‘We have a rule when we hear the sirens: if you’ve...

Like the soldiers they battle to save, combat medics in Ukraine are under constant attack. Three years after the invasion, one NHS doctor bears witness. “The frontline here is cold, hard, true war. My comrades and I had more than 40 bombs dropped on us by drones over two hours. You can’t hide from drones in a trench, but you can’t outrun them either. Your only hope to live is to zigzag, to be cleverer than the drone.”.

Image Credit: the Guardian [A patient whose lung was punctured by shrapnel has a chest drain fitted at a field hospital near the frontline of the war in Ukraine]

A gaunt 28-year-old former IT worker sits patiently beneath a window barricaded with sandbags, awaiting his turn on the operating table, cloaked in dust. Now an infantryman in the Ukrainian army’s Third Assault Brigade, “Sasha” (not his real name) has shrapnel embedded in his shoulder after the Russian assault on his foxhole. “When you hear a drone, you run as fast as you can and see if you can reach any trees,” he says. “If you’re out in the open, you try to get the drone behind you, so it won’t destroy your face. It’s not panic, this running; it’s a professional response. You know what you have to do to save your life and you do it.”.

Image Credit: the Guardian [Blood and air bubble into a flask on the floor of a field hospital near the frontline of the war in Ukraine, from the lung of a patient who has a chest drain fitted]

The war in Ukraine is dominated by drone use on an unprecedented scale. Some of the largest and most expensive drones in use are the winged Shahed attack devices bought by Russia from Iran, capable of flying more than 1,000km before smashing, kamikaze-style, into buildings. Much more common are the improvised drones that went for Sasha – tiny, adapted commercial quadcopters that used to be popular for filming weddings, yet which, once armed with explosives, become diminutive killing machines. Sasha made it to the trees, but not out of danger. He was hunted initially by nimble, first-person view devices controlled by operators using headsets and joysticks. These are usually aimed directly at their targets, killing them on impact, but they cannot follow fleeing troops through undergrowth. So Sasha’s pursuers switched instead to higher altitude drones, armed with explosives, that can lock on to targets from above the tree line.

Image Credit: the Guardian [Andrii Myzak, a civilian neurosurgeon, outside bombed flats on the eastern front of the war in Ukraine]

Having saved his own life by following his training and wrapping his limbs around a tree trunk, Sasha dismisses his injuries with a shrug. “This is a scratch,” he says. It takes a young civilian paediatric surgeon turned frontline trauma surgeon over an hour to extract the metal embedded in Sasha’s shoulder, using only a local anaesthetic as he burrows and probes. Sasha doesn’t make a sound. Medical equipment for the army’s walking wounded is often rudimentary. In this case, the surgeon resorts to a first world war technique of shrapnel extraction: inserting a magnet into the incision to drag the metal out. Even as his shoulder is being sutured shut, Sasha begins negotiating with the doctors to get back to his platoon without delay. Later, one of the doctors says to me, “Infantry, these guys are the guts of war. They go into hell every day. I’ve seen guys injured for the tenth time and they still go back, because this is their land they are fighting for.”.

Image Credit: the Guardian [Walking wounded soldiers arrive at a field hospital from the frontline of the war in Ukraine]

For security reasons, I cannot reveal the precise location of this field hospital, a few kilometres from Ukraine’s eastern front. Military medics and patients are regularly targeted by Russian forces, in violation of the Geneva conventions. I have travelled here with the Third Assault Brigade from Kharkiv – the country’s second largest city, located just 30km from the border with Russia – to join combat medics for 24 hours. It has taken two overnight trains, a 4x4 and more than 48 hours to reach this point from the Polish border, 1,000km to the west. We crossed empty plains, blank horizons. There is little to check either tanks or troops on this bare, steamrollered land. “Geographically, we are made for invasion,” observes my friend Andrii Myzak, a civilian neurosurgeon from Kyiv with whom I am travelling.

Image Credit: the Guardian [A soldier called Mykola, who was pinned down on the battlefield by drones for three days, is treated by anaesthetist Jenya at a field hospital near the frontline of the war in Ukraine]

This is my fourth visit to Ukraine since Putin launched his full-scale invasion three years ago. As an NHS palliative care doctor, I have been supporting and helping train local hospice teams. The more I learn about the ferocious resolve of Ukrainian healthcare workers to keep looking after their patients, the greater my respect for their efforts and my desire to bear witness. Adult, paediatric and maternity hospitals have all been targeted, including, in July 2024, Ukraine’s largest children’s hospital, Okhmatdytin Kyiv, where a missile strike killed two members of staff. Last August, the World Heath Organization reported 1,940 confirmed attacks on Ukrainian healthcare, the highest number recorded in any humanitarian emergency globally to date.

Image Credit: the Guardian [The leg of a soldier called Mykola, who was pinned down on the battlefield by drones for three days with his leg in a tourniquet, at a field hospital near the frontline of the war in Ukraine]

For Andrii, 54, operating in Kyiv means balancing the risks of opening up a patient’s skull with those of getting trapped above ground when a bombardment starts. “We have a rule when we hear the sirens,” he says. “If you’ve started, you don’t stop, not once the patient is anaesthetised.” Every time Andrii and his team continue a neurosurgery during an air raid, they risk their own lives to save their patient. It sounds dauntingly selfless, yet for Andrii, it’s still not enough. Last year he tried to join the Third Assault Brigade’s company of combat medics. Its chief medical officer, Viktoriia Kovach, a 31-year-old former obstetrician from Kyiv, permitted Andrii to spend a few days working in a field hospital before telling him bluntly, “Your skills are needed in Kyiv. I won’t employ a doctor who can do more good in their specialty back home.”.