"We accepted that we were going to die": the military anaesthesiologist who volunteered to go to the besieged Azovstal steelworks

In the spring of 2022, Oleksandr Demchenko volunteered to fly to the Azovstal steelworks, then encircled by Russian forces, in Mariupol. He knew that it could be a one-way trip, but it was not up for discussion – as with many other decisions he's made along the way.

Oleksandr hasn't allowed himself to dwell on the situations where seriously wounded patients had to be anaesthetised with mechanical ventilation and oxygen – not in an operating theatre, but in a cold, damp basement underground where the word "sterile" sounds almost like a joke.

There were no thoughts of surrender when medicines at Azovstal were running out and limbs had to be amputated under local anaesthetic – something that would be unthinkable under normal conditions.

Oleksandr is a military anaesthesiologist. During his nearly 10 years of service, he has worked in a mobile military hospital, flown with medical air evacuation teams, operated on and treated the wounded in the underground hospital at Azovstal, and endured Russian captivity and the notorious Olenivka prison camp. Following a POW exchange, he has returned to medicine: last year he signed up for Medical Education for Heroes, a training programme run by the Dobrobut medical network.

Now Oleksandr has shared his story with Ukrainska Pravda. It's the story of a man who time and again took responsibility for his patients, for sometimes unpopular decisions, and for working in situations where failing to be strong could mean leaving someone without a chance of life.

"I'm kind of the first one"

"There were no doctors in my family," Oleksandr says when we ask how he got into medicine. "I'm kind of the first one."

As a teenager, Oleksandr fell seriously ill and spent a long time in hospital. He says it was then that he first looked at medicine not from the patient's point of view, but from inside the process.

"There were complications: pneumonia, all sorts of details. I was in hospital for quite a long time. And that's when I started thinking: why is it that some people can pull others out? How does that work?"

A few years later, in 2008, he enrolled at Dnipropetrovsk Medical Academy.

"I can't say that I knew then exactly what I would become. But I had an inner sense that medicine was something serious, where you can truly be needed," Oleksandr recalls.

In his fourth year of medical school, Oleksandr decided that theory wasn't enough and went to work as a nurse in the burns unit at City Hospital No. 2 in Dnipro.

"I realised very quickly that just studying isn't enough. Theory's great, but you can't do anything without practice. So I went to the hospital. It was important for me to see what medicine looked like outside the lecture halls. To see patients, pain, anaesthesia, complications – what it's really like," he says.

"That was when I chose anaesthesiology, and I've never once regretted it. Of course there have been times when I've burned out. I think everyone who works in medicine for a long time goes through that."

Oleksandr graduated from medical school in 2014, just as Russia was starting its war against Ukraine. Even during his internship he wanted to join the military, but his parents insisted he finish his studies first: "They said, 'You'll be more useful if you complete your training properly and become a specialist.'"

"Either you take responsibility for that decision or you shouldn't be there"

In 2016, Oleksandr passed his exams and voluntarily enlisted in the legendary 61st Mobile Military Hospital, which was then based near the city of Mariupol.

"We didn't have a military department at the Academy – they'd all been abolished," the medic says. "So I joined as a private. After seven or eight months, I was given my first officer rank – junior lieutenant in the medical service.

At the hospital it very quickly became clear what battlefield medicine means. The responsibility it entails. The decisions that have to be made in conditions that no one prepares you for."

He recalls one incident near Volnovakha in Donetsk Oblast when a medical error could have cost not only the patient's life, but also the lives of everyone in the room.

At first everything looked normal enough, Oleksandr says. A wounded soldier was brought to the hospital and they began to stabilise him and get him ready for surgery. Usually this follows a standard procedure where every movement by the medics is rehearsed. It was only after the X-ray had been done that they realised what they were dealing with. It wasn't shrapnel in the wounded man's body, but a munition that had not fully detonated and had already split apart inside him.

"When I saw the image, I knew immediately that every next step was going to be risky. General anaesthesia in a situation like that is no longer just anaesthesia. The wrong combination of drugs can cause fasciculations – involuntary muscle contractions throughout the body. And when there's a munition inside the patient's body, fasciculation means the possibility of detonation.

That doesn't mean it would definitely explode, but the likelihood is fairly high. In effect, any mistake could have led to an explosion on the operating table," the medic explains.

At that moment, he says, it became clear that doing nothing was not an option. Leaving the operating theatre would have meant leaving that person without a chance of life.

"Either you take responsibility for that decision or you just shouldn't be there," the anaesthesiologist says.

The medics calculated everything down to the smallest detail. The anaesthetists did their part, the surgeon did his.

In the morning, the patient woke up – now without the munition in his body. He was passed on further along the evacuation chain.

"After that, any illusions I had about battlefield medicine finally disappeared. I'm not talking about the conditions or comfort, but about the responsibility, and the fact that you take it on completely," Oleksandr says.

Oleksandr was soon appointed acting head of the department, and later he became head of the rehabilitation department at the 61st Mobile Military Hospital.

In 2020, he transferred to the Eastern Military Medical Clinical Centre and began regularly flying with the medical air evacuation teams. They transported patients in Mi-8 helicopters from frontline mobile hospitals – often extremely critical cases on mechanical ventilation.

Oleksandr speaks about this as just another part of the job that you quickly get used to: "When you're constantly dealing with critical cases, your perception changes. You don't look at emotions, but at parameters. And at what needs to be done."

Up until 2022, like many others, Oleksandr believed that in the event of a full-scale invasion, the war would look more or less the same as in 2014. On 24 February 2022, those ideas were soon shattered.

"We understood that the road to Azovstal could be a one-way trip"

"When the full-scale invasion began on the morning of 24 February, after the speech by our enemies, everything was clear to me," Oleksandr recounts. "My bag was packed. I arrived at the hospital and I already knew what to do: be in the right place and wait for orders. Then there were months of very intense work – basically working 24/7."

And then there was the "specific mission", as the medic calls it.

Oleksandr is one of the heroes who volunteered to fly to the Azovstal plant in Mariupol when it was encircled by the Russians.

"A team was put together – two anaesthetists, two surgeons and a nurse – and it was made clear that this wasn't a standard task. At the time I didn't fully realise exactly where we were going and what awaited us there," he recalls.

They set off at night. A Mi-8 was waiting at the airfield. Oleksandr says it was obvious they would be flying a long way and that it could be a one-way trip, but there was no discussion: "In situations like that, no one sits down and starts debating it. You just do your job."

The flight lasted almost two hours. They flew at extremely low altitude, bypassing everything they could. As dawn approached, the sea came into view.

"We landed in the area of the seaport of Mariupol. A mortar attack started while we were unloading. The helicopter essentially worked like a pendulum: it landed, unloaded, took on the wounded and took off," the medic recalls.

Oleksandr later learned that the aircraft they had arrived on was shot down on its return journey.

After landing at the seaport, the medics received orders to approach the plant by water – it was the only possible way to reach Azovstal. Medicines, instruments, ammunition and provisions were loaded onto a boat, and they set sail.

"The engine on the boat died. By that time, the coast was already controlled by the enemy. Cold, water, spray.

I realised that if they started firing at us, we'd have to throw off our body armour, otherwise you'd drown in it," Oleksandr recounts.

As the medics reached the shore, a massive air raid began. Aircraft were coming in at supersonic speed and dropping bombs.

"At some point your brain simply refuses to believe that this is actually happening. You look at it and think: this can't be real. It's like in a movie. But it's not a movie. It's happening here and now.

I'd known Mariupol as a thriving city, a beautiful city with great infrastructure. And when we got there and I saw what had been done to it, the contrast was just incredible – there are no words to describe it. But I focused on why I was there, what I had to do there and, most importantly, that I had to make it to the Azovstal bunker."

Once at the plant, it became clear that this wasn't going to be over quickly. There were large numbers of wounded people, few medical staff, and minimal space.

"At first there was one operating room. But it soon became clear that that wasn't enough. We decided to work in a ventilation shaft, because there were no other options. It was an enclosed space and offered at least a minimal possibility to organise the work.

It was cold and damp. But the guys ran power lines, there were generators. And that helped a lot," Oleksandr says.

There was full general anaesthesia with an oxygen supply, albeit through a portable concentrator, he said.

"None of this was done in an operating theatre. It was done underground. In the cold and damp. In those conditions, the word 'sterile' is notional," the medic says.

The number of wounded kept rising. There was no separate post-operative ward – instead, there was one area where they brought all the "newbies" so it would be easier to monitor them: "You'd just walk between them and look: this one is breathing, this one's blood pressure is dropping, this one has problems with oxygen saturation."

As time went on, the medication began to run out. When the drugs for intravenous anaesthesia were finished and the ventilator had been destroyed, they had to switch to local anaesthesia for limb amputations.

"That would be unthinkable in normal conditions. But in those conditions, there were simply no other options. However, I want to stress that no one was operated on without anaesthesia. Even dressings – everything was done with pain relief. That was a matter of principle."

"We all accepted that we were going to die there"

Up to a certain point, the work at Azovstal was sustained by routine – insofar as that word can even be applied to an underground hospital in a besieged city. Wounded patients, operations, dressings, the shortage of medicine – all of it had become a familiar backdrop.

At Azovstal, Oleksandr says, "you quickly lost any sense of either the present or the future. We all accepted that we were going to die there, because, essentially, there were no other options."

The breaking point came after a heavy aerial bomb struck.

"I can't say with 100% certainty what it was," Oleksandr says. "But I feel it was something very substantial, like an FAB-3000."

The strike hit the upper floors of the building where the medics were stationed. The five storeys above them collapsed almost instantly. According to Oleksandr, they were mere seconds away from everything ending in a single moment.

"The blast wave was so strong that everything around us went flying – instruments, equipment. I remember that moment so clearly: I turned to the right, then – darkness, the smell of gunpowder and fire.

We were all wearing body armour and helmets, but that meant absolutely nothing. You're just thrown. You fly like a feather. I was hurled about seven metres and smashed into a concrete wall. The beds with wounded men lying next to me were lifted into the air.

Almost immediately a fire broke out. One of the exits was blocked and the other was on fire. There were about four or five hundred people there, including staff. We knew that if the smoke spread, we simply wouldn't get out," Oleksandr recalls.

In situations like this, he says, you don't think about being afraid: "You don't think about yourself or about being afraid. The only thing you think about is what to do next."

The medics and soldiers began extinguishing the fire, pulling people out and moving the wounded to safer places.

"Even in those conditions, we didn't stop working with the wounded. We were doing blood transfusions. And I can say for certain that everyone who had a blood transfusion that day was alive up until the moment we went into captivity," the medic assures us.

"In captivity, everything is reduced to basic things: cold, hunger, constant exhaustion"

Oleksandr describes the decision to leave Azovstal not as a single moment, but as a state that everyone there gradually arrived at. He says it was not unexpected, but it also wasn't something you could prepare for.

"It was clear that we couldn't hold out much longer. There were a lot of wounded, almost no medicines left, and the ability to work was minimal."

The departure was organised according to lists. People were called out in groups.

Leaving the plant was hard – not physically, but psychologically.

"You walk out and realise you're leaving behind the people you treated. The wounded you know by name. And that, perhaps, was the hardest part."

After leaving the territory of the plant, they were immediately taken under the control of Russian soldiers.

"We were escorted under guard, always at gunpoint."

Thus began Oleksandr's time in Russian captivity. He was taken to the notorious Olenivka prison camp. He says the days there were hard to distinguish from one another. They did not form a sequence, rather a collection of sensations: "In captivity, everything is very quickly reduced to basic things: cold, hunger, constant exhaustion."

Oleksandr is reserved as he speaks about his time in captivity. For him, he says, something else mattered more – not losing himself.

"It's very easy to break there. Very easy to become bitter. It was important for me, in my own eyes, to remain human."

"Lads, you're home"

Oleksandr recounts his return from captivity in detail, as if he can still see the journey unfolding.

"It happened on 20 September. They started going around the barracks, calling out names from a list. It was getting colder, and there were rumours that we were going to be transferred to other penal colonies, other cities. When you're there, you don't belong to yourself.

When they read out my surname, I hugged my brothers-in-arms and said goodbye, because I had no idea where they were being taken or where I was being taken," he says.

They were held until evening, then gathered together – people from different units and ranks.

"Our hands were bound. We were blindfolded. You can't see anything anymore – you just walk where you're led. Then some covered KAMAZ lorries arrived, or Urals – something like that. They tied our hands, blindfolded us again and threw us into those vehicles. They didn't mess around. It was all pretty brutal and rough," Oleksandr recalls.

"They drove for a long time. We were sitting in very uncomfortable positions. Food is a whole other story. We'd lost a lot of weight and there was just nothing to sit on – we kept sliding down."

Towards morning, the prisoners realised they'd arrived at an airport. They were loaded onto a plane.

"We said to each other quietly that it would be galling if either enemy air defence or ours shot us down, or if this tin can simply fell out of the sky. Because we know how well they fall. When that plane took off, it felt as though it was about to fall apart," Oleksandr remembers.

Later it became clear they had landed in Moscow. Some prisoners were taken off, others were added, and the plane took off again.

"We landed in Belarus. They began unloading us. Everything was still being done on command. Blindfolded, hands behind our backs.

We were forced to run. You run, they direct you, you fall over, you run again. Then they put us on buses. And the first thing that surprised us was – they were soft buses. Soft."

At that stage, Oleksandr says, he was deliberately refusing to allow himself to believe in anything hopeful: "I tried not to build up any illusions or hopes until it actually happened, because you don't know how things are going to turn out."

He notes that the escort in Belarus was different: "Physical force was no longer used. It was a different kind of escort – the way they spoke and the way they treated us. They even began taking us to the toilet in groups."

Eventually the buses came to a stop. A man got on, and Oleksandr remembers what he said word for word.

"This man came and said: 'Lads, you're home. Not long to wait now.' After that, we came alive. You realise that that stage of your life is over. You survived," he says.

When the blindfolds were removed and their hands were untied, Oleksandr stepped off the bus at the exchange point wearing a blue medical uniform.

"I'd decided long ago that if I survived, I'd step out in medical scrubs. In blue. That's what I wanted."

And Oleksandr did exactly that. There were ambulances on duty at the exchange point, and people were gathering, welcoming the heroes with hugs.

"They gave us phones to call home. When I rang my family they didn't even recognise my voice, I was so happy," he recalls.

Start with yourself

After returning home, Oleksandr almost immediately went back to medicine. He says he never considered doing anything else.

"I returned to the profession because I love it. I genuinely love my work. I didn't consider waiting or doing something else, because I realised that if I didn't go back straight away, it would be harder later."

Oleksandr served for a year at the Main Military Clinical Hospital, then transferred to the 75th Rehabilitation Hospital.

"When you work with the wounded, you begin to see very clearly that it's not just physical injuries that people come back with. There are things that can't be seen on a CT or MRI scan. And if nothing is done about that, it will resurface later – just in another form," he says.

The experience of war and captivity profoundly changes not only your perception of life, but also your attitude towards the system in which you work, Oleksandr says.

"The system isn't perfect. And it needs to change. Not cosmetic changes, but decisive, radical, unconventional change. Otherwise it means losing personnel, losing time, losing human lives and quality of life for the wounded.

After you've looked death in the eye, it's very hard for anyone to scare you. But you start to get extremely irritated when people refuse to change anything simply because it's more convenient for them the way things are," he says.

Among the new generation of doctors, Oleksandr says some genuinely want to change things and make a difference, while others quickly adapt to the old system because it's easier.

"There are some green shoots. But they need to be allowed to grow, not trampled on immediately," he notes.

He is convinced that in wartime conditions, the experience gained by military medics is invaluable. It needs to be systematised, adapted, and taught to those who want to learn from it.

"Military medicine isn't just for the military. It's knowledge that someone has today, and tomorrow, God forbid, a missile could strike – and it's gone. And that's their experience, the mistakes they made, knowing how to choose what works best – it's priceless."

That was why Oleksandr decided to further his education and apply for the Medical Education for Heroes programme run by the Dobrobut medical network – a free professional training scheme for 20 veteran medics who want to update their knowledge after service, confirm their qualifications, or specialise in a new area.

"I decided for myself that I need to develop. Not just talk about what needs to change, but start with myself. As a commander, as an anaesthetist, as a person who has experienced these conditions, I should have an influence on the development of the system. I see this training not as a formality or an addition to my CV, but as a way to expand my capabilities and prepare for situations that I could find myself in again," Oleksandr notes.

As part of the programme, he is studying Healthcare Organisation and Management.

He believes it is particularly important that the programme offers not abstract knowledge, but a practical framework for action in conditions where the usual rules don't apply.

"What we did at Azovstal often went against the standard procedure," says Oleksandr. "But if we'd acted only as the protocols and guidelines dictate, we would have lost many more people.

I'm not saying everyone has to work the same way, but I am convinced that a country at war can't afford to ignore this experience. Everyone must be prepared for it. It might not apply to you today, but you could be in that situation tomorrow."

Author: Anastasiia Mosorko

Translation: Anastasiia Yankina, Yelyzaveta Khodatska

Editing: Teresa Pearce