In a field hospital on the eastern front all was calm. And then, suddenly, it wasn’t. A casualty arrived. It was a badly wounded Ukrainian soldier. An enemy mortar had landed nearby, leaving him with shrapnel wounds. Within seconds a team of medics got to work. Their operating theatre was in a former apartment, now functioning as a clinic. Children’s drawings with patriotic messages – Glory to Ukraine! – hung on the wall.
The unconscious patient was transferred onto an operating table. He looked more dead than alive. Doctors gave emergency transfusions of blood and plasma. A paramedic cut away his uniform. Another bandaged his left leg. A third gave him a shot of fentanyl, a powerful painkiller. A heart monitor beeped. Outside were regular whumps from outgoing Ukrainian artillery. The frontline with the Russians was 5km away.
After 20 minutes, the wounded man’s condition stabilised. He began to groan: a good sign. Medics put him back on the gurney, tilting him upwards. The soldier was wrapped in a gold-coloured foil blanket. From the makeshift medical centre he was taken by ambulance to a fully equipped hospital. It was a perilous journey. Russian troops frequently shell the muddy route, which twists between drooping sunflower fields and semi-abandoned villages.
“He had lost an awful lot of blood. In another 30 minutes he would have been dead,” said Dr Denys Sholom – the head of the medical team. He added matter of factly: “Now he will probably live.” The “stabilisation point” ensured soldiers suffering from serious battle wounds survived, long enough for them to be treated further down the line. The doctor added: “We save 98% of our patients.”
Sholom said shrapnel caused the majority of cases he saw – “80-85%” – in a conflict characterised on both sides by relentless and terrible artillery bombardment. The latest casualty had been hit in the leg, stomach and head. Typically, injured soldiers arrive in the early hours, brought in from trenches under cover of darkness, he said. The dead go straight to the morgue.
The Russians frequently target the ground floor clinic, he added. Sholom – a children’s anaesthesiologist by training, and aged 37 – said he and a surgeon would continue working, whenever bombs fell, as his colleagues took cover in a basement. “I worry about them,” he confided, adding: “Sometimes we have to amputate. If there’s the smallest chance of saving a limb we send them for treatment elsewhere.”
The location of the hospital cannot be revealed for security reasons. Nearby is Bakhmut. In May Russian forces occupied the city in the eastern Donbas region after a grinding year-long siege. Across a 600-mile front, in the east and south of the country, Russians forces are trying to advance. Further north in Kharkiv province, they are pressing towards Kupiansk and the Oskil river. Every day they launch skirmishes and attacks, firing from forest cover.
In October, Russia staged its biggest and most ambitious offensive for months. At least three brigades mounted a surprise dawn assault on Avdiivka, a Ukrainian-held frontline town near the occupied city of Donetsk. It involved tanks, armoured vehicles, and thousands of supporting infantry. The Russians made some progress, but failed to encircle Avdiivka which sits in a salient, and suffered big wipeouts of men and equipment.
Ukraine’s army, meanwhile, has made a few tactical gains. In September its soldiers retook two villages – Klishchiivka and Andriivka – 8km south of Bakhmut. There are intense clashes for control of the heights along a railway track which connects the two mini-settlements. The Russo-Ukrainian conflict has become a battle of trenches and field guns – eerily reminiscent of the first world war – with the modern addition of electronic communications and killer drones.
Vladimir Putin’s war plan remains unchanged. Twenty one months after his large-scale invasion he wants to capture fully Donetsk oblast, and the Ukrainian garrison towns of Kramatorsk and Sloviansk, grinding out a PR victory after his military failure last year to take Kyiv. In the south the Russian army has dug defences to thwart a Ukrainian counter-offensive. Meanwhile, with no end in sight, Ukrainian soldiers defending their homeland continue to die.
Sholom said he was used to the daily carnage. He and his medical staff survive by guzzling energy drinks and puffing cigarettes during lulls in the fighting. They congregate in a smoke-filled stairwell, protected by concrete walls. The shattered town where they are based has no water or electricity. A generator provides light for operations and wifi. How did he cope with constant presence of death? “The devil knows. It’s OK,” he said.
Ivan, a 30-year-old doctor, said there was little prospect the conflict would stop. “I would like it to end. But I don’t think it’s going to happen.” He said Ukrainians knew why they were fighting and noted: “There is a difference between Ukraine and Russia. They are slaves and we are not. Slaves go where they are told.” A handful of his patients were wounded Russians. “We treat them like anybody else,” he explained.
Not all of the team are professional medics. Yevhenia Kolesnichenko used to work as a religious studies teacher. She said she became a volunteer and nurse after her husband died last year while fighting inside Bakhmut. “He was severely injured. He didn’t get medical help in time. Now I try to save guys here.” She arrived at the clinic two weeks ago. Was she scared? “Not remotely. I’m focused on my work. I’m uninterested in the world,” she said.
The hospital consists of two main treatment rooms. Doctors sleep nearby. The corridor is decorated with pictures of Ukrainians through the ages, from a medieval knight dressed in armour, to a Cossack warrior and a modern soldier. One photo on the wall is of Yevhen Konovalets, a Ukrainian nationalist leader murdered in 1938 by Stalin’s secret police. A blue-and-yellow banner reads: “5th separate assault brigade, medical division. At the tip of a spear saving lives.”
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Morale among Ukrainian soldiers appears high. On a break from fighting near Bakhmut Serhiy Kraynyak – a member of the 5th brigade – said neither side was close to victory. “They have not completely lost the war. We have not completely won it,” he reflected. He added: “We are going forward but not at the tempo we would want.” The Russians had mined “everywhere”, making progress extremely difficult. “Our sappers have to go forward inch by inch,” he pointed out.
He continued: “Ukraine has a strong army. But there are moments when it’s not enough.” The chief problem was a lack of supplies – ammunition and shells, primarily, plus mid-range artillery systems and aviation in the shape of F-16 jets. In Kraynyak’s estimate 70% of Russian soldiers were “idiots’” and 30% “professionals”. “The stupid ones will stare up at a drone. If you hear one, you have immediately to hide,” he said. Rainy weather was the soldier’s friend, he said, since it meant drones could not fly.
Kraynyak shared videos taken by his six-man unit. One, filmed in May, showed bodies of dead Russians lying in a grassy verge, west of Klishchiivka. A second featured street fighting in Bakhmut, before Ukraine relinquished the city, with snow on the ground. A Browning machine gun spat out bullets. Later the platoon stopped for a tea-break in a tree-splintered grove. There is footage of Chasiv Yar, a town 1okm from Bakhmut, where two foreign aid workers died last month in a Russian attack on their car.
Exact figures for casualties are unknown. According to US estimates around half a million combatants on both sides have been killed or wounded – with 120,000 dead Russian soldiers, and 70,000 Ukrainian ones. Dmytro Bezverbnyi – an actor from the western city of Lutsk, now serving with the fifth brigade – said it was tough when his friends got killed. “We feel angry. My heart hurts. But it doesn’t stop us,” he said. “We know that they died for Ukraine, for a better life for Ukraine.”
Bezverbnyi said he spoke regularly to his wife and parents, who worried about him. They tend to avoid talking about the war, and instead chat about “normal” life. “I always tell them everything is OK,” he said. Was this accurate? “Not entirely,” he replied. In his view, Russia invaded Ukraine for classically imperial reasons. “Russia is an empire. For empires it’s important to take more territory and resources. The whole Russian state system thinks this way.”
Back at the clinic the doctors relaxed again. Some scrolled their phones; others dozed or prepped medical equipment. A cat padded on a parquet floor. Percussive booms continued: a steady thump, thump, thump. “We need tanks and heavy armour, as much as you can give us,” Sholom said, by way of parting message. “The more we get the closer we come to victory. And then we can all go home.”
Invasion by Luke Harding (Guardian Faber Publishing, £10.99). To support The Guardian and Observer, order your copy at guardianbookshop.com. Delivery charges may apply.