In Donetsk, accordion player Anatoly Bukhtiyarov was a living attraction. They were known with drummer Nikolai Gladkov under the name "Grandfathers-rockers". Street musicians became famous in peacetime, but did not leave anywhere after the start of the hybrid war. They were even awarded some kind of medal from the self-proclaimed DPR for their contribution to cultural life. Nikolai Gladkov did not live to see a full-scale invasion, and Anatoly Bukhtiyarov was not protected by national fame. In autumn, a Donetsk celebrity was unexpectedly found in the regional center of one of the national republics of the Russian Federation.
Volunteer Diana Ramazanova, who tried to save the pensioner, is even afraid to name the region:
“I have hundreds of wards there, and I cannot spoil relations with the administration. And that's how we found it. Our volunteer brought a winter hat for one woman to a temporary accommodation center (TAP). And she told her that in one of the rooms there was some kind of grandfather, who no one cares about at all. This was the rocker Anatoly Bukhtiyarov.
He, along with many other old people from the unrecognized republics controlled by Russia, was evacuated either just before the invasion, or at the beginning of the war. Grandfather was cheerful, played the button accordion on the street, and with the money he earned he bought sweets and ice cream for the children from the TAP. And then he suddenly ended up in the hospital and returned from there already lying down. Diana still doesn’t know exactly what happened to him:
“Our volunteer was secretly told at the hospital that he had prostate cancer with complications. But then they put me in a palliative care unit for people with neurological problems. Although the grandfather remained in a perfectly clear mind. For the New Year, we gave him a player, uploaded music there. When the volunteer was handing over the gift, she said that if any other tracks are needed, we will upload more. And the grandfather gallantly replied: “I like everything that a woman likes.”
Diana and her associates were already preparing to take the pensioner to Finland for treatment, but he died. Like many other refugees from Ukraine, the grandfather rocker was never able to get proper medical care in Russia.
Alien among their own
Another elderly refugee, Vladimir Igorevich, born in 1944, was a Russian citizen at all, he simply lived with relatives near Kharkov. During the evacuation, they lost each other. The wife and son managed to get to Germany, and the pensioner himself disappeared. We found him, one might say, by chance, in a nursing home in the Belgorod region. He was lying there with a fractured femoral neck and terrible bedsores, sick and useless.
Volunteers from St. Petersburg bought the man a train ticket and hired an accompanying nurse. We were met at the station and taken to one of the hospitals. In the border regions, medicine is heavily loaded with wounded and refugees, so volunteers, Diana Ramazanova explains, are trying to take sick civilians to St. Petersburg or Moscow:
“But a few days later Vladimir Igorevich was expelled from there. The doctor told us that he could not leave a person whose documents are not in order.”
The fact is that when leaving the territory occupied by the Russian army, my grandfather lost his Russian passport. The volunteers had photographs of the lost documents, but they did not convince officials and doctors.
Vladimir Igorevich had to be placed in a paid ward. There he received treatment that was not very effective, but very expensive. According to Diana, even a simple blood sampling was estimated at 2,000 rubles.
When the pensioner was treated a little, they decided to take him to his relatives through Estonia. From St. Petersburg, only six hours by car to the border – the easiest way to medical evacuation. They hired a commercial ambulance for transportation. Another brigade was supposed to meet him on the other side of the border. Diana constantly called up the attendants:
“His pressure was jumping, and I even offered to cancel everything, pay, but not take him anywhere. The problem is that just these days, in early August, Estonia began to let people from Russia through badly. In the first months of the war, almost everyone was allowed in, but then they began to find fault. And they did not want to let Vladimir Igorevich with his lost passport. They stayed for several hours. I was in touch all the time. And right during the conversation, his heart stopped. They began to resuscitate him, took him to the nearest hospital, but they could not save him.”
Diana's voice breaks into a cry. But she also has stories with a happy ending. Albeit with a very bad start. For example, Victoria and Vladimir Shishkin, who were in the Mariupol maternity hospital during the infamous Russian shelling. The wife then received a shrapnel in the stomach and lost the child, the husband had to amputate his leg.
Diana at first did not even know what she was getting into:
“In May, a woman came up to me in a St. Petersburg TAC and asked me to help her sister and her husband. She said he had some problems with his leg. We remotely organized a meeting for them in Taganrog, transportation to Rostov-on-Don and from there to St. Petersburg. The train ran for two days, but we did not know then how difficult the situation was. On the way, Victor's temperature rose to 39 degrees. And he really could die – an infection in his leg, multiplied by a terrible psychological state.
The man's documents, of course, were Ukrainian. But doctors from a commercial ambulance forced the hospital to accept him. They stopped the infection, found additional fragments of a shell in the back, although they did not remove it. Meanwhile, Diana contacted one of the German hospitals:
“They promised to make him a good prosthesis. And we were able to take them out. Vika and Vova were given a separate house in Germany. The fragments have already been removed. Now they are forming a stump – they are preparing the leg for prosthetics. Vova recently bought Vika a teddy bear and sent me a photo where all three of them are sitting at the table.
Parallel system
During the war, caring Russians built an entire infrastructure to receive refugees from Ukraine. Its important element is the “Doctors to Help Refugees” Telegram chat. At first it was just an open correspondence, where patients applied, and doctors responded. Then, when there were more refugees, they made a chatbot. Now applications are automatically distributed among doctors of different specialties. For example, Evgenia, a pediatrician from Moscow, together with several other colleagues, helps sick children:
“Whoever frees himself first is responsible. The region is not important – everyone is consulted remotely.”
She spends about an hour a day on this free work. The first months of the war were especially difficult. A lot of refugees came, in crowded rooms, children were ill with SARS and intestinal viruses. Most of all there was a need for psychologists and dentists. After weeks and months in basements where there was no water for personal hygiene, many children complained of toothache.
A lot of refugees came, in crowded rooms, children were ill with SARS and intestinal viruses
They did not have compulsory medical insurance policies, and medical institutions often refused to provide assistance. And this was decided, according to Evgenia, not even at the regional level, but at the level of a particular clinic:
“One surgeon in Rostov-on-Don will accept, help, open an abscess, prescribe medicine and will not ask for any documents. And the other will not even talk without a compulsory medical insurance policy. Now it has become easier, because medical institutions have been informed that they still have to help refugees.”
Rheumatologist Irina, also a Muscovite, works in a TAC assistance group in one of the neighboring regions. And, according to her, even between them there is a big difference in terms of medical care:
“There are only three PVRs there. In two of them, people buy all the medicines if they have a doctor's prescription. Even expensive ones. A nurse is always present, and a doctor visits twice a week. The doctor comes to the third PVR only if he is specially called. And they don’t even buy analgin for the wards. Elderly people live there, many in poor health.”
Irina helps them buy medicines. Collects lists from refugees, excludes any means with unproven effectiveness, such as “immunity pills” popular in the post-Soviet space, and forms an order.
Pediatrician Evgenia admits that she also pays for medicines and tests for her wards:
“We had a boy with epilepsy who had not received anticonvulsants for a long time. The family had a recipe, but Ukrainian. We could hardly buy this medicine in Moscow and send it to a sick child. Another example is a girl with pyelonephritis. The situation is not life threatening. But she urgently needed to start antibacterial therapy, and for this she had to pass a urine test. And she flatly refused to take urine from her in the clinic. We had to chip in and do an analysis for money.”
Rheumatologist Irina in the “Doctors to Help Refugees” chat helps in her main profile – people with autoimmune diseases. And often takes in one of the two commercial clinics in which he works. One is more expensive, and there Irina can sometimes examine patients without paying at all. In a normal situation, friends and relatives of employees are treated this way, and now they are refugees. In the second clinic, we managed to agree that Irina's consultations for refugees are free of charge, and all other examinations are half price. And she usually pays these 50% of the amount out of her own pocket.
There are such specialist doctors and private clinics in almost all medical specialties. During the year of the war in Russia, a parallel state system of medical care was formed for civilians from the territories occupied by Russian troops.
During the year of the war, a parallel state system of medical care for refugees was formed in Russia
In theory and practice
Olga, a lawyer for one of the charitable organizations that helps refugees, explains that, purely legally, these people do not have the right to be denied medical care:
“Last summer, amendments were adopted to Decree of the Government of the Russian Federation No. 1134, and now people arriving from any region of Ukraine should receive emergency and emergency medical care, as well as free drug provision within the framework of state programs. The only condition is a diagnosis confirmed by a doctor, under which this medicine is required. In fact, people are often not provided with everything. For example, cancer patients are given chemotherapy drugs, but not painkillers. And this is not only about accounting drugs like tramadol, but also about simpler drugs like nurofen. In some cases, people with diabetes may be given insulin but denied glucometers and test strips. Usually, a person makes an appointment with a doctor, receives a preferential prescription, and uses it to receive medicine at a state pharmacy. This is a regular preferential provision of a person who is entitled to it. But with refugees, this process looks different: a person comes to a polyclinic, asks for a prescription, he is denied a discount, he starts complaining, they knock on the departments, he comes back to the polyclinic, and often they give him a certain amount of medicine without writing a prescription, – just give and take. The patient is provided for for some time, but it still rarely becomes a regular preferential provision.”
A refugee now receives a CHI policy along with the right to temporary asylum. And there is no need to give up the Ukrainian passport for this. Sometimes obtaining Russian citizenship even complicates matters, says Olga:
“As long as a person has a temporary shelter, his drugs are paid for by the federal budget. And as soon as he gets a passport, the burden falls on the region. The patient comes to the polyclinic, where he has just received medication, and he is told that the regional budget does not have funding for him. By and large, this should not be a problem for the patient, the region may request the missing funds. But often they do not want to do this. And only complaints help – to the regional department responsible for health care, or to Roszdravnadzor. The problem is that the people who need these drugs are sick and disoriented, they come from a war zone, and they simply do not have the strength to get their way. Many give up and lay down to die quietly. Or not quietly, but very painfully.
But this is all legal theory. Practice is much more complicated. For example, one of the wards of the same foundation, 65-year-old Maria Petrovna (name changed), only thanks to the war found out that she was infected with HIV. Having started to draw up Russian documents, she passed the test, which is mandatory in such cases, and it turned out to be positive.
Maria Petrovna, 65-year-old ward of the foundation, learned only thanks to the war that she was infected with HIV
For an elderly woman who does not belong to any of the risk groups, this was a real shock. Fortunately, in a private Moscow clinic, she was provided with drugs for three months of treatment as a charity.
But it turned out that obtaining a Russian passport and a compulsory medical insurance policy is a much longer story. In December, she applied to the fund. According to volunteer Anna, who helped her there, the elderly woman was most afraid of interrupting antiretroviral therapy:
“This is such a treatment that once you start it, you can’t take a break. And documents in Russia are drawn up for a long time. We bought her medicine for another two months. During this time, Maria Petrovna received a passport, but they still didn’t want to treat her in Moscow for free because of the lack of a permanent registration.
The fact is that the woman is from the region of eastern Ukraine, which Russia, after the annexation, considers its new territory. Therefore, in the Moscow infectious diseases hospital, they tried to send her to be treated "at the place of residence." The pensioner had to write a separate request to the Moscow Health Department. And only a month later she was provided with the prescribed free drugs.
The foundation has its own internal medical chat. And every second request for help there is diabetes. Here is a recent example: a 58-year-old man with a Ukrainian diabetes disability. He even had his toes amputated due to a concomitant complication called "diabetic foot." In the district polyclinic in New Moscow, he was sent to another city to see an endocrinologist. He confirmed the diagnosis, but instead of prescribing a medicine, he suggested that he apply for disability again, this time according to Russian rules. This whole event, trips to doctors in different cities is very difficult for an elderly sick person. But, according to the volunteer Katya who supervises the man, the matter is again in budgetary matters:
“The federal budget pays for the treatment of diabetes for people with disabilities, and the regional budget for ordinary diabetics. Theoretically, the region could apply to Donetsk to the Ministry of Health and ask them to transfer funds to Moscow to provide for this person. But I don't know of any case where this has worked."
As a result, Katya had to buy medicine, syringes for insulin injections and test strips for a month for 14,000 rubles. All this is donations from the foundation, and they have to be spent on what the state should give for free. There are many such cases. Diabetics fail to receive insulin, people with exacerbation of stomach ulcers – gastroscopy. A recent example from Katya’s practice is a grandfather over 70 years old from one of the regions recently annexed by Russia. He ended up under the rubble and lost his sight, and for a long time Katya tried to find someone who would give him a rather rare eye examination:
“I told everyone his story, I thought that people would have something triggered and they would want to help. But no, everyone was ready to examine him only for money. So, during the MRI, the doctors discovered what they call a stroke in progress, that is, a stroke that has just begun. It is rare luck to detect this condition so early. It was in the federal neurological center. So the doctors suggested that we go outside and call an ambulance. December, cold rain, and a blind elderly man with a stroke is told to stand there and wait. We decided to pay for an appointment with a neurologist right in the center – for another 3,000 rubles. After that, the doctor took pity and agreed to call an ambulance to her office. Although, perhaps, if my ward was a Russian, he would have been sent to the street to call an ambulance in the same way.
Just Russia
Some refugees found themselves without help, not even because of their difficult status, but simply because they are in Russia. In many settlements where TAPs are located, the situation with doctors was bad and without any war. Let's say rheumatologist Irina took her ward to Moscow just to show him to a normal neurologist. Pediatrician Evgenia had to pay for a psychiatric consultation for a small refugee:
“There are problems with sensible child psychiatrists in the regions. One of the children received free help, but the doctor wrote something not very reasonable – mental retardation. While the child was clearly not it. We found a good Moscow doctor. He correctly diagnosed ADHD. But this is not a unique situation for refugees. A child from a Russian family could be in exactly the same position.”
On the other hand, according to rheumatologist Irina, some elderly people from small towns in Ukraine generally for the first time in a long time got to normal doctors, Moscow, paid, who were found by volunteers:
“People are trying to fix their teeth, fix their eyesight. Many people say that: we have not gone to the doctors before. Вчера одной женщине собрали 80 тысяч на зубные протезы. И тут она написала, что не такие зубы хочет, а другие — еще на 12 тысяч дороже».
Ирине, по ее признанию, вообще далеко не все ее нынешние подопечные приятны как люди. Некоторые из них не хотят слушать врачей и не особо благодарны за помощь. Другие прямо признаются, что «думали три дня пересидеть в эвакуации, а потом стать частью России». Среди волонтеров, помогающих беженцам, много людей с антивоенными взглядами, а среди тех беженцев, что приехали в Россию, хватает пророссийски настроенных людей. Подчас с довольно агрессивной позицией. Но какие бы они ни были, среди них много больных и беспомощных людей, которым никто, кроме волонтеров, не поможет.
Среди волонтеров много людей с антивоенными взглядами, а среди беженцев хватает настроенных пророссийски
Ирина объясняет это так:
«Да, зачастую это вполне себе „глубинный народ“. Мы же не можем их сегрегировать. Одним помогать, а другим нет. Но так мы, волонтеры, помогаем еще и друг другу. Себе помогаем. Дети вырастут и спросят: мама, что ты делала в 2022 году? Что я им иначе отвечу»?
