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Sparse foliage hide the entrance. One sloping wooden passageway descends to a brightly lit reception area. Inside lies a surgery unit, outfitted with gurneys, heart rate sensors and ventilators. And cabinets full of healthcare supplies, medications and neat piles of spare clothes. In a staff room with a laundry appliance and kettle, doctors monitor a display. It shows the movements of enemy surveillance UAVs as they zigzag in the sky above.

Medical personnel at an underground medical center observe a screen displaying enemy kamikaze and surveillance UAVs in the region.

This is Ukraine’s covert underground hospital. This center began operations in August and is the second such installation, situated in the eastern part of the country not far from the frontline and the urban area of a key location in Donetsk oblast. “Our facility sits 6 metres under the earth. It’s the safest way of providing help to our wounded soldiers. It also ensures medical personnel safe,” said the clinic’s surgeon, Major Oleksandr Holovashchenko.

The stabilisation point treats 30-40 patients a each day. Their conditions vary. Certain individuals suffer from devastating leg injuries necessitating amputations, or severe abdominal injuries. Some patients can move on their own. Almost all are the casualties of enemy first-person view (FPV) drones, which drop grenades with lethal precision. “90% of our cases are from first-person view drones. We encounter minimal gunshot wounds. This is an era of unmanned aircraft and a different kind of conflict,” the surgeon said.

Maj Oleksandr Holovashchenko at the subterranean facility for treating injured troops in eastern Ukraine.

During one afternoon last week, a group of three soldiers limped into the facility. The least severely hurt, 28-year-old Artem Dvorskyi, said an first-person view drone blast had torn a minor wound in his limb. “Conflict is terrible. My comrade beside me, a fellow soldier, was fatally wounded,” he stated. “He fell down. Then the Russians dropped a second explosive on him.” He continued: “Everything in the village is demolished. There are drones all around and casualties. Our side's and the enemy's.”

The soldier explained his unit spent over a month in a forest area close to the city, which enemy forces has been trying to seize for many months. The only way to reach their position was by walking. Necessary provisions arrived by quadcopter: food and water. Seven days after he was hurt, he walked 5km (about 3 miles), taking several hours, to a point where an armoured vehicle was able to evacuate him. Upon arrival, a medical staff assessed his physical condition. Following care, a nurse gave him new non-military attire: a T-shirt and a set of pale jeans.

Artem Dvorskiy, 28, stated a FPV aerial device caused a minor injury in his leg.

Another patient, 38-year-old a serviceman, said a UAV explosion had resulted in concussion. “My position was in a dugout. It suddenly became black. I couldn’t feel anything or any sound,” he explained. “I believe I was fortunate to remain alive. My cousin has been lost. There are continuous explosions.” A construction worker employed in Lithuania, he noted he had come back to Ukraine and enlisted to serve days before Vladimir Putin’s large-scale attack in February 2022.

Another military member, a serviceman, had been struck in the upper body. He expressed pain as doctors laid him on a medical cot, took off a bloody bandage and treated his recent injury from fragments. Covered in a foil blanket, he used a mobile phone to call his family member. “A fragment of mortar struck me. It was a deflected projectile. I’m OK,” he told her. What comes next for him? “To recover. This may require a few months. Subsequently, to return to my unit. Our forces must defend our nation,” he affirmed.

Medical staff care for Taras Mykolaichuk, who was hit in the back by a piece of mortar.

Over the past years, enemy forces has consistently targeted medical centers, health facilities, obstetric units and emergency vehicles. According to human rights groups, over two hundred health workers have been killed in almost 2,000 attacks. The underground facility is built from multiple reinforced shelters, with timber beams, earth and granular material placed above reaching the surface. It is designed to resist impacts from large-caliber projectiles and even three eight-kilogram explosive devices released by aerial means.

A major industrial group, which financed the construction, plans to build twenty units in total. A senior official of the nation's security agency and ex- defence minister, the official, said they would be “vitally important for preserving the lives of our military and supporting troops on the frontline.” The organization referred to the initiative as the “largest-scale and demanding” it had undertaken after Russia’s invasion.

An example of the centre’s operating theatres.

Holovashchenko, said some wounded personnel had to endure delays many hours or even days before they could be transported because of the threat of aerial attacks. “We had a pair of severely injured patients who arrived at 3am. It was necessary to carry out a double amputation on one of them. The soldier's bleeding control device had been applied for such an extended period there was no other option.” What is his method with severe surgeries? “My career in healthcare for 20 years. One must focus,” he said.

Orderlies transported Mykolaichuk up the tunnel and into an ambulance. The transport was parked beneath a shrub. He and the other soldiers were transferred to the city of a major city for additional medical care. The subterranean hospital staff paused for rest. The hospital’s ginger cat, the mascot, padded up to the doorway to greet the next arrivals. “We are active 24 hours a day,” Holovashchenko stated. “It doesn’t stop.”