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Scrubby trees conceal the entryway. A sloping wooden passageway descends to a brightly lit welcome zone. Inside lies a surgery unit, outfitted with gurneys, heart rate sensors and breathing machines. And cabinets stocked of healthcare supplies, drugs and organized stacks of extra garments. Within a staff room with a washing machine and hot water heater, physicians monitor a display. It shows the flight patterns of Russian spy drones as they zigzag in the sky above.

Medical personnel at an underground hospital observe a monitor showing Russian kamikaze and reconnaissance UAVs in the area.

This is Ukraine’s secret underground medical facility. The facility opened in August and is the second such installation, situated in eastern Ukraine close to the frontline and the urban area of a key location in the Donetsk region. “Our facility sits 6 metres under the ground. This is the most secure method of providing help to our injured military personnel. And it keeps medical personnel safe,” said the facility's surgeon, Maj the chief surgeon.

The stabilisation point handles 30-40 patients a each day. Their conditions vary. Certain individuals suffer from catastrophic leg injuries necessitating surgical removal, or severe abdominal injuries. Others can move on their own. The vast majority are the casualties of enemy first-person view (FPV) aerial devices, which release grenades with lethal accuracy. “90% of our patients are from FPVs. We see few bullet injuries. This is an era of unmanned aircraft and a different kind of conflict,” the doctor said.

Maj Oleksandr Holovashchenko at the subterranean installation for caring for injured troops in eastern Ukraine.

During one day recently, three soldiers walked with difficulty into the hospital. The most lightly injured, twenty-eight-year-old one soldier, said an first-person view drone blast had torn a small hole in his limb. “Conflict is horrific. The guy next to me, a fellow soldier, was fatally wounded,” he said. “He fell down. Subsequently the Russians released a second explosive on him.” He added: “Everything in the settlement is demolished. There are drones all around and bodies. Ours and theirs.”

The soldier explained his unit spent over a month in a forest area near Pokrovsk, which enemy forces has been attempting to capture since last year. Sole access to get to their location was by walking. All supplies arrived by quadcopter: rations and drinking water. A week after he was hurt, he walked five kilometers (roughly three miles), requiring three hours, to where an military transport was able to evacuate him. At the clinic, a medical staff checked his vital signs. Following care, a medical attendant gave him new non-military attire: a T-shirt and a pair of light-colored jeans.

The soldier, twenty-eight, said a first-person view drone caused a small hole in his leg.

A different casualty, thirty-eight-year-old a serviceman, recounted a drone blast had resulted in concussion. “I was in a trench shelter. It suddenly went dark. I couldn’t feel any feeling or hear anything,” he said. “I believe I was lucky to survive. A relative has been killed. There are ongoing explosions.” A builder working in a neighboring country, he noted he had returned to Ukraine and enlisted to serve days before Vladimir Putin’s full-scale invasion in early 2022.

A third soldier, Taras Mykolaichuk, had been struck in the upper body. He expressed pain as medical staff placed him on a bed, removed a stained dressing and cleaned his recent injury from fragments. Covered in a thermal sheet, he borrowed a mobile phone to call his family member. “A piece of artillery struck me. It was a ricochet. My condition is stable,” he informed her. What comes next for him? “To get better. That will take a few months. Subsequently, to go back to my unit. Someone has to protect our nation,” he affirmed.

Medical staff care for the wounded soldier, who was injured in the dorsal area by a fragment of artillery shell.

Over the past years, enemy forces has consistently targeted hospitals, health facilities, maternity wards and ambulances. Per international monitors, 261 health workers have been fatally attacked in almost two thousand assaults. The underground facility is built from multiple reinforced shelters, with wooden supports, earth and sand laid on top up to ground level. It is designed to resist direct hits from 152mm artillery shells and even multiple 8kg TNT charges released by drone.

A major steel and mining company, which financed the construction, intends to build twenty facilities in all. The head of Ukraine’s security agency and ex- military leader, the official, declared they would be “vitally important for saving the survival of our military and supporting troops on the frontline.” The organization described the project as the “largest-scale and challenging” it had undertaken after the enemy's invasion.

One of the centre’s operating theatres.

Holovashchenko, explained some wounded personnel had to endure delays hours or even days before they could be transported because of the danger of air assaults. “Our facility received two severely injured casualties who came at the early hours. It was necessary to carry out a double amputation on one of them. The soldier's tourniquet had been on for such an extended period there was no other option.” What is his method with traumatic surgeries? “My career in medicine for 20 years. You have to focus,” he remarked.

Medical assistants wheeled the soldier through the tunnel and into an ambulance. The vehicle was parked beneath a bush. The patient and the other military members were transferred to the city of a major city for further treatment. The subterranean hospital staff paused for rest. The hospital’s orange feline, the mascot, walked up to the doorway to greet the incoming patients. “We are open 24 hours a day,” Holovashchenko said. “It doesn’t stop.”