Military briefing: the medics battling on Ukraine’s ‘second frontline’

A Ukrainian soldier with shrapnel wounds to his legs howled in pain as medics lifted him off a bloodied gurney and on to Volodymyr Veselovskyi’s operating table.

“You will live. You will probably keep your legs, too,” Veselovskyi, an army surgeon, told the soldier. He tugged on the tourniquets fastened around the soldier’s thighs that had kept him from bleeding to death. “These are good,” he said. “You’re lucky.”

At this “stabilisation point” about 10 miles west of the battlefield at Bakhmut, Veselovskyi works alongside other volunteers who traded their medical practices for military fatigues after Russia’s full-scale invasion of Ukraine 20 months ago. Dozens such emergency units have been set up along the 600-mile frontline, serving as critical first stops for wounded soldiers needing emergency treatment before being evacuated to larger hospitals.

Ukraine’s soldiers have received praise for their acts of valour on the battlefield, where they are locked in a David-versus-Goliath fight against the much larger and more powerful Russian army. But Ukraine’s doctors, nurses and paramedics are no less important, as they wage a daily battle of their own to save the lives of their country’s defenders.

“This is the second frontline,” said army surgeon Bohdan at a different stabilisation point in Pokrovske, a town about 25 miles north of the main focus of Ukraine’s counteroffensive in the southern Zaporizhzhia region.

More than 20 months into the intense all-out war, Ukraine’s medics are in constant need of crucial supplies. More than a dozen combat medics interviewed since the start of Ukraine’s counteroffensive in May expressed frustration that defective medical equipment and a lack of medical training were costing soldiers’ lives.

Ukraine does not disclose its casualties but the latest US estimates suggest that about 130,000 Ukrainian soldiers have been injured and 70,000 killed since February 2022. Russia’s military is believed to have lost about 120,000 troops, with another 280,000 wounded, according to US estimates.

Those figures will keep rising as Russia’s invasion becomes a contest over mere metres of land, with heavy artillery duels and any ground assault hampered by fortifications and vast minefields.

Faced with Russia’s formidable firepower and fortified defences, Ukraine’s counteroffensive has not produced the results Kyiv had hoped for this year. Neither side has made significant gains and military analysts predict 2024 will be a similar slugfest.

The conflict’s grinding nature is evidenced by a steady flow of wounded troops to stabilisation points, including five facilities visited by the FT in the Donetsk and Zaporizhzhia regions. Between 30 and 80 wounded Ukrainian soldiers pass through each facility every day, medics say. But when the fighting rises, it is not unusual for the rate to increase to 150 a day.

Alina Bilous, a combat medic in Pokrovske, said she saw a three-fold increase in wounded soldiers after the counteroffensive began. She and the other medics there have since been working “24 hours a day, seven days a week”.

They sleep in cots down the hall from the operating tables and bloodstained stretchers, with a pungent metallic smell mixed with the stinging odour of antiseptic hanging in the air.

The soldiers’ injuries are predominantly shrapnel wounds caused by artillery fire and landmines.

Veselovskyi said he performed seven amputations in less than 24 hours, removing the limbs of soldiers who came under enemy shelling while advancing through a minefield during an assault north of Bakhmut, the Donetsk city captured by Russia after 10 months of intense, attritional fighting. They all lost limbs but their lives were saved, thanks to good-quality tourniquets, the surgeon said.

But he and other medics have increasingly had to work with poor-quality medical supplies, making it tougher to keep patients alive. At one stabilisation point, a “museum of killer tourniquets” was on display with over a dozen broken devices that failed to save the lives of their wearers.

“I’ve seen this first-hand when a soldier had a defective tourniquet which broke and the soldier lost his life,” said Rebekah Maciorowski, an American nurse who volunteered as a medic with the Ukrainian army in March 2022.

Cheap tourniquets, many made in China, have flooded Ukraine and made their way into soldiers’ first-aid kits, Maciorowski said. With a bad tourniquet, a soldier could bleed to death in three minutes, she added. “This is not something to save money on.”

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Ukraine’s Medical Forces Command was made aware of the issue in early summer and Anton Shevchuk, one of the top medical commanders, requested in July that the cheap tourniquets be replaced immediately. He said such devices were found in more than 5,000 first-aid kits issued by the military.

Shevchuk said he was “severely reprimanded” for his comments, but “I could not let the guys go into battle with the Chinese tourniquets”.

The scandal sparked a rare public discussion about military procurement. Since Russia’s full-scale invasion, publicly criticising the armed forces has been largely taboo and seen as unpatriotic by officials and citizens alike.

Public broadcaster Suspilne recently asked the Medical Forces Command why soldiers still received “poor-quality” first-aid kits and tourniquets. In late August, the Ukrainian military received an order to issue 80,000 new tourniquets meeting US military standards, Suspilne reported. It is unclear whether those were obtained and distributed among soldiers.

The Medical Forces Command did not respond to a request for comment.

“What is lacking [is] any kind of standardised reviewing of first-aid kits,” Maciorowski said.

As important as having good quality materials is knowing how to use them — and many medics say better first-aid training for soldiers is needed.

“A large portion of tactical medical training is just entirely omitted,” Maciorowski said, including when Ukrainian troops are being trained abroad. In addition to soldiers, medics have also been receiving training in the US, UK and other allied countries. “Because there’s such a push to get guys to the front, they can be given a month of training [with] maybe one or two days of tactical medical training. They’re not going to remember that.”

Mykyta Zavilinskyi, a photographer turned volunteer combat medic, said soldiers were being taught to apply a tourniquet whenever they saw an injured limb, without considering if one was needed.

“We see situations where guys had to spend like six, seven, even eight hours with a tourniquet on, which would harm the extremity to the point of amputation, when they never needed to apply it in the first place,” Zavilinskyi said.

He has also noticed a certain amount of disregard among the soldiers for medical training.

“I really want more soldiers to understand the sheer importance of medical training, because your knowledge of first-aid and tactical medicine is important not only for you but for your buddies, as well.”

But not even good training could fully prepare soldiers for real-life situations, said Veselovskyi. “You can train a million times how to apply a tourniquet. But when you’re bleeding and your leg has been blown off you can forget how to do everything.”