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Sparse trees conceal the entryway. A descending wooden passageway descends to a brightly lit welcome zone. There is a operating ward, outfitted with gurneys, cardiac monitors and ventilators. Plus cabinets full of healthcare supplies, drugs and neat piles of spare clothes. In a break area with a washing machine and kettle, physicians keep an eye on a display. The screen reveals the flight patterns of Russian surveillance UAVs as they weave in the sky above.

Hospital staff at an underground hospital look at a screen displaying Russian kamikaze and reconnaissance UAVs in the area.

This is the nation's secret underground hospital. This center began operations in August and is the second such installation, situated in eastern Ukraine not far from the frontline and the city of a key location in the Donetsk region. “We are six meters under the earth. This is the safest method of delivering care to our wounded soldiers. It also ensures medical personnel protected,” said the facility's surgeon, Major the chief surgeon.

This medical station handles 30-40 casualties a day. Cases differ widely. Some have catastrophic limb trauma necessitating amputations, or severe stomach wounds. Some patients can move on their own. Almost all are the victims of Russian first-person view (FPV) drones, which release grenades with lethal accuracy. “90% of our cases are from first-person view drones. We encounter few gunshot wounds. This is an era of unmanned aircraft and a different kind of conflict,” the surgeon explained.

Maj Oleksandr Holovashchenko at the underground facility for treating wounded troops in the eastern region.

During one afternoon last week, a group of three military members limped into the facility. The most lightly injured, twenty-eight-year-old one soldier, said an FPV blast had torn a small hole in his limb. “Conflict is terrible. The guy next to me, Vasyl, was killed,” he said. “He collapsed. Subsequently the enemy forces released a second explosive on him.” He added: “Everything in the settlement is demolished. We see drones all around and casualties. Ours and theirs.”

Dvorskyi said his unit endured over a month in a forest area close to the city, which enemy forces has been trying to seize for many months. Sole access to reach their location was on foot. Necessary provisions arrived by drone: rations and water. Seven days following he was hurt, he walked 5km (about 3 miles), requiring several hours, to where an military transport was able to evacuate him. Upon arrival, a medical staff assessed his vital signs. After treatment, a medical attendant provided him with fresh civilian clothes: a shirt and a set of pale jeans.

Artem Dvorskiy, twenty-eight, said a FPV aerial device caused a small hole in his leg.

A different casualty, thirty-eight-year-old Pavlo Filipchuk, recounted a UAV explosion had resulted in a head injury. “My position was in a trench shelter. 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 killed. There are continuous detonations.” A construction worker working in a neighboring country, he said he had returned to his homeland and volunteered to fight shortly before Vladimir Putin’s full-scale invasion in early 2022.

A third soldier, Taras Mykolaichuk, had been struck in the upper body. He groaned as medical staff laid him on a medical cot, took off a bloody bandage and cleaned his two-day-old shrapnel wound. Covered in a foil blanket, he borrowed a cellphone to ring his sister. “A piece of mortar struck me. The cause was a deflected projectile. My condition is stable,” he told her. What were his plans now? “To recover. This may require a few months. Subsequently, to return to my unit. Our forces must protect our nation,” he said.

Doctors treat Taras Mykolaichuk, who was hit in the back by a fragment of artillery shell.

Over the past years, enemy forces has consistently targeted medical centers, health facilities, maternity wards and emergency vehicles. According to international monitors, over two hundred health workers have been fatally attacked in almost 2,000 attacks. The underground facility is built from four steel bunkers, with timber beams, soil and sand laid on top reaching the surface. It is designed to resist impacts from 152mm projectiles and even multiple 8kg explosive devices dropped by drone.

A major industrial group, which financed the building, plans to erect 20 facilities in total. The head of Ukraine’s security agency and former defence minister, Rustem Umerov, said they would be “vitally essential for saving the survival of our military and supporting defenders on the battlefront.” The organization described the initiative as the “most ambitious and challenging” it had implemented since the enemy's invasion.

One of the centre’s operating theatres.

Holovashchenko, explained certain wounded soldiers had to endure delays many hours or even multiple days before they could be evacuated due to the danger of air assaults. “We had two critically ill casualties who came at the early hours. I had to carry out a removal of both limbs on a patient. The soldier's bleeding control device had been on for such an extended period there was no other option.” How did he cope with traumatic operations? “My career in healthcare for 20 years. One must focus,” he said.

Orderlies wheeled Mykolaichuk through the passage and into an emergency vehicle. The vehicle was stationed under a bush. He and the two other military members were taken to the city of Dnipro for further treatment. The underground hospital staff paused for rest. The facility's ginger cat, Vasilevs, walked up to the entrance to await the incoming patients. “We are open 24 hours a day,” Holovashchenko said. “It doesn’t stop.”