The ragtag force of volunteer paramedics evacuating Ukraine’s injured

On a rainy day in October, Polish paramedic Jakob Balaban and seven of his colleagues woke up before dawn to evacuate eight patients out of Ukraine. All of them were young soldiers, forever branded with the kinds of injuries that have begun to mark this iteration of the war on a daily basis: amputations, fléchette wounds, limbs held together by metal cages.

It was a typical run for Balaban’s volunteer team. Since he started transporting patients out of Ukraine in March, he’s done evacuations like this almost every day. They transport as many patients as their vehicles can fit, usually five to 10 who are stable enough to travel and need surgeries or rehabilitation that Ukraine’s hospital system can’t accommodate. In total, his small team has transported nearly 2,000 patients, the vast majority of them injured by Russian attacks.

Evacuations like those Balaban coordinates are essential as Ukrainian hospitals buckle under the pressure of caring for war casualties on top of the country’s standard health-care needs.

In the rural outskirts of Lviv in western Ukraine, a church lent them space on its campus to set up a makeshift base camp. At any given time, Balaban has between a half- to two-dozen emergency medical technicians on duty, out of a force of around 60. For an early morning transport like this one, the primarily Poland-based volunteers will head into Ukraine the night before and sleep at the base camp. On-duty EMTs cook a family meal together before sleeping in a cramped room, where cots with mismatched linens line the walls. That night’s dinner was chicken stir-fry. The on-duty paramedics waited for Balaban and another volunteer, Michal Leczynski, to commute in from Warsaw before eating, around midnight. A few hours later, they would head to a hospital in Lviv to triage the day’s patients.

Three days after Russia invaded Ukraine in February, Balaban unilaterally decided his role. A career paramedic who served in Poland’s air ambulance service, he recognized the tactical challenges emergency responders in Ukraine would face. Chief among these was that Ukrainian men ages 18 to 60 wouldn’t be allowed to cross the border as easily as he could as a Polish citizen. Within 10 days, Balaban had solicited enough donations from Polish companies that he could afford two old ambulances. A friend connected him with a Polish nonprofit called Humanosh so he could easily accept donations, and Balaban’s ragtag force of volunteer paramedics began making almost daily runs from across Ukraine to Poland.

“I know that somebody in my age now is on the east side and in five or 10 minutes will be hit by rockets or by bullets,” he said. “I see a father die, a mother without legs, children without arms. So, I’m not tired.”

Balaban and other ground evacuation teams coordinate with the Ukrainian and Polish governments, the European Union and the World Health Organization to determine where each patient will be treated, based on resources available in that country to treat certain conditions. In September, the E.U. and WHO partnered with the Polish Center for International Aid (PCPM) and opened a medical evacuation hub near the Rzeszow, Poland, airport, where patients needing emergency care can be treated or stabilized before the next leg of their journeys - something that might be necessary if winter weather makes the trip difficult.

“They were doing this process without help,” Adam Szyszka, a medical coordinator and paramedic with PCPM, said of ground transport teams such as Balaban’s. “Sometimes the airspace is closed, or because of weather they cannot continue to travel. They need to stop somewhere.”

In October, the rain on the path from Rzeszow to Lviv was usually manageable for Balaban’s overworked vehicles. All of his ambulances were donated or purchased cheap and jury-rigged with equipment needed to treat combat casualties. They were reorganized to fit patients, their evacuating families and a few pieces of luggage. Since most of the patients have traumatic injuries but are stable enough to survive the long drive, Balaban said, he forgoes some equipment that might take up space and not get used. The result is a utilitarian fleet of rigs with no singular setup.

“They’ve all got the lamp for check engine,” he joked. “They’ve got no brakes.”

It took Balaban’s team only a few hours to get their patients from the hospital in Lviv to the tarmac in Rzeszow, where a Spanish air force aircraft was waiting for the transfer. The soldiers they transferred had been injured on the front lines in eastern Ukraine and transferred among hospitals and medical clinics over several weeks until they made their way to one in Lviv. Between Lviv and Rzeszow, the caravan of ambulances bypassed the kilometers-long line to cross the border into Poland. By 11 a.m., several waypoints and weeks removed from the front lines where they were injured, the patients were headed to Grenada, where an E.U. hospital volunteered to provide them with long-term, specialized treatment.

As Balaban’s crew ate its first warm meal of the day at a traditional Polish restaurant minutes from the border, their patients were already in the air.

Between bites, Balaban turned his phone to show a video of one of his old rigs, a black skeleton of a vehicle engulfed in flames. It was hit by a missile during an evacuation in Kherson in March, he said, when Russia was hitting health-care facilities. That’s when things were the most difficult. His phone was so full of footage like this - of ruins, fire, carnage and broken medical equipment - that it took a few seconds for each image to load. Then, his finger landed on a picture of a dog, and his deep worry lines gave way to a smile.

“Her name is Sparta,” he said.

Over the previous two days, he’d slept a total of six hours. “It’s nothing,” he said.

Everyone on Balaban’s team is a volunteer, and the vast majority are Polish. For months while they waited for funding from the WHO, no one on his team got paid. Many are also full-time students or have day jobs. Leczynski headed straight to work after lunch. Balaban went home to a wife, two kids and Sparta. When asked whether he was worried about being targeted by Russian forces again, Balaban laughed.

“Please, the Soviets know me,” he said. “If they want to find me, they’ll find me.” He had just gotten word that a Polish city would be donating two old buses to his fleet so he could transport more injured soldiers at one time. He was more concerned with that.

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This reporting was supported by the International Women’s Media Foundation’s Howard G. Buffett Fund for Women Journalists.