I often remark that I like to “see my news firsthand” and not rely on reading and hearing others’ reports. I’ve just returned from central Ukraine – navigating the set nighttime curfews and 12 midnight to 4 AM travel restrictions, unpredictable fall weather conditions, and air-raid sirens. This isn’t my first time in this country; my visits to Ukraine have been numerous – even last year and during the pandemic. But this one felt like a first. War makes everything different. War takes its toll on civilian health – physical and psychological.

No Military Value – Yet Still Struck by Missiles

Each year, I head to a small city of 90,000 residents called Uman– a community between Kyiv and Odesa. – two cities hard hit continuously by Russian targeting of civilian populations and the destruction of hospitals and schools. I’ve often written about my reasons for going to this distant town. This year, the motivation to share is different. Ukraine is in the second year of defending itself against a formidable aggressor in Russia. The ongoing conflict has resulted in the merciless bombing of Ukrainian cities and civilian infrastructure.

Uman has no military bases, yet Russian missiles have targeted this historic city. On April 28th, toward the end of the nighttime curfew, Russia launched more than 20 long-range missiles against residential buildings in Uman. Russia claims it was “aiming for the reserve units and used high-precision weapons” – but no soldiers were counted among the scores of civilians killed and wounded. There are no military or otherwise strategic targets within the city. Like the war, this attack was launched without rhyme or reason.

Not New to War and its Civilian Impact

I’m not new to war. I served for six years as a paratrooper and combat medic. I’ve seen how constant exposure to violence and desperate displacement impacts civilians. I’ve seen firsthand classic images of people pushing wagons with salvaged household possessions—mothers carrying their babies to safety. I’ve even seen the fronts of buildings peeled off, creating a dollhouse effect, and watched families in these apartments continue daily routines in this surreal setting.

Whenever I had time and permission – the latter always given – I joined other medics entering refugee camps to treat civilians – often women and children. Faces of gratitude are still etched in my thoughts. Decades afterward, those images are vivid.

Many years later and in Ukraine, I remain confused and troubled at how the world continues to let Russia brutally attack Ukrainian cities and issue outrageous statements that its targets are military and not civilian. In Uman, I saw firsthand that these missives are bald-faced lies.

When Shells Stop Raining – the Sewage Flows in the Streets

One evening, leaving a dinner gathering, I thought there had been a heavy downpour that escaped my notice while indoors. The main street had become a fast-flowing river – something I’d seen before. But the sidewalks were completely dry. This wasn’t rain runoff, and the smell confirmed it. This was backed-up sewage running down the street.

During my five-day visit, there were ample indicators of infrastructure buckling under wartime stress. The power was unpredictable. Streets were damaged. Refuse piled high. And all the while, air raid sirens warn citizens of risks – even in the still quiet that prevailed. People are on edge.

But I also saw remarkable resilience. The central marketplace was teeming with shoppers picking choice fruits and vegetables. Shopping bags were printed with words of encouragement – “Ukraine –Be strong and courageous.” The coffee shops were filled. As they have for years, people again welcomed me and were thrilled to see that the world stands with Ukraine and its struggle as a developing democracy to press forward. One man hugged me and said: “America,” – reflecting an appreciation for continued generosity.

War and Public Health Intersect

What is the impact of people fleeing, leaving behind loved ones, and being exiled, not knowing when it will be safe to return or if they’ll be able to at all? In these instances, refugees and internally displaced persons often first live in temporary housing with unsanitary conditions, making them susceptible to illnesses that range from flu to COVID-19. I helped people with primary health concerns resulting from stress and sanitary conditions.

While many men are mobilized or supporting the defense infrastructure, displacement disrupts access to education and care, particularly for women and children, contributing to long-term health disparities. In nearby Moldova, where I visited during the past two years on my way to and from Ukraine, I marvel at how a small nation – called Europe’s poorest – opens its borders and houses people not in tents but rather by ordinary citizens throwing open the doors to their homes. Places of worship have become free food centers for the hungry. I saw the power of kindness become an operational governmental guide and policy as Moldovan citizens rallied to help their refugee neighbors.

Physical and Mental Health Casualties

How will we measure and address the mental health needs of the civilian population? They are not warriors trained to fight. But they are certainly in the thick of a different battle. Hospitals and clinics are targeted and damaged, and healthcare workers are forced to flee or have joined troops at the frontlines. This lack of access and limited availability of medical care translates into diminished health of people whose conditions might otherwise be manageable in normal circumstances.

The news media may worry that their readers and viewers are growing weary of this war—ratings and viewership rule. In response to the numbers, they move on to other topics. That plays into the hands of the aggressor. That’s what Russia hopes for –the world’s attention will turn elsewhere, and Ukraine’s appetite for perseverance will wane, securing a dictated unjust victory.

Apathy is the Aggressor’s Ally

As my friend and teacher, Nobel Prize recipient, the late Elie Wiesel, said in his “Perils of Indifference” White House remarks: “The opposite of love is not hatred, it’s indifference… Even hatred, at times, may elicit a response. You fight it. You denounce it. You disarm it. Indifference elicits no response. Indifference is not a response. Indifference is not a beginning; it is an end.”

While I have returned from Ukraine, memories are vivid and will be shared. As I reflect on this visit and compare it to my others, I am already thinking about my next journey and the friendly faces that welcome me each time. I hope and pray they are safe.

For my part and for whatever difference I can make, I refuse to give in to apathy. The human cost has been and is too high. A just and enduring peace must be the outcome.