After violence broke out in in Nagorno-Karabakh in September, doctors began to enter the conflict zone.

“They don’t think in another way except to be there as soon as possible,” said Dr. Hambardzum Simonyan, a pediatrician and public health expert who acts as the Armenian monitoring officer for the nonprofit group Artsakh-Armenia Fund, or AAF.

Dr. Simonyan hasn’t heard much from his contacts inside the conflict zone, and he said it’s difficult to get a sense of what’s happening on the ground. When he asks, the answers he gets back are “very short, nothing more than one or two sentences that everything is OK, or something is terrible.”

The Nagorno-Karabakh region is officially considered to be part of Azerbaijan, although many of its citizens are ethnic Armenians.

Tensions over the region have existed between Armenia and Azerbaijan for decades. In late September, fighting broke out in the region. It is believed that hundreds of soldiers and civilians in the region have been killed.

Russia negotiated a cease-fire between Azerbaijan and Armenia on October 10, after about two weeks of open conflict, to allow for the exchange of prisoners and bodies of those killed.

However, fighting restarted days later. A second cease-fire, intended to go into effect on October 18, met a similar fate.

“If we are talking about an actual cease-fire, it doesn’t exist,” Dr. Simonyan said. Even a short break would allow for an opportunity to gather more information about what’s happening, and what’s needed most on the ground.

In peaceful times, medical care in the region is well-managed and of high quality, Dr. Simonyan explained. “They have a good, well-established health care system [in the Karabakh region], with hospitals, with rural outposts, with very good nurses,” he said.

But conflict can devastate a medical system quickly, damaging facilities, killing health care providers, and making it difficult to access even the most remedial care. It’s difficult to know exactly what the situation is in Nagorno-Karabakh right now.

Dr. Simonyan expects to see four main categories of medical need emerge from the outbreak of conflict: Most urgently, severe injuries. Chronic conditions that have gone untreated and unmanaged. Increased numbers of Covid-19 cases, as people remain in shelters to be safe from the artillery. And vastly increased mental health needs.

“It’s terrible, because we are always wanting peace and we are always looking forward to good things, positive things,” Dr. Simonyan said. “I think war is a game for politicians, not for people.”

Direct Relief, working closely with AAF, shipped a 14-pallet delivery of medical aid to Armenia’s Ministry of Health, whose humanitarian aid committee will receive the medicines and supplies, worth a total of slightly less than $3 million. The shipment departed Direct Relief’s warehouse Monday and is now en route to the region.

From there, some supplies will stay in Armenia, used to treat those needing medical attention there. The rest of the shipment will be delivered by truck to the Karabakh region, where Karabakh’s Ministry of Health plans to distribute it to health care providers and facilities working on the ground.

The shipment contains a large Emergency Health Kit, 12 Emergency Medical Backpacks – designed to be used by health care providers working in the field to treat people who may not be able to get to a hospital – antibiotics, wound dressings, syringes, inhalers, and women’s hygiene kits, among many other medications and supplies.