LIFE UNDER OCCUPATION – Part III. Substitution therapy under fire

Time passed. The occupation continued. As spring came, the situation in the city hardened. The Russians began to behave more brazenly and defiantly, and gradually life turned into a chronicle of violence and crime. 

March, which every year previously brought the promise of spring and the miracle of nature’s revival after a long winter, this year promised nothing but more death and destruction, sown by the horde that came from the east. In Kherson, people continued to take to the streets for anti-Russian protests. On March 21, the occupiers used tear gas, stun grenades, and firearms on them. People were injured. 

Information began to emerge that Russian soldiers were moving into the houses and flats of Kherson residents who had left, brazenly taking pictures in other people’s interiors, which they then posted on social media. 

April passed with an unusually deserted Easter. It was frighteningly quiet on a warm Easter night, with only a lone bell somewhere in the distance telling Christians the good news of the Saviour’s resurrection. 

Traitor Saldo, the Kremlin-appointed gauleiter of Kherson, muttered some nonsense about creating a “Kherson people’s republic^[1]“, while collaborators of various kinds called people to be more active in receiving Russian passports. This led to reports of forced “passportisation” of civil servants and pensioners. 

May came with a real summer sun, the first bathers on the beaches, and walks in the already green and transformed city. The occupiers introduced a “dual-currency” payment system in shops (where customers can pay in both Ukrainian hryvnia and Russian rubles) and threatened to convert utility bills into rubles. 

At times, in the distance, outside the city, there was a lot of rumbling – from fighting in the northwestern part of Kherson Oblast. In May, when the Ukrainian armed forces received HIMARS systems, they began targeting the headquarters, command posts, and ammunition depots of the occupants. The guerrillas did not allow themselves to be bored either. 

This was encouraging. Like, for example, the story of the famous Chornobaivka. The Kherson suburb of Chornobaivka, the city airport (which was supposed to reopen in the spring of 2022) was transformed by the occupiers from the very first days of the occupation into a kind of logistical hub: a place to store fuel and equipment, including helicopters. The first strike on Chornobaivka was launched by the Ukrainian armed forces on 27 February, the day the Russians seized the settlement. The strike was powerful, using Bayraktar drones. 

Since then such strikes have been repeated with startling regularity, and by mid-July there had already been more than 20. A huge amount of equipment and manpower, including senior officers and even generals, were destroyed in Chornobaivka. And each time, sometime after such devastating strikes, the Russians would drive equipment and personnel back into Chornobaivka. 

This strange stubbornness of the Russians caused bewilderment and was the cause of many jokes. And the reason was trivial. Chornobaivka airfield is located in the so-called “bottle neck” – a narrow passage from Antonov bridge (the only road bridge in this part of the Kherson region) towards Nikolayev and Odessa. Russia simply had no other way of moving in that direction. At the time, the occupiers had not yet abandoned plans to capture Odessa.

For all that, the city lived on. It was pretty devastated, wounded, covered in checkpoints, frightened and tired, but still alive. People who still had jobs continued to go to work, ambulances came on call, janitors continued to clean the areas, children played in the yards, doctors treated their patients, fishermen fished, communal workers took out the rubbish. But what struck me most was that Kherson continued to provide harm reduction services, including the provision of substitution therapy! 

It goes without saying that under the conditions of the occupation there was no possibility of bringing in substitution drugs, as well as syringes, condoms, rapid tests, and other handouts. However, due to the declining population in general and harm reduction clients in particular, the pre-war supply was sufficient for quite a long time. Moreover, when it came to substitution therapy, the cessation of provision was not because the drugs had run out. 

Just imagine there is heavy fighting literally 20 kilometers from the city. The occupier’s secret police are scouring everywhere for enemies, breaking into houses and flats, roadblocks and patrols are all around, and people are regularly kidnapped. And yet the continuity of treatment with drug substitution therapy is irreproachable. It’s unbelievable! 

Later, clients of Kherson’s OST programme told me how, in late February and early March 2022, unsure whether anyone cared about them in such a situation, they called the organisation and suddenly heard a calm voice answering: “We are working, come on over”. In April, May, and as late as June, the site worked and continued to dispense substitution therapy^[2] – life-saving medication for several hundred Kherson residents. 

This went on until the end of June. Until, on Sunday evening, the invaders broke into the safe at the site and stole all the substitution therapy drugs, buprenorphine and methadone.. 

I have thought a lot about why harm reduction programmes were able to work for so long – almosthalf a year – under occupation. And I think I have found the answer to that question. In my view, there are several reasons for this. The first is the strong resistance of the residents of Kherson, the proximity of the front line, the active work of partisans, the regular shelling of headquarters, warehouses, and places of deployment of the occupiers by the Ukrainian armed forces. All of this frustrated their plans, making much of what they had planned impossible, taking up a lot of time and human resources, which they clearly lacked.

The second, and perhaps most important reason harm reduction programmes in Kherson have lasted so long, is the dedication of the staff of these programmes and the medical staff of the substitution treatment site. Their responsibility, their fearlessness, and their commitment have saved many lives. I am absolutely certain of this. And every tablet of antiretroviral therapy or substitution therapy given by them these days, despite the pressure, the difficult situation, and the direct threat to their freedom and their lives, is further proof of that. 

Kherson is very lucky to have such people!

Igor Kuzmenko

Footnotes:

[1] In 2014 the creation of the so-called Donetsk and Luhansk people’s republics became the justification of the Russian occupation of part of Ukrainian territory. Recognition of these so-called republics by the Russian Parliament and the proclaimed necessity of their protection became the justification for the full scale invasion into Ukraine in February 2022.
[2] The surprise reaction of OST clients is due to the ban of OST in Russia and their violent closing of the sites before this in Crimea, Donetsk, and Luhansk in 2014.

Read the series by Igor Kuzmenko on how they survived the occupation in Kherson: