Even before active fighting broke out in eastern Ukraine in the summer of 2014, there had been no pharmacy or local medical service in Semyonivka, a village just outside the city of Slovyansk. Today, the needs are more dire than ever.

It’s here that every day, in all weather, Red Cross visiting nurse Natalia Babenko rides her bicycle along the pot-holed streets to visit her 22 patients; elderly people living alone.

Previously, Babenko worked at the same district psychiatric hospital in Semyonivka that brought 80-year-old Raisa Onyschenko here in 1959 to work, build a house and raise two sons. After the house was hit by a shell in July 2014, Onyschenko managed to save little more from the ruins than the dress she was wearing.

“Who would have ever thought I’d end up with nothing,” she says.

With her husband and one son dead, and the other somewhere in Russia, Onyschenko lives in her tiny summer kitchen, which survived the blast, with two cats for company. Now Babenko comes regularly to check her health, buy supplies and provide support. “She’s like family,” says Onyschenko. “I don’t know what I’d do without her.”

The visiting nurse programme is one of the longest-established services provided by the National Society. It is much needed now as more people are left alone and isolated from basic services.

The Semyonivka psychiatric hospital, also destroyed in July 2014, is just a grim ruin. But on the rubble of Onyschenko’s home a new house has been built, thanks to a joint project with the Ukraine Red Cross and the Luxembourg Red Cross, which is providing ten new homes for people affected by the crisis. On an evening in January it’s practically finished, already papered with pristine pink flowered wallpaper. “I’ve already been inside,” Onyschenko says, “on tip-toes.”

Challenges since the beginning

Such services from the Ukraine Red Cross have played a critical role in helping people around the country cope since civil unrest in late 2013 erupted into armed conflict in 2014. Providing a response that meets the growing needs has not been easy. From the beginning, Ukraine Red Cross staff and volunteers have experienced challenges similar to those many local humanitarians face when their societies undergo upheaval.

One incident foreshadowed some of those changes. On 9 May 2014, masked, armed men entered the Ukraine Red Cross Society’s Donetsk regional office and detained volunteers from a Ukraine Red Cross Society emergency team from the capital of Kiev. The city was tense. After months of civil unrest in the Kiev, people protesting in the eastern regions of Donetsk and Luhansk had organized in opposition to the new national government. Members of the volunteer emergency team were in Donetsk. Their tunics showed they were with the Red Cross, but their identification documents showed they were from Kiev. This led the armed men, part of the opposition Movement, to question and detain the volunteers.

The volunteers were released the following day, but by then other Red Cross volunteers had informed the media, and it was clear the National Society was caught up in a split that would pose many challenges for those trying to deliver neutral and impartial humanitarian services.

Nearly two years on, the conflict has cost over 9,000 lives, and displaced more than 1.6 million people internally and caused some 1.1 million to seek refuge outside Ukraine, according to the United Nations. And it has presented the National Society with an enormous task: to expand services rapidly in extreme circumstances to provide aid to the huge numbers in need.

The Ukraine Red Cross has made considerable progress, transforming from a National Society providing fairly routine services in a peaceful, relatively stable country, to an important first responder and provider of aid for people going through tremendous upheaval.

Among other things, the National Society has continued providing first-aid training by volunteer emergency response teams, visiting nurses for the elderly, mobile medical brigades and tracing services. These services have been supplemented by vouchers for food and medical items, shelter vouchers, first-aid kits, other basic necessities such as hygiene and household goods, as well as cash assistance.

The National Society’s transition has been about not only building up operational capacity, supported by the Movement, but about less tangible yet vital attributes such as retaining public trust and acceptance while internalizing principles that before the conflict seemed relatively abstract.

“We held seminars, we talked about the importance of these principles, but until the conflict broke out, however much we talked we didn’t really understand them, we didn’t take them to heart,” says Iryna Mitchenko, deputy head of the Donetsk regional branch. As the crisis escalated, many of the Donetsk volunteers left the branch, and even the city. “They realized they couldn’t be neutral,” says Mitchenko.

Learning on the move

The Ukraine Red Cross is a well-known entity represented at town and region levels throughout Ukraine. But as the Red Cross symbol had come to be used for anything from private pharmacies to computer repair shops, few people were really aware of what the organization stood for, or what it actually did.

That changed in late 2013. Red Cross emergency response brigades were in the thick of the violent civil unrest that seized Kiev and other cities, their tunics and helmets with the Red Cross symbol highly visible in images shown across the world as they tended the wounded.

But some demonstrators also set up their own first-aid teams using a red cross symbol and since then, the National Society has had to deal with several other instances of emblem misuse. With the help of Movement partners, the National Society countered with public education campaigns aimed at educating people about the Red Cross and international humanitarian law. But the improper emblem use complicated the National Society’s efforts to gain the trust of those in need throughout a divided east Ukraine and to inform and persuade all the parties operating there to allow them to work freely.

“We never thought that this could ever happen to us,” says Mitchenko.

“After nearly two years, I’ve truly learned how to use the Red Cross principles. Since then, it’s become easier for me to work, and to accept reality.”

Ivan Usichenko, president of the Ukraine Red Cross Society, says the crisis has forced the National Society to adapt quickly under pressure. “When this situation began we were resolving questions on the hoof together with the ICRC and IFRC about how better to provide aid in Donetsk and Lugansk regions, to displaced people, hospitals, civilian and military wounded,” Usichenko says.

A more recent challenge, he adds, is the waning interest internationally for the conflict in Ukraine. Overshadowed by other major events — migration, terrorism, different conflicts — some worry that Ukraine is becoming what humanitarians call ‘a forgotten crisis’ even though the needs are just as great as ever.

“I follow the news,” says Violeta Lombarts, head of the IFRC country office in Kiev. “The Ukraine crisis is invisible… so how can we attract people [and convince them] to provide support?”

Growth under pressure

Nevertheless, since early 2014, implementing bilateral aid projects with 30 Red Cross Red Crescent Movement and 12 external partners, National Society committee staff has grown significantly, according to Liliia Bilous, Ukraine Red Cross first secretary deputy general and head of the newly-formed disaster management department.

“The National Society, with the support of the IFRC and ICRC, has managed to increase its potential quickly and react rapidly to emergency situations, during civil unrest in Kiev,” says Bilous. “New challenges have arisen, but the more challenges we overcome, the stronger we grow.”

Alongside mobile medical teams (now numbering 26 and funded by the World Health Organization) and more than 3,000 visiting nurses, National Society branches deliver humanitarian aid to front-line settlements and to the huge numbers of internally displaced people (IDPs) who have moved into towns such as Slovyansk and Severodonetsk.

One morning in January, three visiting nurses from the Severodonetsk Red Cross branch, having already seen their patients before 10 in the morning, are distributing food vouchers to people they have invited to the office.

“When 300 people were coming per day, we had to be psychologists and labourers and listeners all at once because there was no one else,” says nurse Yelena Menayeva. “To start with, there was only the Red Cross, and it was all so sudden and we had to orient ourselves so quickly among this huge crowd of people.”

The vouchers, introduced in 2015, can be spent in any branch of a supermarket chain. “People can buy what they need,” says Menayeva. “Before, people would come who had diabetes, and all we had was rice and other goods that diabetics can’t use.”

A more recent innovation is the cash-assistance programme, which gives people even more flexibility to cover their needs; monitoring shows that most of the money gets spent on gas and electricity through the long cold winter.

At the branch office in Severodonetsk, Ukraine Red Cross workers Inna Ringina and Elena Menayeva give out vouchers for products to people in need of food and basic household goods. Photo: Anastasia Vlasova/ICRC

The National Society, working together with the ICRC, also offers a critical service for people seeking answers about lost loved ones who’ve gone missing during the crisis. Often requests come from people abroad or elsewhere in Ukraine who have lost touch with relatives in the conflict zone, in areas where electricity services and postal services no longer function.

“Some are old people with no means of communication, sometimes they are IDPs,” says Irina Tsariuk, who heads the tracing service. “We ask our volunteers to visit them, or help find them via the IDP registration.”

As of February 2016, more than 500 families contacted the Ukrainian Red Cross to re-establish links with a family member from whom they were separated due to the armed conflict in eastern Ukraine. Over 140 cases have not yet been solved.

The price of conflict

Meanwhile, life for long-time residents of towns such as Severodonetsk , which has increased by a half since the conflict began, is also hard. Local National Society branches, which have long served the community, are well aware of simmering resentment towards IDPs.

“Local people need help, too, with pensions so small and prices going up,” says Tatiana Babich from the Lisichansk branch, near Severodonetsk. “People see the help we’re giving IDPs and they run to us, weeping, ‘Give us something as well’. We have to explain, ‘At least you are living in your own home’.”

Donors now allocate 20 per cent of aid to local residents, and the rest to IDPs.

Mikhail Maslov, a soft-spoken father and former factory worker says he understands the plight of both local residents and IDPs. Maslov fled Donetsk with his family in August 2014, and initially came to the Red Cross for help. Now he helps determine which people qualify for the voucher and cash-assistance programmes using specific selection criteria.

Ukraine Red Cross visiting nurse Natalia Babenko checks in at the house of Raisa Onyschenko, who lives alone in her damaged house in Semyonivka village, in the Donetsk area. “I don’t know what I’d do without her,” Onyschenko says of the Red Cross nurse. Photo: Anastasia Vlasova/ICRC