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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning, everyone. Today on The Brian Lehrer Show, the New York State primaries thrown into chaos, and along with them Democrats' hopes of retaining control of Congress. Why New York's highest court yesterday threw out the new Congressional district lines as unconstitutional, state Senate lines too. We'll explain how the lines might have to change to be more friendly to Republican candidates. How there may now need to be two different primaries in New York State this year. What about Texas and Florida and all those Republican-controlled states that gerrymander for their party's advantage and get away with it? That's coming up.

Also today, we'll complete a three-part series for the first week of legal recreational cannabis sales in New Jersey. Today, anticipating more cases of cannabis use disorder in New York and New Jersey, and how to treat and minimize them. We'll follow up on yesterday's reference to a line in Mayor Adams' new budget to expand a program that sends mental health professionals to calls of a mental health crisis rather than police in some cases. How do they decide where the line is between someone who just needs help and someone who's a threat that requires a police response? Sometimes it's a close call. We'll talk about that.

We begin with something that's not a close call. There is a need for doctors to cross borders into Ukraine, and some are doing it. We're very happy to have with us Avril Benoît, the executive director of the renowned international group Doctors Without Borders - USA. She is back in New York now after a month in Ukraine herself. As a neutral nonprofit, they help people in need of medical assistance on all sides of military conflicts. We'll hear how that's playing out in the context of the Russian invasion that most of the world is labeling a war crime.

Avril Benoît herself has worked with Doctors Without Borders or Médecins Sans Frontière, as they're known in the original French, in many countries providing aid to refugees, asylum seekers, and migrants. Among her projects, a global mobilization to end violent attacks on hospitals and health workers. We'll talk about that. Before joining Doctors Without Borders she was a journalist and broadcaster in Canada. Ms. Benoît, thanks so much for making this one of your stops. Welcome to WNYC.

Avril Benoît: Really happy to be with you, Brian.

Brian Lehrer: I see that one of your main projects in Ukraine right now is medical evacuations by train. Can you describe who you're evacuating and how that works?

Avril Benoît: Yes. This was something that we identified fairly early on as a possibility in discussions with hospitals in the east that knew that they were likely to have large influxes of wounded people from the war.

Also in our discussions with the railway authorities, the trains somehow are still able to function. The possibilities of converting a train into a medical ward at least to be able to have doctors and nurses on board to stabilize patients that had a good prospect of surviving what is an incredibly long journey across the country. Takes 20 to 24 hours, even sometimes up to 30 hours for a variety of reasons, and to alleviate some of the pressure on those hospitals in the war-affected areas. The hospitals that are under regular bombing in their area. Hospitals that are likely to be overwhelmed with patients that need follow-up surgery, long-term rehabilitation, things like that.

What they identified was the need to just have a medical referral to take patients from those eastern hospitals in cities such as Dnipro, Kramatorsk, even Kharkiv, and to take them on this journey across the country to hospitals in the west. In cities like Lviv that are comparatively safe, where the people can undergo their follow-up surgery and the longer-term post-operative care that they need.

This is the train that we've been running for several weeks. We've transferred a lot of patients. Sometimes the train is really overflowing with patients and their caregivers or family members who also make the decision to leave the east. It's something that's worked quite well despite all the risk. Despite the fact that there have been some attacks on train stations. There have been some attacks on the railway system, but nonetheless, it seems to be working.

Brian Lehrer: I'm sure you know, because you just said it, that Russia is attacking trains and railway stations in one of its latest bombing campaigns within the war. Multiple news organizations report five railway stations in the western and central parts of the country, for example, in the last few days. I think that's where you're evacuating too from the east. Russia says-- they claim it's because of weapons shipments by train. Political analysts say it's because the US Defense Secretary and Secretary of State entered the country by train last weekend and Russia was trying to make a statement about that. In either case, how does railway stations being targeted affect your medical evacuation operations?

Avril Benoît: Well, certainly it creates a sense of outrage but also a sense of urgency. Kramatorsk was the first railway station to be attacked, and there were a lot of civilians waiting on those tracks. We had been there the previous day and the day before evacuating patients from that very city. We saw the thousands of people that were waiting there patiently waiting for their opportunity to leave.

The fact that the train station was bombed right after we had been there, seeing the people ourselves evacuating from that zone, really made us feel like we have to just keep this train going continuously. Now we have two trains. A longer one that's got a little more intensive care unit capacity plus the shorter one. The methodology of the railway authority - I did one of the long journeys - they stop a lot. Everyone is using the railway system. Yes, the military, they're moving weapons, they're moving soldiers, moving civilians as they evacuate, all the supplies coming and going. The railway system is active in every sense.

The railway authority, we had a lot of discussions with them. What they concluded with us was that we probably should not identify this train with a big red cross on the roof. We should be somewhat discreet about it because we didn't want to attract a whole lot of attention to this activity. We don't talk about where the train is going. We certainly don't talk about it on the phone or on WhatsApp. We use a signal. It's all very discreet. It's handled with the utmost sense of just wanting to protect everyone on board, and the people at the station that are doing the transfers.

Then when you're on the journey, you don't know exactly what route they're going to take. You think, "Oh well, this is probably going to stop or go through the Kyiv main station," and then all of a sudden you zip further south. I was following along just to see what kind of route we were taking, and sometimes it stops for a long time because there's a military movement in the area. It also stops, of course, because there's an air raid siren in the area.

These are some of the factors that mean that the-- The railway authority is well aware of the importance of the civilian access to their services, but they also know that it's a war zone. They are extremely nimble, flexible, but cautious when we're doing things like civilian transportation, including the medical referral train.

Brian Lehrer: Listeners, we can take your questions or comments or stories for Avril Benoît, executive director of Doctors Without Borders - USA, especially in the context of Ukraine, but it doesn't have to only be about Ukraine. 212-433-WNYC. Has anyone listening ever been to Doctors Without Borders? Worker or volunteer, or what would you like to ask? 212-433-WNYC, 212-433-9692, or tweet your question or a very brief story @BrianLehrer.

I see you're also working in subways in Ukraine. Before we get off the topic of trains, will you say many people are taking refuge? Probably a lot of New Yorkers don't even realize there are subways in Ukraine. What cities in Ukraine have subways where that's happening, and how are you working there?

Avril Benoît: There are subways that are quite small because they're relatively small cities. In Kharkiv, for example, it's a city that before the war had about 1.5 million people. With the air raid sirens and the knowledge that bombs are actually falling, bombs that it's hard to know whether it's targeted or not but they're definitely falling in residential areas, everyone goes to the basement.

The subways have become the place where people whose apartment buildings have been damaged. They really feel like this is probably their best bet. They have been in the subways sheltering with their families since the beginning of the bombing in Kharkiv. Kharkiv is also a place where you've got a medical community of Ukrainian doctors and nurses who are very dedicated, staying behind, running hospitals. When there's shelling in the area, they also go to the basement with the patients. This is one of the dramas of this whole situation, is that there are some patients who can't hustle out of their hospital beds and run down the stairs like everybody else to take shelter when the bombs are falling.

The whole situation has brought people underground, including our medical activities. We have all these families that are in different subway stations. They have cots on the ground, blankets have been distributed, food is being distributed down there by a variety of civil society organizations, voluntary organizations. We have what you might call walking clinics doing first aid, checking in on people. We also have in some of the larger stations little primary healthcare clinics.

Obviously, we can't do a whole lot in that kind of setting, but it is also giving us a window into the agonizing mental health suffering of people. Just this unknowing about the future. The sense of panic, of anxiety, of stress, of depression, of PTSD, depending on what they experience. That is also something that we're trying to offer, not only just through that caring presence, the solidarity of just being with them in their time of extreme suffering, but also having mental health specialists identify those who really do need specialized help.

Brian Lehrer: Wow. Subways as bomb shelters. I see you've been involved in the campaign beyond Ukraine to end attacks on hospitals and healthcare workers. Where, for example, and why have they been explicit targets?

Avril Benoît: Well, you may recall in 2015 we had a trauma hospital in Kunduz in Afghanistan that was bombed by US forces. Subsequently, we had several bombings of hospitals in Yemen. An ongoing factor in the war in Syria was the targeted attacks of hospitals. Even through all those years from the very beginning, many clinics started to work in caves, again just trying to avoid shelling. This effort, which started all those years ago, was really demanding a respect to hospital structures, but really it extrapolates to all civilian infrastructures.

What we see in Ukraine is appalling. Where you've got people sheltering in theaters, in schools, in nurseries, and there's just no respect to the fact that this is a civilian space. A hospital should never be a target. It is a violation of international humanitarian law. A hospital is a place where one should feel refuge. That you should be able to have the dignity of the health care. Of being able to recover in your time of desperation and of great vulnerability.

Even in the rules of war, the Geneva Conventions is very specific and explicit about all health infrastructure. It's not only hospitals, it's also ambulances. It's healthcare workers. This is something that we, along with the International Committee of the Red Cross in the wider humanitarian community, we're just calling for respect to those civilian infrastructures, including hospitals.

Brian Lehrer: Why does anyone attack a hospital? What's the military advantage to be gained?

Avril Benoît: Well, look. It certainly causes a lot of ripple effect suffering on the population, doesn't it? Because people then who lose access to their hospital will have wider consequences. Even in Ukraine, we see that the ruptures in access to health care for people with what you would consider fairly straightforward things to manage like chronic heart disease or diabetes, all their ongoing medical treatment and follow up is in jeopardy when you attack health infrastructure.

Quite apart from not being able to save those who are trauma wounded in the area, not being able to safely deliver babies or deal with the orthopedic cases that inevitably happen, you've got just this wider sense of grievance that you create in the population and a vulnerability that this one place that they counted on to be safe and to be able to go to in their time of need is no longer there.

We do have a lot of evacuations of areas in Ukraine now, but really, it was remarkable in my time there, Brian, to see the extent to which Ukrainian health officials, doctors, nurses, and all the caregivers in these hospitals and institutions were willing to stay behind with the people who were their patients or in their care. It really was impressive to see.

Brian Lehrer: My guest is Avril Benoît, executive director of Doctors Without Borders - USA, just back from a month in Ukraine. 212-433-WNYC. Bruce in New Brunswick, you're on WNYC with Avril Benoît. Hi, Bruce.

Bruce: How are you? Just calling to make a comment about yes, what you're saying is true about the railway stations because we're working with people in Ukraine, and I have to go back into Ukraine. Then months ago, I said, "Okay, it's cool, but if they start bombing the railway systems, that's a different story." That's what they're doing now. Literally, you have people like myself with knowledge bring a certain equipment in Ukraine. There are no trains going off from Poland into Ukraine.

The other comment I had was about the medication. We've been trying to get certain medications in but we had issues. One of my colleagues told me to reach out to Doctors Without Borders because we've been trying to get some injector pens for some of these soldiers regarding this chemical warfare. I would like to know how can we go about doing that because the legal rules about getting medications from out the US into Ukraine and other countries. Which is different from Ukraine because in Ukraine sometimes you can get medication on the street or in a pharmacy that you can't get here in the US.

Brian Lehrer: Hello?

Avril Benoît: The issue of medical supplies is one that we identified fairly early in our discussions with hospitals. Even prior to the invasion we had some people going around in anticipation of this. A lot of the reaction at the time was, "Well, we don't really think that's going to happen. We don't think the war is really going to happen." Thankfully we had an established network in order to be able to bring in supplies at scale. Now, in our case, we work with procurement specialists. There's a lot of quality control. There are certain lists of medications that you're allowed to bring in. It is limited.

There's sometimes some requests for very specific brand name drugs that we're receiving and we're saying, "Well, how about the generic because that's how we work and it works fine." [chuckles] There's always a tremendous amount of discussion that goes into these things. We don't accept donations of drugs because, as I mentioned, we have a very strict policy for the quality control and so forth. Not to say that anything you're trying to do would be incorrect, but it's a process because we have so much experience in working in war zones.

Now, the thing with the chemical weapons, biological weapons, nuclear weapons is that although we know certain elements of how to treat people, there are products out there, the reality is there are not many people in the world that really have experience in this, especially all the talk of nuclear weapons. We have nothing. Our pockets are empty in terms of a toolkit, a skill set. There's very limited things you can do, but I know that there are a lot of efforts from some really fine people to see how we can at least mitigate what could come without suggesting that it necessarily will.

Brian Lehrer: If Bruce is working or working with an organization to get things into Ukraine, can they contact your organization for at least some advice?

Avril Benoît: Yes, although our advice would be "Talk to the ministry of health," because that's what we do. Things are organized state by state, and so there are what they call oblasts, the administrative areas. They have a considerable amount of autonomy when it comes to the importation of medical supplies. At that level, we would also just advise speak to the officials in the area that you think you'd like to make your donations to.

Brian Lehrer: Bruce, thank you for your work. Thank you for calling us again. Good luck out there. Please, stay in touch. Juan in Manhattan, you're on WNYC with Avril Benoît from Doctors Without Borders. Hi, Juan.

Juan: Hi, Brian. Thank you for having me on your show. Big fan. I just wanted to thank Doctors Without Borders because my colleague Brent Renaud, we were both journalists. He was the first casualty in Ukraine and I was wounded. If it wasn't for the work of Doctors Without Borders I wouldn't have been unable to be extracted from Kyiv, so I wanted to thank Anja, Marcel, and Dan. They were the three doctors who were in Kyiv. I believe I was the first patient to be evacuated in a train. It was a 12-hour ride from Kyiv to Lviv. It's a very memorable evacuation. They really took good care of me.

I wanted to thank Doctors Without Borders but also encourage the listeners to donate because I know the work that they do really save lives. I just really wanted to take this opportunity to thank you for the work.

Brian Lehrer: Wow.

Avril Benoît: Oh. I heard about your story, and it really was a question of-- Yes, it was-- What can I say? You happened to be injured and brought into a hospital where one of our finest, most experienced vascular surgeons, a man who's had a lifetime of experience in war zones, he happened to be doing a training in trauma surgery. As you know in the discussions, they said, "Okay. Well, show us how it's done," and you happened to be the patient. I'm so glad it worked out and I'm really glad you called in. It's a hell of a story.

It was a little awkward for us also because the first patient that we did surgery on was an American. Of course, we didn't go to Ukraine to do that. We're there for people in Ukraine no matter what their circumstance, background. We're humanitarian and we'll treat anybody, but I'm really glad it worked out for you.

Brian Lehrer: Juan, thank you-

Juan: Thank you very much.

Brian Lehrer: -for your testimonial. As most people try to rush away from war zones, when do people from Doctors Without Borders rush in? How do you decide when it's even safe enough to go in as medical workers, or how do you draw the line?

Avril Benoît: Well, we do have a duty of care toward our staff, and a lot of very strict regulations and protocols, but there's no doubt that we have a higher risk tolerance than many others. We have a lot of experience in just remaining calm under pressure, doing the risk analysis. We are very cautious about our movements because it's when you're driving from A to B, it's when you're even in Kharkiv, leaving the place where you've spent the night and driving to the subway station where you're going to run that primary healthcare clinic that day, that's when the main risk really is out there.

It's just we have various procedures. Keep the windows slightly rolled down. Definite protocols on what to do when there's an air raid siren. We had a team in Mykolaiv when there was a bombing. They were actually walking into a hospital to have some meetings when a bombing happened and they were immediately waved into a kind of a pit area right next to the hospital, and for 10 minutes the bombs were falling all around them. The effects on the ground afterward made it appear to be cluster bombs, which are not very discriminate in their aim. It's just incredible luck that they came out of that unscathed.

As a consequence of that we decided, okay, we're going to support the hospitals in Mykolaiv, but we won't have people on the ground there ourselves. We'll just take very calculated risks when we come and go to offer the support and deliveries.

Brian Lehrer: I imagine you work with refugees outside of Ukraine as well, right?

Avril Benoît: That's an incredible story of solidarity from people in Poland especially, but also all those countries around, and the European community. There are a tremendous number of national organizations that really stepped up. Voluntary groups. What we found is that the medical burden, the specific medical burden on those refugees, and by now there are 5.1 million of them that have fled Ukraine, their health needs are for the most part being covered at the moment by the hospital system, the health system that exists there, in addition to all the civil society organizations that have rallied.

That's why our focus really is in Ukraine, where you've got more than seven million people who are internally displaced, including a lot of our staff. I was working for the most part in Lviv. Everybody I talked to on our team as we're having lunch or tea, I realized that most of them are displaced. They were either from Kyiv and had to evacuate when the bombing started, or they're from Mariupol. Their families are split up. Maybe their wives and children are in another country. For the ones with elder-care concerns, their parents are back in the east and refused to leave because they've never left the east. They just didn't want to go anywhere even as the threat was looming.

There's just this tremendous sense of social disruption, and the loss of the social contacts and the safety net that one would normally have from community. That also is one of the reasons that we're really focused on Ukraine, and the acute needs that are closer to the contact line in the war zone.

Brian Lehrer: Do you treat wounded Russian soldiers? I know you're a neutral organization. Has that come up?

Avril Benoît: Hasn't come up yet. Typically, militaries have their own MASH system. They have their own medical support system with their own doctors and nurses, some of them conscripts in the Ukrainian side. It hasn't come up yet for us.

Brian Lehrer: Let's take another call from somebody who I think wants to volunteer for you, if you take volunteers. Patricia in Yonkers, you're on WNYC with Avril Benoît, Executive Director of Doctors Without Borders - USA. Hi, Patricia.

Patricia: Hi. Thank you very much for your work all over the world. Just a question about how many medical volunteers do you have currently in Ukraine and how many more do you need? Are you looking for more volunteers and what is the process?

Avril Benoît: We are an aid organization that has aid workers. We have the spirit of volunteerism in the sense that people have to say, "I'm willing to go there." We have a fairly strict recruitment process. If you go on our website, doctorswithoutborders.org, you'll see that it's not just doctors we're looking for or nurses. It's also logistics, finance professionals, human resources professionals. There are a number of different areas. I came in myself through communications. What we're looking for are people who already have experience in the kinds of places where we work.

We work in more than 70 countries. Some of them are middle-income, but most of them are really in humanitarian crisis. They're low-income countries with a lot of complex needs and often a fair degree of violence. These are the kinds of things that we look for in the experience level of the people that come to us. We don't say, "Oh yes, we're looking for volunteers now for Ukraine," specifically because what concerns us on a number of levels is that we have all these other places where we work where there are acute needs. Afghanistan, Yemen, Syria, Democratic Republic of Congo, South Sudan, Central African Republic. I could go on and on.

What we try to do is when somebody has been accepted and recruited and taken in through a very rigorous process to check professional references and accreditation and all of these things, we then say, "All right. What is that person's real skill set and where do we have a gap? Where do we have a need?" That's how it actually happens.

Patricia: Okay. Thank you very much. Appreciate it.

Avril Benoît: Thank you.

Brian Lehrer: Patricia, thank you very much. We're going to leave it there with Avril Benoît, executive director of Doctors Without Borders - USA, just back from a month in Ukraine. Good luck, Ms. Benoît, as you do some of the most important work on Earth. Thank you for joining us today.

Avril Benoît: Thank you so much, Brian. Take care

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