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Scrubby foliage hide the entrance. A sloping timber passageway descends to a brightly lit reception area. There is a surgery unit, outfitted with gurneys, cardiac monitors and ventilators. Plus shelves full of medical equipment, drugs and organized stacks of spare clothes. Within a break area with a washing machine and kettle, doctors monitor a display. It shows the flight patterns of enemy surveillance UAVs as they zigzag in the air above.

Medical personnel at an underground medical center observe a screen displaying Russian suicide and reconnaissance drones in the area.

This is the nation's secret below-ground hospital. This center opened in August and is the second of its kind, situated in the eastern part of the country close to the combat zone and the urban area of a key location in the Donetsk region. “Our facility sits 6 metres under the earth. This is the most secure method of providing help to our injured military personnel. It also ensures medical personnel safe,” said the facility's surgeon, Maj Oleksandr Holovashchenko.

This medical station handles 30-40 casualties a day. Cases differ widely. Some have catastrophic limb trauma necessitating amputations, or severe stomach wounds. Others can move on their own. The vast majority are the victims of Russian FPV aerial devices, which release explosives with deadly precision. “90% of our patients are from first-person view drones. We see minimal bullet injuries. It’s an age of unmanned aircraft and a different kind of conflict,” the surgeon explained.

Major the senior surgeon at the underground facility for treating wounded troops in the eastern region.

During one day recently, three soldiers walked with difficulty into the hospital. The most lightly injured, twenty-eight-year-old Artem Dvorskyi, reported an FPV blast had torn a minor wound in his limb. “Conflict is horrific. My comrade next to me, Vasyl, was killed,” he said. “He fell down. Then the enemy forces released a second grenade on him.” He continued: “Everything in the village is demolished. There are drones everywhere and bodies. Our side's and theirs.”

The soldier explained his squad endured over a month in a forest area close to the city, which enemy forces has been trying to seize since last year. The only way to get to their location was by walking. All supplies arrived by drone: food and water. A week following he was hurt, he walked 5km (about 3 miles), taking three hours, to a point where an armoured vehicle was able to pick him up. Upon arrival, a medic checked his vital signs. After treatment, a nurse gave him fresh civilian clothes: a shirt and a set of light-colored denim trousers.

The soldier, 28, stated a first-person view drone caused a small hole in his leg.

Another patient, 38-year-old Pavlo Filipchuk, said a drone blast had resulted in a head injury. “My position was in a trench shelter. It suddenly went dark. I couldn’t feel any feeling or hear anything,” he said. “I believe I was fortunate to remain alive. A relative has been lost. There are continuous explosions.” A builder employed in a neighboring country, Filipchuk said he had returned to Ukraine and volunteered to serve days before Vladimir Putin’s large-scale attack in early 2022.

Another military member, a serviceman, had been struck in the back. He groaned as medical staff placed him on a bed, took off a stained dressing and treated his two-day-old shrapnel wound. Wrapped in a foil blanket, he used a cellphone to call his family member. “A piece of artillery hit me. It was a ricochet. My condition is stable,” he told her. What were his plans now? “To get better. That will take a few months. After that, to go back to my military group. Our forces must protect our country,” he said.

Medical staff treat Taras Mykolaichuk, who was injured in the back by a fragment of artillery shell.

Since 2022, Russia has consistently targeted hospitals, health facilities, obstetric units and emergency vehicles. Per international monitors, over two hundred health workers have been killed in nearly two thousand attacks. This subterranean hospital is constructed from multiple steel bunkers, with wooden supports, earth and sand laid on top up to the surface. It is designed to resist direct hits from 152mm projectiles and even multiple 8kg explosive devices dropped by aerial means.

The Ukrainian industrial group, which funded the construction, plans to build twenty facilities in total. A senior official of the nation's national security council and former military leader, Rustem Umerov, said they would be “critically essential for preserving the survival of our armed forces and assisting defenders on the battlefront.” The organization described the project as the “most ambitious and challenging” it had undertaken since Russia’s military offensive.

One of the centre’s operating theatres.

The surgeon, explained certain injured soldiers had to wait many hours or even days before they could be evacuated due to the danger of aerial attacks. “We had two critically ill casualties who arrived at the early hours. I had to perform a removal of both limbs on a patient. His tourniquet had been applied for such an extended period there was no alternative.” What is his method with severe operations? “I’ve been healthcare for two decades. You have to concentrate,” he remarked.

Orderlies wheeled Mykolaichuk through the passage and into an ambulance. The transport was parked under a bush. The patient and the other military members were transferred to the city of Dnipro for additional medical care. The underground medical team took a break. The hospital’s ginger cat, the mascot, walked up to the doorway to greet the next arrivals. “Our facility operates active around the clock,” the surgeon stated. “It doesn’t stop.”