MSF did its first medical train referral on a 2-carriage train converted specifically. This is a precursor of a bigger and more highly medicalised train that is in the process of being converted. The first transfer of patients took place between Thursday 31 March and Friday 01 April 2022. There were nine patients, and nine MSF medical staff. The patients were all wounded in, or while trying to leave, the besieged city of Mariupol. We made the selection of patients with the management team of a hospital in the town of Zaporizhzhia, where the patients were first treated after leaving Mariupol. We transferred them to referral hospitals in Lviv. The idea is to take patients needing higher levels of care, but stable enough to endure a long train journey (up to 24 hours). We want to enable them to have the best possible care, away from the active areas of warfare in Ukraine, and we want to relieve some of the pressure on the hospitals that are closer to frontlines of the war.