unit of volunteer fighters named after the eastern region now divided by the war.
In August 2014, he was recovering in hospital from an injury when his battalion was routed at Ilovaisk, where Russian troops are thought to have helped local separatists halt the advance of government forces.
“I’m not a soldier and I found the war terrifying,” Butov says. “And we’re not fighting just to get our land back, but so that people can do something good with it and live better. So I decided to start a little business.”
He has used a UN development grant to establish a small chicken farm in Drobysheve, 40km from Mykolaivka, and joined with like-minded locals to encourage business start-ups.
“Now life is hard,” Butov says. “But we have to think of Ukraine’s future, and of what we’ll do after the war.”