USA TODAY In Lviv, Ukraine’s beleaguered government plans for what might happen in war with Russia

© Jessica Koscielniak, USA TODAY A roadblock is seen from the road entering the city of Lviv, Ukriane.USA TODAY spent 36 hours with a team of overseas nurses, engineers and logistics personnel invited by Ukraine’s authorities to build a field hospital for emergency and specialized trauma care here. It is being established to serve an expected wave of people – military and civilian – impacted by Russia’s assault on Ukraine as Moscow counters resistance to its invasion with more firepower.

The location of the planned hospital on the fringes of Lviv in western Ukraine – identified as a potential capital if Kyiv falls to the Kremlin – is being withheld over fears it could become a target for Russian missiles. Descriptions and details about the site that could be used to geolocate it are also being withheld.

“I’ve set up hospitals in war zones, and we’ve deliberately marked ones that have been bombed and we’ve left them unmarked and gotten bombed,” said Ken Isaacs, the slightly gruff but affable 69-year-old American who is leading the effort to construct the hospital on behalf of Samaritan’s Purse, an evangelical Christian humanitarian aid organization headquartered in Boone, N.C. It will have an operating room that can handle up to 10 surgeries a day and treat as many as 100 patients.

© Jessica Koscielniak, USA TODAY Ken Issacs, Vice President, Programs & Government Relations at Samaritan’s Purse meets with Ivan Sobko, a senior health official in the Lviv’s regional state administration on the side of the road just after crossing into Ukraine.“When an airplane wants to bomb you, they bomb you,” said Isaacs, who has spent more than 30 years responding to complex crises from famines to natural disasters – Democratic Republic of the Congo during the Ebola crisis, earthquakes in China and Haiti, battlefields in Iraq.

The medical facility could be operational as early as this week.

USA TODAY shadowed Isaacs and other emergency relief planners as they met with Ukrainian health officials in Lviv and toured potential sites for the hospital.

They said the decision to situate the facility underground was taken partly because it offers more protection from Russia’s military, which has a reputation for causing widespread civilian casualties through indiscriminate bombing and shelling. It used such tactics in wars in the southern Russian republic of Chechnya, as well as in Syria’s protracted civil war.

Research groups such as Bellingcat, an open-source investigation unit, say there is credible video and photographic evidence indicating that Russia is using cluster bombs and other highly lethal weapons in civilian areas in Ukraine. Cluster bombs are rockets or missiles that contain smaller explosives within them that scatter over a wide area.

© Jessica Koscielniak, USA TODAY Ivan Sobko, a senior health official in Lviv’s regional state administration meets with Ken Issacs, Vice President of Programs & Government Relations at Samaritan’s Purse on the side of the road just after crossing into Ukraine.“The situation in the Lviv region at the moment is stable,” said Ivan Sobko, a senior health official in Lviv’s regional state administration. “But at any moment it can change and we have to be ready. We’re doing everything we can to be prepared.”

Grueling journeys to Lviv, then Poland

Lviv’s cobblestone streets, its green-domed churches, history-rich architecture and vibrant café culture and arts scene remain far from the main battlefronts.

But already, Lviv is feeling the strain of hundreds of people pouring off trains each day as they flee for destinations in western Europe and beyond. Around 1.5 million people have left Ukraine for Poland and other neighboring countries, according to the United Nations High Commissioner for Refugees.

Lviv’s streets are congested with vehicles, people and pockets of patrolling soldiers. Some private buildings, such as art galleries, have been hastily converted into impromptu distribution centers for humanitarian aid.

At Lviv’s shabby yet ornate Art Nouveau main railway station, the line to board a train to Poland snakes around the corridors, out the front doors and across an adjoining plaza.

Because Ukraine is only permitting women, children and the elderly to leave the country, there are few men in the crowds. Women waiting in these lines juggle bundled up children and suitcases. Mothers hold the hands of sons and daughters, whose little legs try to keep up. Volunteers hand out soup, bread and noodles. Fires burn in steel drums as elderly men try to keep their hands warm while smoking cigarettes.

For many, the journey to Ukraine’s largest western city has been long and grueling. It took one woman four days to get to Lviv from eastern Ukraine. In many cases, women have left behind husbands and brothers and sons – some as young as 18, who have joined up to fight Russia with just a few days of military training.

“Are there any men?” a medic shouted to an assembled throng of people on Friday, a plea for help to carry a man to further medical help after he collapsed on a platform.

Nearby, a middle-aged man sat down on a bench to remove his socks. When his feet were revealed they appeared to be painfully swollen and suffering from infection.

“We just took what was at hand and left, because there were tanks there, they were smashing (things up) near us,” said a woman who only gave her first name – Larisa – and had traveled from Odesa, a port city in southern Ukraine on the Black Sea.

For those who brave the journey from Lviv to Poland, they can face a difficult wait to get into the European Union. Crossing by foot requires standing in a line for up to three days in freezing temperatures. At the border, families huddle together while wrapped in blankets. One person told of how a a woman had given birth in the line.

Lviv prepares for war

No Russian bombs have hit Lviv, though nearby towns have been targeted. And nerves became frayed a few days after the start of Russia’s hostilities on Feb. 24, when there were reports that Russian helicopters had dropped several dozen paratroopers a few hundred miles west of Kyiv to try to cut off Lviv from the rest of Ukraine.

In recent days, this cultural capital 250 miles from Poland has accelerated its war footing, as advancing Russian troops and air and artillery strikes laid waste to Ukrainian towns and cities in the east and south, and the number of civilian deaths reached at least 351, according to the United Nations Human Rights Office.

© Jessica Koscielniak, USA TODAY Government employees and aid workers take shelter in the basement of the Lviv Oblast regional state administration building following air raid sirens.Siege preparations appear to be in full swing.

The drive east from Poland to Lviv is studded with checkpoints. Down most country lanes that peel off the main highway and lead to villages and small industrial enclaves, groups of armed volunteers keep wary watch behind sandbags or patrol nearby with rifles and other weapons, often with their faces covered by balaclavas.

Trucks, vans and military vehicles buzz up and down the highway, channeling weapons, medicines, aid workers, large-scale equipment and supplies promised to Ukraine by U.S. and European allies to frontlines and other strategic positions. Hundreds of thousands of people use the road to flee the other way on buses and in civilian cars.

Closer to Lviv, soldiers stop vehicles and question drivers about where they are going. Anti-tank “hedgehogs” and smaller spiked metal angles and beams form barriers to some buildings.

In Lviv’s city center, which was founded in the late Middle Ages and has retained a medieval topography, volunteers and municipal workers have started safeguarding some of the UNESCO world heritage city’s precious landmarks, such as statues and churches’ stained-glass windows, by wrapping or boarding them up. Sandbags are stuffed into the basement windows of government offices.

There was a reminder of Ukraine’s precarious position, when air raid sirens went off halfway through a meeting Isaacs and his Samaritan’s Purse team were having with health officials in a government administration building. There was a quick scramble to a basement shelter for safety.

“We are down here at least three times a day, and more in the night, too,” said a secretary in the building, as she took refuge with about three dozen others in part of the building’s network of subterranean passages. Most waited patiently and idly scrolled through their phones, a few read books.

The woman, who did not want to be identified because of her government job, said the sirens typically blared anywhere from 15 to 45 minutes.

“We are terrified,” she said. “We need governments around the world to give us all the help they can.”

Ready to fight

More than a week into the invasion, it remains unclear when or even if Kyiv will succumb to Russia’s military advantages. Ukrainians are fighting back with all they have, whether with weapons, information, stoicism or the growing networks of volunteer support that facilitate everything homemade molotov cocktails to recruiting foreign fighters.

“I want to make sure this hospital goes up because it’s going to save lives,” said Vitaliy Smolin, an American-born Ukrainian who was helping Isaac’s team with logistics, translation and driving while in Ukraine. Smolin is letting displaced Ukrainians stay in his house in Ternopil, about 100 miles east of Lviv. He is trying to raise money for the war effort, source body amour and helmets, and evacuate women and children.

He broke down in tears as he reflected on how his life has changed in just a few weeks. His wife, Natalia, who was also part of team supporting Samaritan’s Purse’s attempt to build a hospital outside Lviv, is on her way to the U.S. with their three children.

“I’ve lost friends in this war already,” said Smolin, insisting that Russia’s attack on Ukraine should be called a “genocide” because Moscow is the aggressor.

© Jessica Koscielniak, USA TODAY Maksym Kozytskyy, the Governor of Lviv Oblast, speaks with USA TODAY about the Russian Invasion of Ukraine and how the region of Lviv is preparing on March 4, 2022.Maksym Kozytskyy, the governor of this region, a former surgeon, said in an interview at his office in Lviv that “military engineering structures” such as trenches and fortified barricades, were being constructed around Lviv. He said schools and libraries were being repurposed to be able receive and house the hundreds of thousands of internally displaced Ukrainians arriving in Lviv either to stay or transit farther west to Poland.

“We need air defense, anti-tank systems and aircraft,” said Kozytskyy, echoing repeated appeals by Ukrainian President Volodymyr Zelenskyy to U.S. and European lawmakers and NATO leaders for additional help in fending off Russia’s invasion.

Kozytskyy said that while it was “impossible not to fear the war” his staff and the area’s civilian population more generally were keeping focused and motivated because “they are not doing this for me or anyone else but for their own country and freedom. People here are not ready to lose this war. They are not going to fight and die, but to win.”

This article originally appeared on USA TODAY: In Lviv, Ukraine’s beleaguered government plans for what might happen in war with Russia