Ukraine: The Condition of Wounded Soldiers Raises Concerns

In some areas of the front line infested with drones, evacuating wounded soldiers is becoming virtually impossible. The situation in many units is exacerbated by the lack of training in
tactical medicine and the shortage of medical personnel and individual first aid equipment. This is a problem that goes beyond the military sphere and deserves attention beyond Ukraine’s borders.

Over one year of service as a military medic in the Ukrainian army, Kristina Voronovska, 36, has evacuated more than 100 wounded from the front lines. She had been working in the humanitarian sector until the start of the Russian offensive in 2022, but she has no formal training in healthcare; however, she speaks English. In the first weeks of the conflict, once her son had fled abroad with his father, Kristina committed herself to the Ukrainian cause as a volunteer. For several months, she offered her services as an interpreter to various foreign associations that had come to help civilians threatened by the advance of Russian troops, as well as to veterans who had come to train Ukrainian soldiers in tactical medicine. In September 2023, the death of two volunteers from the French association Road to Relief, targeted by a Russian missile strike, as well as that of other volunteers she knew, finally convinced her to join the armed forces, for the sake of her family if she were to lose her life.

Well versed in extreme situations and emergency care protocols from translating them, but without having had the time to obtain the certifications corresponding to her skills, Kristina was naturally assigned to a military rescue team in March 2024. During her first few months, she carried out what is known in military jargon, both in English and now in Ukrainian, as “casevacs” (casualty evacuations), i.e., evacuating the wounded from the front lines.

Initially, recalls Kristina, who even in the frontline bunkers never goes anywhere without a book, “we could go straight to the shelter [where the wounded were gathered, editor’s note]; like straight into the trenches, to retrieve the wounded.” Within a few hours, they could be taken care of by the evacuation team, handed over to a medical team, and taken to a stabilization point for the wounded located a few kilometers from the front, or directly to a military hospital, where they would receive emergency care from a team of doctors. In recent months, however, this pattern has become almost impossible to follow.

Drones, a constant threat

The reason, explains Kristina, whom we met in her garrison village in the Kharkiv region and interviewed by phone, is that the front line is infested with killer drones in some areas, and in increasing numbers. In 2022, she continues, facing this threat “was extremely rare […]. In 2023, of course, there were already a lot of drones everywhere; reconnaissance drones […]. It wasn’t that dangerous, but in 2024, things changed considerably.”

Derived from civilian technology, these drones, used by both sides, are modified to carry an explosive payload
intended to be delivered onto the target along with the drone itself (kamikaze drones) or to drop ammunition. Their range extends to about 20 kilometers. Highly maneuverable, they can track and strike a moving target, whether people or vehicles. These targets are all the more easily spotted as the front line is constantly scanned by observation drones flying at higher altitudes. During the day and, increasingly, at night, no movement can escape the enemy.

When asked about the risk posed by these cheap weapons, a Ukrainian army drone pilot we met in the east of the country said that driving less than ten kilometers from the front line without signal jammers (designed to disable drones as they approach the vehicle) is no longer reasonable, especially since, in recent months, the Ukrainian battlefield has seen the emergence of a new type of killer drone, guided by a fiber-optic cable that makes it immune to jamming.

Evacuation is becoming a challenge

“That’s why, these days, in the Donbas and Kharkiv regions and, I think, in the south [of the country], it’s almost impossible to get close to the front line by car. As a result, evacuation teams have to walk perhaps three kilometers [toward the front line] and then back again, carrying the wounded. Cars can’t get there: they would be targeted,” explains Kristina. Three kilometers; but sometimes four, sometimes five, sometimes more, says our interviewee, adding that even on foot, it is not always possible to reach the front line.

This view is shared by Olga Sikyrynska, 24, founder and president of the Mamay Foundation, an association of civilian volunteers specializing in casevacs and tactical medicine training for the military. Evacuation teams, she adds, “are always one of the favorite targets, because the Russians aren’t stupid. In a medical vehicle, there’s not just one person: there are a driver, two paramedics, and often the wounded. Sometimes we have one wounded person with three caregivers, but sometimes we can have five wounded in the car because the caregivers and soldiers have crammed in as many people as they can before leaving. Unfortunately for the enemy, it’s always a good target because they know they can destroy a vehicle and everyone inside.”

The drone threat, Kristina says, “makes evacuations almost impossible.” That is one of the reasons she decided to switch brigades a few weeks ago to become a drone pilot herself. Olga, who ended her last mission in November, adds: “It’s becoming so dangerous that many units simply don’t want to take responsibility for a team of volunteers anymore.” Olga, who completed her law degree in the summer of 2022, says she has evacuated more than 200 wounded people from the front lines with her teams since her organization was founded in August of that year.

Like Kristina, Olga acquired her medical knowledge as a volunteer interpreter during the first months of the conflict, working with an American association that came to teach tactical medicine techniques to Ukrainian soldiers. After losing her father, who was killed in combat in June 2023, she decided to work directly with the armed forces and underwent various training courses in Ukraine and Poland. The young woman, a fan of Tarantino’s film Inglorious Basterds, who even on missions rarely goes anywhere without her dog – a 60-kilogram Cane Corso named Baton – now has combat medic status. Passionate about emergency care, she began training as a nurse just a few months ago.

Disastrous medical consequences

Kristina says the wounded stuck on the front line “are forced to suffer for a day, sometimes two, sometimes more, with only basic care from their brothers and sisters in arms.” However, not all rank-and-file soldiers are sufficiently trained to properly care for themselves or their wounded comrades, and this lack of preparation costs lives and leads to medical complications that are sometimes irreversible.

Olga, whom we interviewed in Kyiv, explains that “generally, the ‘red’ patients [the most seriously wounded, editor’s note] die. Then the ‘yellow’ patients [those in an intermediate condition] become red patients, and the ‘green’ patients [the least seriously wounded] simply continue to fight, even if they have been hit by shrapnel or are suffering from brain damage.”

When an evacuation can finally be organized, it often takes place at night, with all lights off, if possible in an armored vehicle, with the help of night vision goggles and signal jammers – equipment that costs several thousand euros each and which the brigades do not have in sufficient quantities.

Due to complications arising during the absence of treatment, the medical teams at the stabilization points are no longer always able to care for the most seriously injured. They must then be sent directly to an appropriate hospital. During this new evacuation, which can take several hours, their condition continues to deteriorate and the risk of amputation increases. Ultimately, the recovery and hospitalization time for survivors is extended, which means an increased need for doctors, medical equipment, medicines, and available hospital beds.

In-depth tactical medicine training… for all

Faced with the difficulty of participating in the evacuations herself, Olga now plans to focus on training troops in
tactical medicine, her foundation’s other specialty. In addition to long evacuation times, the Ukrainian armed forces suffer from a lack of military first responders, who, due to their scarcity or civilian volunteer status, do not remain on the front lines. Olga , like Kristina, is therefore convinced that it is a priority for every soldier to acquire advanced mastery of the tactical medicine protocols developed by the US armed forces.

However, training military personnel can sometimes be a challenge, as the subject of emergency care is not always taken seriously by soldiers and their superiors. “If you’re training new recruits, like people who’ve just joined the army,” says Olga with a wry smile, ”whether they’ve been drafted or volunteered, it doesn’t matter, they want to do cool stuff. They haven’t seen war yet, so they want to do cool things. They want to… I don’t know… drive a tank or shoot at the enemy. They say […] that medicine is just for girls.”

This is a serious mistake, because a thorough understanding of these procedures can, to a certain extent, compensate for long evacuation times. In the fall of 2023, Kristina had to treat a wounded soldier whose comrade had managed to perform an advanced technical procedure for a non-first responder: a tourniquet conversion – which involves dressing the wound that caused the bleeding stopped by the tourniquet and loosening the tourniquet slightly to partially reactivate blood circulation in the affected limb. Despite the delay in evacuation, Kristina explains that this soldier, who had “trained extensively” in this type of procedure, managed to “save his wounded comrade’s leg.”

Uneven awareness and lack of resources

As this anecdote illustrates, Ukrainian soldiers are gradually becoming aware of the importance of the subject. Olga, who happens to train the same soldiers she met when they first joined the army, for a second time, confirms this: after the combat experience, she explains, they “listen in a completely different way,” because given “what war is like today, […] generally, the moments when you find yourself in contact with the enemy, shooting at each other face to face, are extremely rare […]. Usually, if you’re an infantryman, you’re sitting in your trench and you’re being bombarded by kamikaze drones, by munitions dropped by drones, by artillery… […] You have a 100% chance of having to treat someone […] but you don’t have a 100% chance of having to shoot.”

The most renowned brigades in the Ukrainian army, such as the Azov Brigade and the Da Vinci Wolves Battalion, are known for the quality of the medical services and training they provide to all their fighters. The most famous of these units, the 3^rd Assault Brigade, Olga explains, “offers initial training lasting 20 to 25 days for new recruits, which includes medical training every day for around four hours. They spend as much time on medicine as they do on shooting.”

However, these advances should be viewed with caution, as the various units that make up the Ukrainian army enjoy a large degree of autonomy and compete with each other to obtain as much funding, donations, and resources as possible. Also, explains Peter Bahr, a 31-year-old German trauma surgeon who has visited Ukraine several times as a volunteer, “if you work with an effective battalion in this area, the training of their soldiers will also be very good […]. On the other hand, you have brigades or battalions that are really lacking in resources […]. These guys are also the ones who are not sufficiently trained, and their soldiers, if they cannot be evacuated, simply die. In some cases, they don’t even have a permanent evacuation chain for the wounded.”

Peter, an enthusiastic young doctor with eleven years of MMA experience, studied medicine i.a. in Lithuania and at the Royal College of Medicine in London. Since the start of the Russian invasion in 2022, he has spent around seven months in Ukraine.

Indispensable volunteers

Fortunately, in this situation, the military can count on the unconditional support of volunteers and donors, both Ukrainian and foreign, who contribute to the functioning of the armed forces’ healthcare system at various levels. Peter says that “the medical system and the evacuation system, especially in the red zone [the area closest to the front line, editor’s note] and the contact zone [the front line itself, editor’s note], would probably not function if there weren’t so many volunteers.”

Bastian Veigel, 47, a German traumatologist, shares this view. The surgeon, who is a fan of metal rock and British writer Terry Pratchett, traveled to the Donetsk Oblast twice as a volunteer military doctor for the Frontline Medics organisation, in the summer of 2023 and the fall of 2024. “Based on my experience and the information I have obtained from my friends and other organizations, without this vast and efficient volunteer system, I believe Ukraine would have lost the war, because up to 50% of the evacuations of the wounded depend on foreign and Ukrainian volunteers,” he explains calmly.

Volunteers are also very active in supplying the armed forces with medical equipment. Bastian’s experience illustrates this on a large scale. In addition to his 70-hour work week and family life, he has raised tens of thousands of euros in donations over the past two years, an activity he describes as a “second job” because it is so time-consuming. Bastian has mainly invested this money in purchasing individual first aid equipment for the military: tourniquets, hemostatic gauze, occlusive dressings, etc. These are all single-use, high-cost supplies that soldiers need on a constant basis as supplies are not always adequate.

In addition, volunteers play a significant role in training soldiers in tactical medicine. Olga, with the help of a team of American volunteer instructors, has already trained several thousand soldiers from around 30 different units.

“To be honest, I think that in this war, if we still exist as a country and if we still have hope of victory in the near future, it is only because we have volunteers […]. I was a volunteer, and then I joined the armed forces […]. I can compare: I am nothing without volunteers,” says Kristina, visibly moved by support from Ukraine and around the world.

The issue of the lack of first aid equipment and its sometimes poor quality was at the heart of several state scandals in Ukraine in the Summer and Fall of 2023, as reported repeatedly by international media outlets including The Kyiv Independent and The Guardian.

Updating concepts of casualty evacuation

For Bastian and Peter, interviewed by phone in English, volunteering, as we have seen, does not stop with their missions in Ukraine. Informing the general public and institutions about the consequences of contemporary high-intensity warfare for military and civilian health services is also part of their mission.

The two doctors say the concept of medical evacuation as envisaged by NATO forces, which include most EU countries, including France, must be updated as a matter of urgency, as it relies heavily on the evacuation of the wounded by helicopter and the deployment of mobile medical points and field hospitals, including in tents and close to the front line. This is indicated, for example, on the website of the French Armed Forces Medical Service.

However, Bastian points out that in the context of a war similar to the one in Ukraine, European armies would not be guaranteed total air and technological superiority over the enemy, and that this type of mobile healthcare structure “would last 24 hours before being completely destroyed.” As for evacuation by helicopter, he adds, this is not even an option: “If you try to fly, you’ll be shot down,” he says, eager to see the lessons of the Ukrainian conflict taken into account.

Bastian and Peter therefore share the view of Olga and Kristina on training fighters to tactical medicine; a view that is widely shared by the many Ukrainian women who play a major role in reforming their country’s military healthcare system.

Europe’s weaknesses are not only military

In addition, Peter points out that the sale of emergency medical equipment is “an area that we should regulate more,” because, he explains, in Ukraine as in the EU, it is now possible to obtain cheap, uncertified equipment that turns out to be defective when it is needed. In a context where the state is unable to meet all the needs of its troops and where volunteers or individual soldiers are trying to fill the gaps, such a situation can prove fatal.

Since 2023, several media outlets (including Ukraine Espreso and The Spectator) have reported cases of wounded people who have died after being treated with counterfeit Chinese tourniquets by volunteers or even by their own units. This situation has been exacerbated by a lack of precision in Ukrainian law establishing the contents of soldiers’ first aid kits. The law only mentions one type of tourniquet, without listing the brands and models considered reliable.

As Bastian points out, the war in Ukraine also raises questions about industrial dependence. The surgeon explains, “If I need a good-quality tourniquet, I have to get it from either the US or Ukraine. I don’t know of any companies in Germany that make tourniquets, and that’s just one example.” In fact, apart from Ukraine, there appears to be no major European manufacturer of military tourniquets that are recognized as reliable. Yet this is one of the most important items in a military first aid kit. What, moreover, can be said about European healthcare manufacturers whose production lines are located in China? China, whose government is regularly accused of supporting the Kremlin in the war in Ukraine.

Finally, our interviewees add that the conflict in Ukraine obviously raises the question of the preparedness of civilian medical facilities. Because, as Bastian points out, “in Germany, we are closing hospitals and reducing our capacity to provide large-scale medical care.” “All doctors are working overtime […],” confirms Peter Bahr, ”and for stupid reasons, we haven’t planned for the aging of the baby boom generation […]. This represents a huge population, and […] no one thought that we might need more healthcare personnel to take care of them.” This situation may give France a sense of déjà vu and could also prompt reflection on how to finance much-discussed rearmament.

With this in mind, Peter is currently giving a series of lectures in the Baltic states and Austria to advise his audience on how to prepare the civilian and military medical systems for a potential conflict with Russia. Bastian, for his part, has given several talks on the topic of military medicine and the conditions for evacuating the wounded in Ukraine (these talks are available on the MDR website and on Podcast.de). This awareness-raising work can be exhausting, but for the two colleagues, sources of motivation, whether tinged with hope or sadness, are never in short supply. Among these is the death of their former translator, Margarita Polovinko, 31, who was killed on duty by a Russian drone in early April. Her death, reported by Le Monde among other media outlets, has moved people far beyond Ukraine’s borders.