International response was swift, in the form of humanitarian aid for people who lost their homes, their livelihoods and all their possessions. 

Boxes upon boxes of American taxpayer-funded humanitarian aid are now flowing across the sea to internally displaced Ukrainians by the thousands. But with continuing calls from Congress for strict accountability, keeping track of all those boxes is a constant and dangerous challenge for the nonprofits that play a critical role in its distribution.

The Mykolaiv Business Center, shown here in early December, suffered damage in a July attack. Cory Vaillancourt photo

Around 4 a.m. on Tuesday, Dec. 6, the small Hyundai cleared a military checkpoint and headed out of Odessa. Inside, a driver and a bodyguard, both Ukrainians, accompanied an American aid worker headed for Kherson, some 160 miles to the east.

The roads were smooth, and traffic was flowing, but as the group passed Mykolaiv about halfway through, the way became much rougher — in spots, still cratered by Russian munitions that had rained down for months. The checkpoints became more frequent, more imposing. 

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This region was the high-water mark for Russian advances in the south of Ukraine. 

They’d tried to capture Mykolaiv but when they failed, they continued to attack civilian targets like the eight-story Mykolaiv Business Center, which still stands spewing its contents into the parking lot below from a gaping hole made by a Russian missile. 

As the group drew closer to its destination, buildings in the small roadside villages appeared little more than empty husks, blown out or burnt down.  

Veering off the highway onto a makeshift dirt road — Ukrainians were rebuilding an overpass that had been destroyed some months earlier — their car came just yards from bright red skull-and-crossbones signage indicating minefields adjacent to the pavement. 

Occasionally, the tails of undetonated rockets could be seen sticking out of the fields like some sort of strange, rusty invasive species. 

“We go places no one wants to go. We meet people who have seen things no person should have to see,” said Caine Cortellino, a program director for U.S.-based nonprofit, Project HOPE. 

Originally from Decatur, Georgia, Cortellino has worked in international humanitarian assistance for 15 years, in places like Nigeria, South Sudan and Sri Lanka. 

Kherson, his destination, is still on the front lines no more than 2 miles from Russian-held Ukrainian territory. The atmospheric thump of artillery shells coming and going is sporadic, but never really stops. 

“I’ve worked across many different countries in the world and Ukraine is really one of the most intense conflicts that I’ve ever been a part of,” he said. 

Cortellino and his Project HOPE team are visiting the town to check in on the aid distribution projects taking place there, ensuring that the proper paperwork is being collected by local volunteers. 

The way that American humanitarian assistance is distributed throughout the world isn’t well understood except perhaps by those involved directly in the process. From start to finish, every detail is scrutinized, every outcome is recorded, every truckload down to the kilogram is tracked and counted. 

“Being a good steward of federal tax dollars is critical to our mission,” he said. “As the only American who’s currently working with Project HOPE in Ukraine, it’s my responsibility both professionally and as an American taxpayer to ensure that we are using American taxpayer funds wisely.”

The United States government administers more than half of all foreign aid through the U.S. Agency for International Development, an independent federal agency with a budget of more than $27 billion that was founded in 1961. 

USAID, as it’s called, integrates various nongovernmental organizations like Project HOPE into its operations. The way it usually works is that the U.S. government will set an objective and invite different NGOs to bid on them by issuing a NOFO (Notice of Funding Opportunity). Those NGOs submit a proposal to USAID, usually through their Bureau for Humanitarian Assistance. The BHA then reviews the proposals they think will make the most efficient, effective use of the aid, and then designates the organization as what’s called an “implementing partner.”

“Generally, we work as implementing partners,” said Chris Skopec, executive vice president for public health at Project HOPE. “In some cases, we receive contracts with a very specific set of deliverables, a very clear set of outcomes that need to be produced, time bound and accountable. We work in the NGO sector as the implementing arm of USAID’s efforts to achieve its development and humanitarian goals.”

Project HOPE was founded in 1958 as a peacetime hospital ship called the S.S. Hope, formerly the U.S.S. Consolation. Before its retirement in 1974, the ship traveled to Southeast Asia, Central and South America, Africa and the Caribbean providing medical care during disasters. 

Today, Project HOPE not only addresses disasters and health crises like COVID-19, but also operates in a variety of other public health sectors. 

“We work with the U.S. government when our missions align, but we are not dependent on U.S. government funding to deliver on our mission,” Skopec said. “In the case of Ukraine, we responded in the earliest days and the days immediately following the invasion, doing contingency planning as the Russian military buildup was happening. That was in February of 2022. We didn’t receive our first government funding until summer of 2022.”

That funding, $10 million over 12 months, will allow Project HOPE to work in Ukraine at the scale appropriate for the amount of displaced Ukrainians. The need there, Skopec said, is “tremendous.”

Once so designated, an implementing partner then opens a base of operations in the specific country if they don’t already have one and begins gathering and assessing information that will inform the needs-based distribution operation. 

“If you’re a health-based sector, you go out and you might talk to hospitals, you might talk to key informants, doctors, ministers of health, other individuals within the Ministry of Health, or the people, to find out what they really need,” Cortellino said. 

The information from the original proposal is then merged with the information gathered during the initial assessment to help inform the procurement process. In the health sector, those procurement needs could be anything from hygiene kits to water purification systems. 

“It’s very similar to the process you would see in a company where you will seek bids. You can purchase items either on a lowest-cost basis or on best value, but we pull together a committee, we issue a tender for whatever it is we’re looking to purchase and then we receive quotes,” Cortellino said. “A committee reviews those to ensure that the quality matches what we’re expecting, that the lead time is appropriate for emergency context, and that it’s going to address the needs of the beneficiary population we’re trying to serve.”

In this case, those little boxes Cortellino’s been chasing all over Ukraine are hygiene kits. They contain everything from hand soap to shampoo to razors, feminine hygiene products and laundry detergent. 

Project HOPE also distributes baby kits, designed for children under three. They contain tear-less shampoo, diaper rash cream and the like. 

“It’s our responsibility to care for the neediest of the needy, and small children are obviously in that group,” he said. 

These items serve an obvious and important purpose — preventing a public health emergency that would compound the effects of the war amongst a transient population. 

Cortellino, however, recognizes another effect of the kits. 

“It is certainly a dignity issue,” he said. “It allows people to reintegrate into society wherever they have decided to settle, or if they’re on the move they can take them with and continue to live a somewhat normal life as they move to their final destination.”

Project HOPE Program Director Caine Cortellino (center) talks with aid workers on Dec. 6 at a distribution point in Kherson, Ukraine. Cory Vaillancourt photo

Formerly a city of 300,000, Kherson sits on the banks of the Dnipro River but is also perched on the edge of a humanitarian catastrophe. Those who remained through the Russian occupation have a distinctive look about them, says Cortellino.

“Sometimes it appears that their faces are longer, or there’s a grayness to it. I think that is sort of a physical manifestation of the intense stresses that these people have lived under for so long,” he said. 

An 18-year-old Kherson native called Olga is one of them. 

“[During the occupation] it was scary, and it was dangerous to go outside,” she said. “Every day you could be taken somewhere to be tortured because these places were here.”

Now, hundreds brave the continued shelling while lining up outside what used to be a Georgian café, hoping to receive one of those boxes Cortellino’s been chasing around the country. 

“It is important for people now to get humanitarian help,” Olga said. “They are in despair; they are scared, and they don’t know what will be next. They are just afraid. Also, they have no place to go. Now there are no places to work, they have no money and humanitarian help is the only helping source for people.”

Once they show up, they’re asked for their names and their documents. 

“When we organize distributions, one of the things that’s really central to what we do is data collection,” Cortellino said. “Sometimes it’s paper-based, but we also have electronic data collection where we use tablets to collect information.”

That data is used to prevent fraud and waste; Project HOPE even goes so far as to destroy leftover packaging, so that counterfeit goods can’t be resold on the black market. 

The distribution at the café is going relatively smoothly, so Cortellino and his team head across town to check on some boxes that ended up at a maternity hospital. 

Aid workers stack Project HOPE-branded USAID hygiene kits in a maternity hospital in Kherson, Ukraine, on Dec. 6. The hospital was destroyed by Russian artillery on Dec. 27. Cory Vaillancourt photo

Workers there said that when the Russians left, they stole everything that wasn’t nailed down. Indeed, the hospital was little more than a collection of rooms with examination tables and some beds remaining. There wasn’t an ultrasound wand or computer in sight. Three weeks after Project HOPE’s visit to the hospital, the Russians finished it off by destroying the building altogether.

After another visit to an outlying suburb — where Russian shelling from across the river was getting uncomfortably close — the team decided to head back to Odessa rather than follow the plan and stay overnight. But first, another visit to another small suburb, Chornobaivka, which has become something of a dark joke among Ukrainians. 

Russians tried desperately to conquer the area, but were pushed back time after time, managing to hold the area for only short periods. Ukrainians called it “Groundhog Day,” after the movie in which Bill Murray relives the same series of events, over and over. Purportedly, 96 separate Russian attacks were repelled over eight months. 

There, at a community center filled with diapers, potatoes and boxes of aid from Project HOPE, the joking stopped. 

SEE ALSO: Western North Carolina’s connection to the war in Ukraine

“When here were occupiers, this was very difficult for people. They lived like they wanted. Robbed. Took people to basements. I suffered by myself. They took my documents, hit me,” said Volodymyr, a 33-year-old man who had to endure the occupation with a broken leg because he wasn’t allowed to leave to seek treatment. “We were afraid to go outside. They were driving through the village [in armored personnel carriers]. They were frightening people. But after the Ukrainian army came, it became much easier to breathe. The village inhaled.”

An elderly woman named Maria who spoke with The Smoky Mountain News can trace generations of her lineage through Chornobaivka. Speaking through a translator, she painted a gruesome picture of life during the brief periods of Russian control. 

“When the occupiers came with the guns we were scared even to go outside, to buy some necessary goods and hygiene because they were driving military cars,” she said. “In first couple of days they killed two people from the village, young boys, for nothing.”

Maria spoke of Russian soldiers confiscating people’s documents and telephones, driving through town, shooting up homes randomly. 

“You don’t know where to run and what will be with you in the next minute,” Maria said. “This is very, very difficult.”

She wouldn’t let Cortellino’s team leave Chornobaivka without a dozen or so jars of homemade marmalade as well as pickled fruits and vegetables, including borscht. She also gave Cortellino a dozen or so laminated holy cards, with pictures of Jesus and the Virgin Mary on one side, and a prayer on the other. She urged him to keep it in his car at all times. 

“For protection,” she said. 

Humanitarians working in public health have become increasingly important as Russia continues to strike civilian infrastructure in Ukraine. Rolling blackouts, along with other power interruptions, don’t just impact noncombatants in their homes — it also disrupts the provision of medical care.

“The impact on the health system in Ukraine is not just limited to theft and looting of the equipment,” said Skopec. “There have been over 700 documented attacks on health care in Ukraine on behalf of the Russian forces, and that includes personnel, infrastructure, hospitals, clinics, ambulances, et cetera. The health infrastructure has been devastated.”

Skopec commended what he called the “tremendous commitment” of health care workers who have remained in Ukraine to serve their country since the invasion began 10 months ago. 

“Just put yourself in the mindset of a person with diabetes or hypertension on regular treatment protocol, or somebody that might be dealing with a physical trauma which we see a lot in the war context. You need health care, you need access to good quality care, and you need it immediately. You need it before anything else,” he said. 

The role of power transmission infrastructure becomes even more critical where it’s used to filter and pump water. Without clean drinking water, people can become sick very quickly as well as create ideal conditions for waterborne diseases and the host of health issues that arise from them. 

“Being able to provide access to good hygiene and hygiene kits is critical to protecting the health of these communities,” Skopec said. 

International NGOs working in Ukraine are trying to do just that. Groups that utilize U.S. government funding, like Project HOPE, are now eyeing the new Republican majority in the House to see what changes, if any, they’ll propose to future aid packages. 

Last October, presumptive Speaker of the House Kevin McCarthy (R-CA) said that Congress shouldn’t write a “blank check” to Ukraine while also calling for more oversight and stricter accountability of the aid that’s already being provided. 

“Of course, the military aid is what most people talk about, but a significant component of it will be for humanitarian assistance to civilian populations, as it should be,” Skopec said. “I know within Congress, the appetite is still high. Anecdotally, among the American public, I’m just always blown away by how many flags I see, how much support I see, just in public as I drive around town here in Washington.”

Throughout the trip to Mykolaiv, Kherson and Chornobaivka, the Ukrainians who talked to The Smoky Mountain News said they were thankful for the boxes Project HOPE had been bringing them, but their stark parting message was always the same: don’t forget about us. 

Cortellino thinks he knows why they’d say that. 

“What we’re really bringing,” he said, “is hope.”

Editor’s note:  The names of the Ukrainians in this story have been changed to protect their identities.