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Scrubby trees conceal the entryway. A descending wooden tunnel descends to a well-illuminated reception area. There is a surgery unit, equipped with beds, cardiac monitors and ventilators. And shelves full of medical equipment, medications and organized stacks of spare clothes. Within a break area with a washing machine and kettle, physicians keep an eye on a screen. It shows the movements of enemy spy drones as they weave in the sky above.

Medical staff at an underground hospital look at a screen displaying enemy suicide and reconnaissance UAVs in the area.

This is the nation's covert below-ground medical facility. This center began operations in the eighth month and is the second such installation, situated in eastern Ukraine not far from the frontline and the city of Pokrovsk in the Donetsk region. “We are six meters under the ground. It’s the safest method of providing help to our injured military personnel. And it keeps healthcare workers protected,” said the clinic’s surgeon, Major Oleksandr Holovashchenko.

This medical station handles thirty to forty casualties a each day. Cases differ widely. Certain individuals suffer from devastating limb trauma requiring amputations, or serious abdominal injuries. Others can walk. Almost all are the victims of Russian FPV aerial devices, which release grenades with deadly accuracy. “90% of our patients are from first-person view drones. We see minimal gunshot wounds. It’s an era of unmanned aircraft and a new type of conflict,” the surgeon explained.

Maj Oleksandr Holovashchenko at the underground installation for treating injured troops in the eastern region.

On one afternoon recently, three soldiers walked with difficulty into the facility. The most lightly injured, 28-year-old Artem Dvorskyi, said an first-person view drone explosion had ripped a minor wound in his limb. “Conflict is horrific. The guy next to me, Vasyl, was killed,” he stated. “He fell down. Then the enemy forces dropped a second explosive on him.” He continued: “Everything in the settlement is demolished. We see drones all around and casualties. Ours and theirs.”

Dvorskyi said his squad spent 43 days in a forest area close to Pokrovsk, which enemy forces has been attempting to capture for many months. Sole access to reach their position was on foot. All supplies arrived by quadcopter: rations and drinking water. A week after he was hurt, he walked 5km (about 3 miles), requiring several hours, to where an military transport was able to pick him up. At the clinic, a medical staff assessed his vital signs. After treatment, a nurse provided him with fresh non-military attire: a shirt and a set of pale denim trousers.

The soldier, 28, said a first-person view aerial device caused a minor injury in his leg.

A different casualty, thirty-eight-year-old Pavlo Filipchuk, said a drone blast had resulted in a head injury. “I was in a dugout. Suddenly it went dark. I couldn’t feel anything or hear anything,” he said. “I think I was lucky to remain alive. A relative has been lost. There are ongoing explosions.” A builder employed in a neighboring country, he said he had returned to Ukraine and enlisted to fight shortly before Vladimir Putin’s large-scale attack in early 2022.

Another military member, a serviceman, had been hit in the upper body. He expressed pain as medical staff laid him on a bed, took off a stained bandage and cleaned his recent shrapnel wound. Covered in a thermal sheet, he used a cellphone to call his sister. “A piece of artillery struck me. It was a deflected projectile. My condition is stable,” he told her. What were his plans now? “To recover. That will take a several months. Subsequently, to go back to my unit. Our forces has to protect our country,” he said.

Medical staff care for Taras Mykolaichuk, who was hit in the back by a fragment of artillery shell.

Over the past years, Russia has repeatedly attacked medical centers, clinics, maternity wards and ambulances. According to international monitors, 261 health workers have been fatally attacked in nearly 2,000 attacks. The underground facility is built from multiple steel bunkers, with timber beams, earth and sand laid on top reaching ground level. It can withstand direct hits from large-caliber projectiles and even multiple eight-kilogram TNT charges released by drone.

A major steel and mining company, which funded the construction, intends to build 20 facilities in all. A senior official of the nation's national security council and ex- defence minister, Rustem Umerov, declared they would be “critically important for preserving the lives of our armed forces and supporting defenders on the battlefront.” The company described the initiative as the “largest-scale and demanding” it had undertaken after the enemy's military offensive.

An example of the centre’s operating theatres.

Holovashchenko, said some wounded soldiers had to endure delays many hours or even days before they could be evacuated due to the threat of aerial attacks. “Our facility received two severely injured casualties who arrived at 3am. It was necessary to carry out a double amputation on a patient. His tourniquet had been on for so long there was no alternative.” How did he cope with severe surgeries? “I’ve been healthcare for 20 years. One must concentrate,” he said.

Orderlies wheeled the soldier through the tunnel and into an ambulance. The vehicle was parked under a bush. He and the other military members were transferred to the city of a major city for additional medical care. The underground medical team took a break. The hospital’s ginger cat, Vasilevs, padded up to the doorway to greet the next arrivals. “Our facility operates active 24 hours a day,” Holovashchenko stated. “It doesn’t stop.”