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Scrubby trees conceal the entryway. One descending timber tunnel leads down to a well-illuminated welcome zone. Inside lies a surgery unit, equipped with gurneys, cardiac monitors and ventilators. Plus cabinets stocked of healthcare supplies, drugs and neat piles of extra garments. In a staff room with a washing machine and kettle, doctors monitor a screen. It shows the movements of Russian spy drones as they zigzag in the sky above.

Medical staff at an subterranean hospital look at a screen showing enemy suicide and surveillance drones in the area.

This is Ukraine’s secret below-ground medical facility. The facility opened in August and is the second such installation, located in the eastern part of the country not far from the combat zone and the urban area of Pokrovsk in Donetsk oblast. “We are 6 metres under the earth. It’s the most secure way of providing help to our injured soldiers. And it keeps healthcare workers safe,” said the clinic’s surgeon, Major Oleksandr Holovashchenko.

This medical station treats 30-40 patients a day. Cases differ widely. Some have devastating limb trauma requiring surgical removal, or severe stomach wounds. Others can walk. The vast majority are the victims of enemy FPV drones, which drop grenades with lethal precision. “Ninety per cent of our cases are from FPVs. We encounter few gunshot wounds. This is an era of drones and a new type of war,” the doctor said.

Maj Oleksandr Holovashchenko at the underground facility for caring for wounded troops in eastern Ukraine.

During one afternoon recently, three soldiers limped into the facility. The least severely hurt, 28-year-old one soldier, reported an first-person view drone explosion had torn a small hole in his limb. “Conflict is horrific. My comrade next to me, Vasyl, was fatally wounded,” he stated. “He fell down. Then the Russians dropped a another explosive on him.” He continued: “Everything in the village is demolished. We see drones everywhere and bodies. Ours and theirs.”

The soldier explained his unit endured 43 days in a forest area near Pokrovsk, which enemy forces has been attempting to capture for many months. The only way to get to their location was on foot. Necessary provisions came by quadcopter: rations and drinking water. Seven days following he was hurt, he traveled 5km (about 3 miles), requiring three hours, to where an military transport was able to evacuate him. At the clinic, a medic checked his physical condition. Following care, a medical attendant provided him with new civilian clothes: a T-shirt and a set of light-colored jeans.

Artem Dvorskiy, twenty-eight, said a first-person view drone ripped a small hole in his lower limb.

A different casualty, 38-year-old Pavlo Filipchuk, said a UAV explosion had left him with concussion. “My position was in a trench shelter. Suddenly it became black. I lost sensation any feeling or hear anything,” he said. “I believe I was fortunate to survive. My cousin has been lost. We face continuous detonations.” A builder employed in a neighboring country, Filipchuk noted he had come back to Ukraine and volunteered to serve days before Vladimir Putin’s large-scale attack in February 2022.

A third soldier, a serviceman, had been hit in the back. He expressed pain as doctors laid him on a bed, took off a bloody bandage and treated his recent shrapnel wound. Wrapped in a thermal sheet, he borrowed a mobile phone to ring his sister. “A fragment of artillery struck me. The cause was a deflected projectile. I’m OK,” he told her. What comes next for him? “To get better. That will take a several months. Subsequently, to go back to my military group. Our forces must protect our country,” he said.

Doctors care for the wounded soldier, who was injured in the back by a piece of artillery shell.

Over the past years, Russia has repeatedly attacked medical centers, health facilities, obstetric units and ambulances. According to international monitors, 261 medical personnel have been fatally attacked in almost two thousand assaults. This subterranean hospital is constructed from multiple reinforced shelters, with timber beams, soil and granular material laid on top reaching the surface. It is designed to resist direct hits from 152mm artillery shells and even three eight-kilogram TNT charges dropped by drone.

A major industrial group, which financed the construction, intends to erect 20 facilities in all. A senior official of Ukraine’s security agency and former military leader, Rustem Umerov, declared they would be “vitally important for preserving the lives of our military and assisting defenders on the battlefront.” The company referred to the project as the “most ambitious and challenging” it had undertaken since Russia’s invasion.

One of the facility's operating theatres.

The surgeon, explained some injured personnel had to wait hours or even multiple days before they could be transported because of the danger of aerial attacks. “Our facility received two severely injured casualties who came at 3am. It was necessary to carry out a double amputation on one of them. His tourniquet had been applied for so long there was no alternative.” How did he cope with severe operations? “My career in healthcare for two decades. One must focus,” he said.

Orderlies transported Mykolaichuk through the passage and into an emergency vehicle. The vehicle was stationed under a shrub. The patient and the other military members were transferred to the urban center of a major city for additional medical care. The subterranean medical team paused for rest. The hospital’s ginger cat, Vasilevs, walked up to the doorway to await the incoming patients. “Our facility operates open 24 hours a day,” the surgeon stated. “It doesn’t stop.”