Sixteen children have died in Ukraine since the start of the Russian invasion on Feb. 24, and 45 have been injured, according to official figures shared with TIME. Many of the wounded are being brought to Okhmatdyt Children’s Hospital in the capital Kyiv.
Ukraine’s largest pediatric facility has already evacuated patients with non-life-threatening conditions, but there are several children who cannot be removed from life support. Their numbers are growing as fighting around the Ukrainian capital intensifies.
There has been shelling near the hospital at night, according to surgeon Vitaly Demidov. Corpses and abandoned cars surround the hospital buildings.
“The saddest thing is that when the siren sounds, we have to go down with the children and parents to the basement,” Demidov tells TIME. “We run five or six times a day in the basement and back.”
He said that children on oxygen support needed to keep breathing while being moved, and this meant staff had to run alongside the gurneys operating manual ventilators.
An image of Demidov, with a rifle slung around his torso as he cradles a baby on life support, has gone viral since he posted it to Instagram on Feb. 26. Underneath, he wrote: “’It was very hot tonight. There are very [sick] children in the hospital, oxygen dependent.”
Volunteers have been bringing food, supplies and medicine. “So far, everyone is provided for,” Demidov posted, “but I don’t know for how long.”
Among the wounded is a boy whose 10-year-old sister and parents were reportedly killed by Russian saboteurs.
Another patient is a boy who suffered shrapnel wounds to his neck during the shelling of Kyiv. “Due to the severity of the injury, in order for us to stop the bleeding the boy had to undergo surgery right in the admission department of the trauma center of the hospital,” says pediatric surgeon Oleg Godik. The boy is currently in critical condition and on a ventilator.
Photos shared with TIME by Demidov and other hospital staff show several other children with appalling wounds. In one, a young boy’s right cheek has been ripped open. In another, a teenage girl lies on a gurney with leg injuries, her pants shredded and bloodied. One appears to show a young, lifeless body lying under a makeshift covering of cardboard. Several children, including babies, are seen lying in the hospital’s basement.
While attempting to save children injured in war, staff are also treating those with preexisting conditions. Amid the shelling, complex surgery was performed on a 15-year-old girl, who arrived four months ago from the Volyn region in Ukraine’s northwest, with a diagnosis of lymphoblastic leukemia.
Vadym Tkachuk, the head of the intensive care unit of the Center for Pediatric Cardiology and Cardiac Surgery, says that for now, the intensive care unit has been moved to the basement. Among them are newborn preoperative patients and children after cardiac surgery, many of whom are in serious condition. Some are on ventilators or undergoing dialysis. “There are also patients who are with their parents in the basement,” he says. “Currently, we only perform emergency surgeries on patients who [would] die without cardiac surgery. We have to postpone planned operations until the end of this war. The medical staff of the clinic has been working invariably since the beginning of the fighting, as not everyone is able to get to the hospital.” As he was writing to TIME, he received information that a child with a congenital heart disease had died because they could not reach the hospital.
Read More: Even If Russia Wins, It Won’t Do So Easily
Amid all of this, staff attempt to boost the morale of their young patients. Songs are sung and games played during air raids. Two birthdays have even been celebrated in the basement. But the challenges are overwhelming. Natalia Karpenko, head of the intensive care unit, struggles to contain her emotions. “The children are suffering,” she says.
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