Medicine under occupation

Regina Gimalova March 05, 2024 |

What happened to healthcare in the occupied regions during two years of war

During the two years of war in the occupied territories of Ukraine, hundreds of hospitals were destroyed, many doctors fled to the part of the country controlled by Kyiv. The remaining doctors and nurses continued to work under constant shelling. The Russian authorities sent thousands of medical workers from all over the country to help them, and allocated more than eight billion rubles to restore the infrastructure. However, as the doctors themselves and appointed pro-Russian officials say, it was not possible to overcome the staff shortage, problems with corruption, shortage of medicines and low payments. “Layout” found out how the healthcare sector works today in the Ukrainian regions occupied by Russia and what doctors and patients themselves say about it.

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The names of the publication's characters have been changed.

The first days: “It was hard to look me in the eyes”

“When I arrived, I immediately experienced such an ambiguous feeling: it was no longer scary, but I still felt horror,” this is how Mikhail, a doctor from Siberia, describes his first trip to the occupation zone. “All the people there have pain in their eyes, the imprint of what they have experienced. For everyone: both small and large. Only an adult can understand, but children...”

Mikhail's specialty is a pediatric surgeon. He first went to the Mariupol intensive care hospital as a volunteer in September 2022. After that, I went to the occupation zone three more times: again to Mariupol and to the Kherson region.

“On the first day I was told to pay attention to people’s eyes. It was hard to look him in the eyes. Many remained fearful,” another doctor, Alexey, recalls his only trip to Mariupol. “Those who were there during the hot phase described what was happening in non-literary terms. That’s what they said, it was “horrible, terrible, terrible,” “fucked up, fucked up, fucked up.”

Alexey left St. Petersburg for Mariupol as a volunteer in August 2022. On the spot, he settled in one of the hospital’s wards and began working in his specialty - as a therapist in the emergency room. After completing his trip to Mariupol, he never returned.

“The overall picture was quite deplorable, because many people... You know, these events suddenly descended on them. The battles were very scary... the situations were terrible,” recalls Elena, a medical psychologist from Moscow.

Elena first went to Mariupol in October 2022, together with 11 colleagues from the Association of Volunteer Centers. She managed to work in the departments of therapy, neurology and surgery, and a few months later she went to the Lugansk region.

“Even when we lived [in Mariupol], there was no heating, no light or water, many continued to live in basements,” she says. - You know, the most depressing, shocking thing is that you see a black house with holes in the walls, charred dwellings; and nearby you can see a luminous window in which people still live .”

“At first, it felt like I was in another state: there are checkpoints all around, military equipment, a lot of soldiers, it’s kind of… unusual,” this is how an endocrinologist from Mordovia describes his trip to the Zaporozhye region in March 2023. He went to the occupation zone on a business trip organized by the regional authorities and worked for a month at a local clinic.

All the interlocutors of “Verstka” note that they went to the city destroyed by shelling “at the call of their hearts” to “treat, save and help colleagues.”

From volunteering to business trips: “You don’t need to go there for money”

According to Vorstka’s calculations, at least 2.5 thousand doctors from 50 Russian regions visited the occupied units in the Donetsk, Lugansk, Zaporozhye and Kherson regions during the two years of war : local media and telegram channels wrote about them, and pro-Russian authorities reported. In reality, this figure may be much higher. i

Doctors interviewed by VERSTKA say that they were not prepared for what they had to face.

“You see that in a ward where it’s almost impossible to get through, these poor old people are lying,” says Elena, a psychologist from Moscow, about the first day of work. “Many of them either had children who left, or someone died, someone was abandoned. Imagine that that’s it, this is the end of life - and that’s what it is.”

Mikhail, a pediatric surgeon from Siberia, recalls that most often children and parents came to him after stray dog ​​bites. “At that time, the dogs had already been homeless for six months and were getting food for themselves as best they could,” says Mikhail. - That is, these are not puppies, they are dogs that were there even before the start of the war, domestic ones. But they were left alone and ate everything in sight, including corpses. And that’s why they rushed at people, at small children.”

When the flow of children ended, Mikhail says, wounded soldiers were brought to the operating table. “It was unusual, so to speak, I’m used to communicating with little ones,” he says. “And here are extreme conditions—a region where fighting took place. Well, then I adapted.”

In the emergency room, according to Alexey from St. Petersburg, by the end of the summer of 2022, the most common occurrence was not gunshot or shrapnel wounds, but erysipelas i . “These are the consequences of people spending a lot of time in basements. This is not even an echo of war, this is still its echo,” he says.

In the first months of the war, doctors traveled to the occupation zone as volunteers under the patronage of Russian politicians and military personnel. As a rule, they took leave from their main place of work and went to the occupation at their own expense. Elena from Moscow says that she spent about 200 thousand rubles on two such trips. “I'm not complaining, but it shouldn't be like this? Even food was not always provided there,” she says.

By the second half of 2022, such trips had already become part of the charitable state policy: doctors were sent by institutes subordinate to the Ministry of Health, hospitals and clinics, state corporations and various pro-state foundations and movements.

For example, Rosatom organized a medical examination for children, Deputy Chairman of the State Duma Anna Kuznetsova, on behalf of her project, initiated medical care for orphans, the Popular Front For Russia movement sent its “Health Train” - a mobile medical complex - to the occupation zone.

By the end of 2022, doctors began to be sent on official business trips from regional Ministries of Health and hired as freelancers in institutions of the Ministry of Health of the Russian Federation - for example, in the Federal Center for Disaster Medicine or the Federal Scientific and Clinical Center. If before this doctors went to the occupation zones as volunteers at their own expense, now they began to pay for such trips . After the annexation of the territories, the government allocated more than a billion rubles to finance “medical landings.” Doctors were given special payments for work in the combat zone and for helping military personnel: from 20 to 100 thousand rubles per month, depending on the duties performed and the amount of time worked.

Ivan, an endocrinologist from Mordovia, says that he went to the Zaporozhye region just at the suggestion of the regional Ministry of Health. One of those who subsequently got a job as a freelance employee at the federal medical center was Michal from Siberia. When asked how much payments were made to these categories of doctors, Vorstka’s interlocutors did not answer.

“You don’t need to go there for money, it’s not worth it,” says Mikhail. “When many people find out [about the payments], they go, and then on the spot they realize that the territories are being shelled and it begins... It’s not a good idea to go for money alone.”

By the end of 2022, such “medical landings” were already replacing each other according to schedule, and doctors returning from trips received awards: medals, certificates, letters of gratitude from governors and State Duma deputies.

Humanitarian aid: “I left everything I brought with me”

Since the beginning of the war in Ukraine, WHO has confirmed at least 1,616 attacks on medical infrastructure. In no less than 242 cases, medical transport was hit. In at least 134 cases, medical staff were attacked. Over the course of two years, at least 118 doctors died from the attacks and at least 253 were injured.

After the end of the active phase of fighting in the occupied territories, local pro-Russian authorities announced restoration work. Regularly, since mid-2022, propaganda media reports contain notes about the repair and construction of buildings, landscaping, and the supply of various equipment for social institutions.

According to doctors who visited the occupation zone in 2022, then most of the necessary medicines, medical supplies and equipment were brought through humanitarian aid. It was also purchased by Russian doctors themselves .

“When I was in Mariupol [in October 2022], of course, there were difficult times, something was missing, and we ourselves went, bought and brought, and whoever could, left what we could,” says Elena, a psychologist from Moscow. “For example, I left everything that I brought with me, right down to the kettle.”

It is noteworthy that already at that time, the pro-Russian authorities of the occupied regions announced purchases from budget funds, payments of salaries and pensions in rubles, although officially before the annexation they could not manage Russian budget money. It is not known for certain how money for such expenses was transferred to the regions. One of Vorstka’s interlocutors claims that representatives of the pro-Russian government brought cash to the region, but it was not possible to find proven evidence of this i .

Partial financing of the healthcare sector probably also came through the federal centers of the Ministry of Health. For example, in October 2022, the National Medical Research Center for Children's Health received 353.2 million rubles from the government to conduct in-depth preventive medical examinations of children in the LDPR, Zaporozhye and Kherson regions. In December, the Russian government allocated another 435 million rubles to continue medical examinations.

Budget expenditures: 8 billion per year

In 2023, the situation changed somewhat: money, including for the healthcare sector, began to be allocated through official channels. As Vorstka found out, during 2023 the government allocated more than 8 billion rubles to healthcare in the newly annexed regions. Data on this are reflected in interbudgetary transfers. Most of this money - more than 80% - relied on the provision of authorities, regulatory institutions and compulsory health insurance systems i .

In 2024, the Russian authorities plan to spend 8.8 billion rubles on healthcare in the newly annexed regions.

“Verstka” studied government procurement data from 178 registered healthcare institutions in the newly annexed regions. In total, they spent more than 788 million rubles in 2023. Most of this money went to heating - about 303.6 million rubles. More than 187.5 million were spent on expenses related to electricity, gas and water. Institutions spent more than 153.1 million on the purchase of medical consumables, maintenance and repair of medical equipment. Another 71.1 million rubles were spent on construction and repair work in hospitals.

The largest suppliers to medical institutions in the occupied territories were state unitary enterprises that supply utilities, including Rosatom subsidiaries that supply electricity to hospitals. The list of smaller suppliers includes legal entities from Crimea, annexed ten years ago, or Russian regions.

Chelyabinsk thief, the family of a Ukrainian volunteer and local businessmen: which companies received tenders from hospitals

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Among the suppliers there is, for example, the Crimean LLC Standard Development, whose owner, Nikolai Strokach, according to leaks, was convicted of theft and hooliganism in the 2000s. “Verstka” was unable to find information about criminal cases against Strokach and court materials in the public domain. However, in 2018, a person with the same last name and initials in Chelyabinsk was tried for drug use and refusal to undergo a medical examination. For several years, Standard Development LLC received multimillion-dollar contracts for the construction and repair of healthcare facilities in Crimea, annexed ten years ago, and last year won a tender for the overhaul of the Melitopol Oncology Center for 32.7 million rubles.

Another example is the pharmaceutical company Miafarm from Kabardino-Balkaria. The company received a tender for the supply of medicines to hospitals for 14.5 million rubles. It belongs to local businessman Amir Nebezhev. His relative Renat Nebezhev, recorded in the phone books of other users as a representative of the Miafarm company, lives in Dnepr, and with the beginning of the Russian invasion of Ukraine, together with volunteers of the Guardians of the Dnieper foundation, he collects humanitarian aid for soldiers of the Ukrainian Armed Forces. In the published photographs, where Renat Nebezhev is noted , among such assistance there are medications.

Several more legal entities and individual entrepreneurs who received contracts for large sums from companies previously lived and worked in the same occupied regions. For example, the owner of the newly created Vianna LLC, Andrei Milokostov, who won a tender for the supply of heating to hospitals for almost 14 million rubles, under the Ukrainian authorities headed the company Luganskpromresurs and was engaged in trading equipment and fuel. A native of Zaporozhye, Anton Nikitin, through his Russian LLC Tayvest, received almost 10 million rubles for the repair of the Dneprorudny city hospital, although before the start of the war he worked in the administration of the village of Balki, Zaporozhye region.

At the same time, in two months of 2024, hospitals have already spent more than 25 million rubles: mainly on utilities and updating computer software.

Purchase of equipment: “They showed our equipment and said that they bought it”

“Verstka” did not find information on the government procurement website about the supply of new medical equipment to hospitals in the occupied territories; there is no such data in the expenses of the newly created departments of the Ministry of Health there.

Although, for example, in the fall of 2022 it was officially reported that the Kherson Ministry of Health allegedly purchased new equipment for the Genichesk Central District Hospital. This delivery was carried out by a businessman from St. Petersburg, Evgeniy Kuzmin, and a year later he became a deputy from United Russia in the Kherson Regional Duma, where he joined the committee on social issues and health care. i

In August 2023, the ZaTV channel published a story about the purchase of new medical equipment for the Berdyansk city hospital and noted that the region’s medical institutions “are provided with equipment and medicines with the support of the Ministry of Health.” In this story they showed an angiograph and a computed tomograph installed in the Berdyansk city hospital.

“Verstka” drew attention to the fact that the Ukrainian authorities purchased devices from the same companies for the hospital even before the start of the invasion. Thus, the Berdyansk authorities bought a Neusoft tomograph in 2018 for 18.5 million hryvnia, and put it into operation at the beginning of 2019. The Berdyansk authorities bought a Shimadzu brand angiograph in 2019 for 22.9 million hryvnia. Journalists’ publications about the installation of the device in the city hospital remained online. At the same time, it is difficult to establish for certain the specific models of devices shown in pro-Russian media stories.

“Verstka” contacted one of the officials of the Berdyansk administration, who oversaw the purchase of equipment for hospitals. After the invasion began, he remained to live in the occupation.

“In recent years, we have purchased a lot of things, updated the equipment as best we could, and made it available for hospitals,” says the interlocutor of “Vestka”. — We purchased an angiograph, X-ray machines, mechanical ventilation, and CT. The same instrument for fibrogastroscopy. And they showed this equipment of ours in their news and said that it was they who bought it and brought it new! Although in reality it all happened in hospitals!”

“Verstka” discovered several more pre-war purchases related to X-ray machines and ventilators, but it is impossible to compare them with those mentioned by pro-Russian media. In some publications there are no frames with equipment or it cannot be identified.

At the same time, problems with the supply of medical equipment are observed not only in the occupied regions, but also in the constituent entities of Russia

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According to Vorstka’s interlocutor in one of the regional administrations of the Central Federal District, officials everywhere were faced with “the problem of purchasing and updating high-tech equipment.”

“A large medical center is being built, the main one in the region. They will make the walls, they will even find the staff with grief. But the level of treatment in the end may not correspond to why it was built in the first place, says the interlocutor of “Vestka”. “In such institutions, according to the plan of the Ministry of Health, and according to the usual logic, care should be provided that is impossible in the first aid station or district hospital - complex diagnostics using tomographs, operations of increased complexity, which then, if successful, are proud of the entire region and are presented at federal symposiums. But the equipment for them is completely “unfriendly”. German, Japanese. And there are two problems with its purchases: on the “other side” they don’t sell, but on our side they “substitute imports.”

According to a source from Vestka, in most cases, when the necessary equipment is not available or cannot be purchased, medical institutions are forced to stand idle without it, waiting for the purchase to be completed.

Most often, equipment is “import-substituted” by companies from friendly countries. For example, this year the Stavropol Territory purchased six VENTUM 32S computed tomographs produced in Belarus. At the same time, the Kaluga Regional Clinical Hospital purchased an optical tomograph manufactured in “unfriendly” South Korea. We are talking about the 2023 Huvitz HOCT‑1/1F model . Although South Korea, as part of the sanctions, has banned the export of 1,159 types of goods to Russia, medical supplies are not among them.

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Local medicine: “It’s hard to find anything other than paracetamol or activated charcoal”

According to residents of the newly annexed territories, the health care situation today is incomparable to pre-war conditions. One of the differences is in the attitude of some doctors towards patients.

“The doctors [on the ground] are the same, Ukrainians,” says Mikhail, a resident of a village in the Kherson region. — The attitude is normal, just a little patronizing. When the Russian Federation came, they seemed to feel their importance: we give medicine to this one, but not to the other one. Такие маленькие боги. There is nowhere to complain, no one cares. Here, either you are friends with them, or you will be forgotten and no one will help you.”

He explained the difference in the quality of services provided and the availability of medicine using the example of his mother. The elderly woman has been sick for several years and needs constant treatment.

“Mom must constantly take medications and donate blood,” says Mikhail. — Blood needs to be donated every six months, but now they take it only once a year. The doctor said that if we really need tests [more than once a year], then we ourselves need to go to Simferopol and get tested there. For my mother, this is like climbing Hoverla. ”

According to Mikhail, another difference is in the range of medications. A resident of the Kherson region says that after the invasion began, there were no Ukrainian-made drugs left in local pharmacies that his mother had previously taken.

“Mom went to the pharmacy, it was somewhere towards the end of spring,” Mikhail recalls. “He says he sees some military men who, right in front of the pharmacy, are beating boxes with some kind of capsules and tablets with sticks. She asks what they are doing. They say that these are Ukrainian-made drugs and that you won’t see them here anymore. This punitive action by the military against boxes of medicine was noticed only once. But the result is obvious - there are no Ukrainian-made medicines .”

Mikhail notes that to this day in the region people resell to each other the remaining packages of familiar Ukrainian-made drugs. A whole group was organized on Facebook for this purpose. The cost of Russian medicines, he said, is on average two times higher than pre-war Ukrainian prices. People are forced to buy them, says Mikhail, but they receive life-saving products free of charge with a doctor’s prescription.

“Mom bought a chocolate bar for the doctor so that she would give medicine not for 1 month, but for 2, well, such local corruption, this didn’t exist before the Russian Federation, if you don’t like something, you say it out loud, and then everyone runs around, so that God forbid there is no conflict,” Mikhail recalls.

A former employee of the Berdyansk administration also spoke about local corruption. According to Vorstka’s interlocutor, in one of the city’s hospitals, doctors “resell” medicines, presumably to pharmacies. The doctors interviewed by VERSTKA also noted that they were aware of such cases.

“There were rumors that many pharmacies here in the regions sell humanitarian aid, but I personally have not seen it. Well, you know, there is a proverb: to whom is war, to whom is mother, ” says Mikhail, a surgeon from Siberia.

In the “LPR,” one of the local telegram channels talked about the resale of disability certificates, bribery in hospitals for operations and treatment, and underpayments to employees.

“Before the start of the SVO, medicine in the LPR existed at the expense of humanitarian aid,” says the channel administrator, who asked not to mention his name. — There was not such a meager range of medicines, because a lot of things were brought from Ukraine. It was possible to get almost any medicine, including Western ones. Так было до начала СВО. In 2022, chaos and an era of change began. They stopped transporting drugs from Ukraine, and import substitution was done in a hurry. Most of the Republic, which was liberated, generally remained in the Middle Ages: even now, in the villages, you can hardly find anything other than paracetamol or activated carbon.”

Personnel shortage: “There are no people willing to work permanently while hostilities are going on”

Besides corruption, the interlocutor of “Vestka” calls the lack of medical personnel one of the main problems of the region. “Doctors (and indeed any people of sound mind) are reluctant to move here from the rest of Russia, so other regions have to send doctors on business trips as if on a shift. For 5 medical positions, 3 are vacant,” says the administrator of the Lugansk telegram channel.

Elena, a psychologist from Moscow, who visited the Lugansk region in 2023, answering a question about the shortage of doctors, says: “It was not such that there was no one to go to work tomorrow.” But he admits that doctors had to work several shifts without rest.

In the Zaporozhye region, the most acute shortage of medical personnel is noticeable in small villages and hamlets, notes Ivan, an endocrinologist from Mordovia.

“There are no people willing to work permanently while hostilities are going on,” says Ivan. — There, of course, they are trying to normalize the situation, they are posting vacancies, the Ministry of Health is working, but there are no particularly willing people. It may now be possible to attract [personnel] to Melitopol, as the regional center of the Zaporozhye region, but they don’t really go to provincial towns.”

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Over the past two years, the level of supply of medical personnel has been falling in almost all Russian regions. By 2022, the sector was short of at least 75 thousand employees. Due to the lack of necessary specialists in the same year, more than 44% of Russians did not receive help in clinics, and the number of doctors at emergency stations continued to be reduced . The Ministry of Health explains the lack of local staff by the disproportion in the distribution of specialists between territories and the outflow of personnel to private clinics.

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At the beginning of 2023, medical institutions in the occupied parts of Zaporozhye, Kheronson, Donetsk and Lugansk regions were not even half staffed with doctors and medical staff. Representatives of the authorities assured that “new doctors are coming to the regions at a good pace and old ones are returning.”

As “Verstka” calculated, by February 2024, 824 vacancies will be open in 178 registered hospitals and clinics in the occupied regions. Еще 1250 размещены в архиве. Medical institutions are looking for personnel, ranging from cleaners and technical staff to management.

To attract employees, the Russian government, among other things, extended the “Zemsky Doctor” and “Zemsky Paramedic” programs to the newly annexed lands. They imply additional payments to health workers when relocating: until recently, payments amounted to up to one million rubles, and when moving to remote and hard-to-reach cities and villages - up to 1.5 million. According to the terms of the contract, after receiving the payment, health workers are obliged to work on site for at least five years. True, many do not wait until the end of the contract; and the main complaints against the program are low salaries, lack of social infrastructure for living and problems with the arrangement of hospitals.

In 2023, 190 million rubles were allocated for such payments. In order to cover the costs of the newly annexed territories, the authorities cut payments to doctors in 21 Russian regions, where there was already a shortage of specialists.

Apparently, the sacrifices were in vain: there was no significant increase in personnel in the so-called DPR, LPR, Zaporozhye and Kherson regions. Already at the end of 2023, the head physician of the Melitopol Oncology Hospital, Konstantin Lakunin, on a direct line with Putin, asked to raise the level of payments to encourage health workers to move. Putin responded by proposing to double the so-called “lifting” i .

However, a small number of Russian doctors still move to the occupied regions. This is what, for example, the author of the question to Putin did, Konstantin Lakunin, who took the post of head of the Melitopol cancer hospital. Being a native of the Moscow region, he headed the central hospital in Reutov for about 20 years, during breaks holding positions either in the Ministry of Health of the Moscow Region or at the Medical Academy. I. M. Sechenov.

While working in Reutov, Lakunin was tried for libel. An application was filed against him by Tatyana Amelina, a patient in the maternity ward, whose child, according to her, suffered from the actions of doctors and subsequently died from the injuries inflicted, and the woman herself received disability after giving birth. Lakunin then stated that the goal of the woman who filed complaints and demanded that doctors be punished was for personal enrichment. The court acquitted the head physician of the hospital.

“You know, I forgave them all,” Tatyana Amelina tells the “Verstka” correspondent. — It was almost 20 years ago. Я решила их простить. Regarding Lakunin, I wanted to ask only one question: how does he manage a cancer hospital, when his specialty is not an oncologist, but a neurosurgeon?”

Lakunin moved to the Zaporozhye region from Reutov after the war. He officially headed the cancer hospital in Melitopol in February 2023, and in December 2023 he became the head of the medical trade union.

“The forms of our interaction will be completely different. In addition to public work to protect the rights of industry workers, we will also hold sports events, competitions, a competition for the best nurse, KVN and many interesting things,” he commented on his appointment as head of the trade union.

“Vorstka” discovered that at the end of February Lakunin updated his resume on one of the job search sites. He noted that he was looking for a job as a chief physician again in Reutov with the desired salary of $2,500 or 229 thousand rubles. However, he did not indicate work experience in the occupied regions in his resume.

Salary difference: “We don’t need your money”

As Vverstka’s interlocutors from among regional residents say, the problem is not only in attracting new employees, but also in retaining old ones. In the first months of the occupation, the pro-Russian authorities introduced special payments in the regions for local doctors: 15 thousand rubles above their salaries. One of Vorstka’s interlocutors, a former official from the Zaporozhye region, said that at the beginning of the occupation people were reluctant to cooperate, but it soon became clear that the Russian army did not plan to leave Ukrainian territories.

“When the banks opened, they started working through Crimea, and all Ukrainian accounts were closed. People in the city were left without money,” says the source. “They [representatives of the pro-Russian authorities] came with Kamaz trucks and handed out cash for work. Initially, 80% of locals said: “We don’t need your money.” But time passed, people's supplies of food and water were running out. And, of course, people went to look for work in order to somehow survive in these conditions .”

An ex-employee of one of the hospitals in the Donetsk region says that a common reason for dissatisfaction is the difference in the salaries of ordinary medical workers and their management. Doctors from the “LPR”, as well as employees of the Berdyansk Medical College, speak about similar problems.

“For example, you, working for several rates, receive, conditionally, 30 thousand rubles with all possible allowances, and your boss, who appears at work for 3–4 hours, writes out bonuses for himself and receives 100 thousand. You look at it, at first you endure it, and then you think, fuck you all,” says the publication’s interlocutor.

Officially, as of July 1, 2023, in the “DPR” the average salary of a doctor was 59,276 rubles, and that of medical staff was 42,868. In December, according to government reports , the salaries of doctors increased to 64 thousand rubles, nursing staff - to 44 thousand, and junior medical staff - to 28 thousand.

The interlocutor of “Vestka” notes that the amounts are inflated: “They calculate the average salary, adding up the salaries of the management. And then, you understand, who has enough imagination for what numbers.”

In advertisements for available vacancies for medical staff in the “DPR”, which “Verstka” was able to discover, the administrations of medical institutions also indicated salaries much lower than the official ones. For example, in Makeyevka doctors were offered 24–28 thousand rubles per month, in Yenakiyevo paramedical staff were promised 25 thousand rubles per month, and technical specialists (cleaners, plumbers, janitors) in Gorlovka were promised 18–19 thousand rubles per month.

В больницах «ЛНР» тем временем врачам предлагают в среднем 19 – 36 тысяч рублей, медперсоналу — 16 – 25 тысяч рублей, а техническим сотрудникам — 16 – 20 тысяч. В оккупированной части Херсонской области «Вёрстке» удалось найти вакансии лишь в одной больнице — Каховской ЦРБ. Там врачам предлагали порядка 80 тысяч рублей, среднему медперсоналу — 50 – 60 тысяч, а уборщику — 30 тысяч рублей.

Самые высокие зарплаты в больницах на оккупированных частях Запорожской области. Так, к примеру, врачам в Мелитопольской больнице готовы предложить до 50 – 100 тысяч рублей в месяц, в зависимости от квалификации, а в Приморской ЦРБ зарплатная вилка составляет 25 – 120 тысяч, также в зависимости от квалификации специалиста.

Страх преследования: «Я не знаю, можно ли здесь кого-то считать коллаборантом»

«Очень большой аспект моей работы в Мариуполе был связан с оказанием психологической помощи самим медработникам, которые там живут, — вспоминает психолог Елена. — Мало того, что они сами страдают, они же ещё должны и помогать».

Десятки медиков, проживающих в зоне оккупации, отказались говорить с «Вёрсткой». Одни ссылались на то, что им нечего сказать. Другие говорили про страх преследования и деанонимизации. «Никто не может ничего мне гарантировать», — ответила «Вёрстке» одна из медсестер через посредника: лишь на таких условиях девушка согласилась пояснить причины отказа.

«Они сейчас стараются не светиться, да», — сказал один из российских врачей, рассуждая об украинских коллегах.

Несколько собеседников «Вёрстки», выступавшие посредниками при связях с врачами на местах, объяснили, что часть медиков опасается преследования со стороны пророссийских властей . Экс-чиновник из горадминистрации в Запорожской области рассказал «Вёрстке», как сам в начале вторжения пострадал от такого преследования. Он пережил пытки и провел в заключении несколько месяцев. Об условиях своего освобождения собеседник «Вёрстки» говорить публично отказался.

«Мне они предлагали пост в администрации. Я отказался, — вспоминает он. — Это было еще в первую неделю оккупации. После этого меня вывезли куда-то в их помещения, держали там и избивали. Так происходило с людьми до тех пор, пока не находился тот, кто согласится. А [учитывая], что тебя ждет за отказ, очень сложно не согласиться. У меня семьи не было в городе на тот момент, мне нечего было терять. А у тех, у кого родные оставались — было что. Поэтому я не знаю, можно ли здесь кого-то считать коллаборантом».

Еще одна причина, по которой медики отказываются от интервью — страх возбуждения дел о коллаборационизме в Украине. Это преступление, по которому украинские власти судят тех, кто пошел на сотрудничество с оккупационными администрациями. Тем не менее, по разъяснениям суда, обвиняемыми в коллаборационизме могут стать лишь медики, которые заняли руководящие посты, публично поддержали пророссийскую власть и всячески способствовали её деятельности.

Украинские СМИ регулярно публикуют материалы с разоблачением тех, кто пошел на сотрудничество с оккупационными властями. Героиней одного из материалов оказалась главврач Приморской ЦРБ Наталья Бровченко, которая, по данным СМИ, участвовала в организации референдума в 2022 году и передавала пророссийской власти списки врачей, подлежащих мобилизации. Также журналисты писали , что главврач Мариупольской больницы скорой помощи Сергей Орлеанский после вторжения и оккупации сохранил пост, а в сюжете «Первого канала» рассказал об обстрелах города военными полка «Азов». Сейчас жена главврача больницы Галина Орлеанская ведёт программу о медицине на пророссийском телеканале «Мариуполь 24», а сын — работает в той же больнице, что и его отец.

В «ЛНР» подобные публикации касались главврача больницы города Счастье Олега Супруна. В 2015 году медик получил звание «Заслуженного врача Украины», но в 2022 поддержал оккупационную власть. «Супрун — человек старой закалки и будет хвалить любую власть и любого министра здравоохранения», — говорит редактор местного телеграм-канала.

«Люди привыкли переобуваться в нужное время: поверьте, вчерашние врачи, которые лечили российских военных, после прихода ВСУ будут петь гимн Украины в вышиванке», — говорит Михаил, житель Херсонской области.

Вместе с этим, украинское законодательство предусматривает ответственность за получение российского паспорта в оккупации . В январе этого года Владимир Зеленскийвнёс проект закона об изъятии имущества тех, кто добровольно сменил гражданство.

Пророссийские СМИ на оккупированных территориях регулярно публикуют сообщения о том, сколько человек получили российский паспорт. Михаил из Херсонской области объясняет, что простые жители часто идут на это вынужденно, чтобы получить полис медстрахования и бесплатную медпомощь: «Постоянно медики говорили [маме], что в будущем без паспорта РФ вам лекарства бесплатно не дадут, нужно брать паспорт. Ну мама и взяла паспорт». В то же время, судя по постановлению российского правительства, украинцы в оккупированных регионах продолжают получать медицинскую помощь в рамках базовой программы обязательного медицинского страхования. Она не требует смены гражданства и получения полиса.

Собеседники «Вёрстки» отмечают, что их знакомые медики тоже были вынуждены сменить гражданство для того, чтобы беспрепятственно получать зарплату. Тем не менее, как рассказывает собеседник «Вёрстки» из Запорожской области, часть врачей остались в оккупации и продолжают работу ради собственных пациентов — без притязаний на руководящие посты и желания стать российскими гражданами.

«Я знаю врачей, которые оставались тупо потому, что не могли бросить пациентов. Одна моя знакомая кардиолог так и сказала: “Я не поеду, на кого я их оставлю, их тут просто убьют”, — вспоминает он. — А у нее в пациентах в основном пожилые люди. Так она осталась и хоть присматривает за ними, лекарства добывает, которые реально могут помочь. Повезло этим бабушкам и дедушкам».

Идейные различия: «У них не было войны до начала СВО, понимаете?»

«Я видел людей, которые занимались тем делом, на которое они не подписывались, — говорит терапевт Алексей. — Например, молодой коллега, который был единственным врачом на сотни человек. Обычный, тихий, улыбчивый парень, а он тем временем провел в этой больнице под обстрелами много времени, видел гибель своих коллег. В жизни я бы по нему не сказал, что он пережил такое, а он пережил, справился».

Михаил вспоминает историю коллег по больнице, которые фактически поселились в ней с первых обстрелов. «Когда началась… когда начались боевые действия, там на смену как раз пришла хирург, великолепная доктор, и был еще заведующий, — говорит Михаил. — Они друг друга сменяли и так до лета в больнице оставались жить и работать».

Российские врачи, с которыми побеседовала «Вёрстка», говорят, что не знают случаев, чтобы местные медики были бы чем-то недовольны или высказывали им претензии. Но в ответах на вопрос о негативе со стороны пациентов собеседники «Вёрстки» разделились.

Алексей, терапевт из Санкт-Петербурга, говорит, что «очень удивился бы, если бы столкнулся с массовыми случаями хейта в свой адрес».

«Потому что я приехал и лечил. Это же больные люди, которым нужна помощь. И я не видел я ни одного случая хейта в свой адрес. Я не помню такого от слова совсем, — говорит Алексей. — Пришел пациент, я его проконсультировал, какую-то первичную помощь оказал, где-то скорректировал терапию, где-то назначил новую, отправил домой. Все люди так или иначе понимали, что с медицинской помощью трудно. А тут я приехал, все сделал. Если вдруг у кого-то там даже и были какие-то мысли… то, что ему помогли, не давало этим мыслям всплыть».

Михаил из Сибири, отвечая на вопрос о негативном отношении, говорит: «Вы же понимаете — либо “ДНР/ЛНР”, которые, восемь лет оказывали сопротивление, либо Запорожье/Херсон, у которых все это время другая ситуация была?» При просьбе пояснить, он уточняет, что «в “ДНР” и “ЛНР” восемь лет шла война», в то время как в Херсонской и Запорожской областях её не было.

«Люди, естественно, все разные. Я не хочу в политику вдаваться. Такие понятия, как “ждуны” не хочу говорить, — рассуждает Михаил. — Мы в ДНР когда шли, они нас действительно ждали. В Донецке люди ждали. В Мариуполе, это тоже ДНР, хотя город был под контролем Украины, но, тем не менее, тоже ждали. А Херсонская область… У них не было войны до начала СВО, понимаете? Даже донецкие говорят, что они там бандеровцы».

Большинство опрошенных «Вёрсткой» врачей в ходе разговоров говорили, что поддерживают действия российской армии на территории Украины и находили этому разные объяснения: от историй про жестокость солдат ВСУ до историй героизма российских военных. При этом все собеседники «Вёрстки» утверждают, что ехали лечить мирных жителей, пострадавших физически и морально, потерявших свои дома и близких.

«Помните, был такой вопрос: “Где вы были восемь лет?” Все эти восемь лет я представлял чуть лучше, чем в среднем по стране, что происходит в народных республиках, что там зачастую гуманитарный коллапс, что там нет врачей и так далее, — говорит терапевт из Санкт-Петербурга Алексей. — Я понимал, что всё то же самое, только в острой фазе будет в зоне боевых действий или в зоне, где боевые действия были только что. Поэтому я понял, что если до этого я не ездил [туда] как волонтер, то сейчас уж точно самое время. Люди страдают — надо поехать и помочь, чем могу».

Infographic: El
Illustrations: Dmitry Osinnikov

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