No medication, pain relief or anesthesia: How Russian frontline hospitals treat patients

“Be a man, lose a leg”

In the spring, a large-scale advertising campaign for Russian army military service contracts began. Leaflets with recruitment hotline numbers and descriptions of the benefits of service were distributed at budgetary institutions, metro stations, and public transportation stops. Streets in cities were adorned with posters and billboards, while online communities known as Z-pages shared uplifting promotional videos that undermined the significance of civilian professions, stating, “Is this really the type of defender you aspired to become? Be a real man! Serve on a contract basis.”

What soldiers actually experience on the front lines is deliberately concealed from new recruits. However, doctors in military field hospitals and medical establishments that treat wounded Russian soldiers are well aware of the reality. The same is true for volunteers who supply medical institutions with medications and instruments. In fundraising chat groups, every third photo or video depicts Russian soldiers lying in hospital beds, missing limbs or on the verge of losing them. Volunteers share these images in an attempt to convince their followers to donate more funds for doctors and hospitals. Priority is given to frontline hospitals, which are facing acute shortages of medications and equipment.

Based on reports from doctors interviewed by The Insider, the most significant surge in wounded occurred in recent months during the “Bakhmut meat grinder,” particularly in February and March. It was precisely during this period that Russia launched an active recruitment campaign to compensate for the losses. Doctors and Z-volunteers further confirm an increased influx of wounded in June. These observations are consistent with British intelligence data, indicating that since March 2023, Russian forces have been suffering the highest number of casualties.

In the fundraising chat groups, there are frequent pleas to pray for the deceased and donate funds to support the doctors treating the wounded. The medical diagnoses include injuries caused by mines, explosive devices, shrapnel, and firearms, particularly head injuries that require the expertise of highly skilled neurosurgeons.

Despite one and a half years of ongoing military operations, the Russian authorities have been unsuccessful in establishing a reliable supply chain for both border clinics and military hospitals. Even now, doctors continue to rely on volunteers for the provision of essential supplies, medications, and instruments.

Within the fundraising chat groups, appeals for assistance are intertwined with images of severed or nearly severed limbs of soldiers. These distressing visuals are juxtaposed with patriotic videos, pro-Russian content from TikTok, and congratulatory messages for “Russia Day” and other national holidays.

In early June, information about the injury of conscripts who were stationed at the Russian-Ukrainian border circulated through volunteer chat groups in the Belgorod region. The border posts were being stormed by the Russian Volunteer Corps and the Freedom of Russia Legion under the auspices of the Armed Forces of Ukraine. There was no official report regarding the injuries or deaths of the conscripts.

“News is intense. The guys repelled several attacks. We desperately need to raise funds,” wrote one of the Z-volunteers in the chat, attaching a photo of a bloodstained medical bed. “Well done, guys!” wrote another participant in the dialogue.

Assistance is not for everybody

“When a serviceman is wounded, he is immediately taken out of harm's way, stabilized, and transferred to the nearest military field hospital located in close proximity to the front line,” told a doctor from a hospital in Voronezh to The Insider. “This hospital serves as the 'forward base' where initial assistance is provided. Subsequently, the injured are assessed and redirected to appropriate facilities based on the nature and severity of their wounds. This approach, known as 'staged treatment,' involves a systematic process of delivering medical care during the evacuation stages. If required, the wounded are transported to local central hospitals in the occupied territories or within Russia. Some may be admitted to dedicated military hospitals under the supervision of the Ministry of Defense.” (You can find more details on how this system works from the perspective of doctors here).

According to the Ukrainian Armed Forces' General Staff, recent reports indicate that only officers are being evacuated to Russian Ministry of Defense hospitals. Allegedly, sergeants and privates are being treated in the occupied territories, irrespective of the complexity or severity of their injuries. As a consequence, makeshift hospitals have been set up in places such as schools and kindergartens. The village of Azov in the Zaporizhzhia region has converted a local school into a hospital, with approximately fifty Russian military personnel receiving medical care there as of the end of May. Artem Lysogor, the head of the Luhansk Regional Military and Civil Administration, reported: “In the area between Svatove and Starobilsk known as Mostiki, the occupying forces have established a field hospital within a local school, currently accommodating over 100 Russian military personnel.”

The military medical facilities located within Russian territory are also facing a shortage of doctors. Residents of Belgorod complained that the military clinic in the city was overwhelmed with patients. Among a team of 40 people, a surgeon could only manage to see 10 patients per day.

“It takes 40-60 minutes per patient, everything is handwritten like in ancient times, and there are no computers. People start queuing up even before the clinic opens. As a result, after spending the entire day waiting, they can't get an appointment,” shared one of the city's residents. In response, Vyacheslav Gladkov, the Governor of the Belgorod Region, explained that he couldn't send additional doctors there as the clinic is under the jurisdiction of the Ministry of Defense. However, he promised to address the issue “systemically.”

No anesthesia, air conditioning or medication

The supply of civilian hospitals is managed by the Ministry of Health, while the supply of military hospitals falls under the responsibility of the Ministry of Defense, specifically the Main Military Medical Directorate (GVMU). Both sectors face problems. Reports of medication shortages emerged shortly after the full-scale invasion of Ukraine by Russia began in March 2022. Over the course of nearly a year and a half of war, the situation has not improved.

The Valuiki Hospital in the Belgorod region, which receives a large number of Russian military personnel, is under the jurisdiction of the Ministry of Health. According to The Insider's sources, the hospital suffers from severe shortages of various supplies, ranging from disposable materials like wipes to prescription medications. The hospital receives assistance from the population, as numerous volunteer groups regularly send tons of medical aid there. The situation has worsened following the start of the Ukrainian counteroffensive.

“We are very grateful for the assistance we receive; we need a lot of things: clothing, footwear, medications,” says a doctor from the hospital in Valuyki, Belgorod region. “We receive all the donated items, which are put to good use. Without this support, both the doctors and the patients would face difficulties.”

The large influx of wounded requires a constant replenishment of notebooks for medical records, which are also provided by volunteers. These medical records are paper-based, as there is no digitization process in place. There is a shortage of disinfectants such as chlorhexidine and hydrogen peroxide, solutions for intravenous drips, probes for decompressing the gastrointestinal tract, drainage systems for the chest, gauze dressings, bandages, and various types of painkillers. Doctors also complain about the lack of instruments and request the purchase of surgical scissors, clamps, staplers, and sutures for closing wounds and internal organs, hemostatic sponges to stop bleeding, as well as tablets for determining blood type.

After the start of the war, some high-quality medications and supplies became unavailable to doctors.

“Russian syringes from the factory in Yelets are good, they don't leak or drip, but sometimes they stop working when used with dispensers. Volunteers bring them to us,” says a doctor from one of the hospitals in the border region. “There are Chinese syringes that are much softer. We used to have German-made 'B. Braun' syringes, the best ones. But we haven't been receiving them for a long time.”

There is a periodic shortage of anesthesia agents, which are especially in high demand in the intensive care unit. Propofol, rocuronium, and the muscle relaxant Arduan, which are used for intubation and surgical procedures, are also purchased by volunteers.

“The influx of wounded doesn't stop, medications are being consumed at a tremendous rate,” complained a nurse at the field military hospital. “In the intensive care unit, we go through approximately two ampoules per hour. Right now, we need about 70,000 rubles ($820) worth of supplies.”

Not only medications are being consumed, but also instruments for amputation. It is one of the most frequently performed operations in the border hospitals. A significant portion of the injuries are caused by landmines and explosions, where it is impossible to save the damaged limb. This is not only due to the nature of the injuries but also because of mistakes made by paramedics in providing initial aid on the front lines, the inability of soldiers to properly apply tourniquets, or even the lack of quality tourniquets in military first-aid kits.

In one of the hospitals, doctors complained about the lack of air conditioning in the operating room, despite its being exposed to the sunny side. Performing surgeries has become difficult with the arrival of summer.

Although the needs of the Russian border hospitals are growing, volunteers claim that there are fewer and fewer people willing to help.

“People are tired of the special military operation, and with each passing month, fewer of them send us money,” complained a volunteer from the Moscow region. “The amounts that people donate have also decreased.”

Another interviewee of The Insider linked the reduction in aid to the events in Shebekino. When the war reached the territory of the Russian region, the residents of Shebekino needed volunteer assistance, as many of them had lost their homes. This diverted resources that were previously directed towards hospital support. Instead of hospitals, Russians began sending money to the evacuated residents of Shebekino and the bordering villages.

Actual losses

The Russian side refrains from disclosing information regarding the number of casualties. The Ministry of Defense's last statement on this matter was nearly a year ago, in September, indicating a figure of around 6,000, but these numbers are widely believed to be significantly understated. The concealment of the true casualty count by the Ministry of Defense is not only alleged by Ukrainians, who estimate Russian losses at 220,000, including wounded in action and prisoners of war, but also by figures like Prigozhin. During the coup, Prigozhin claimed that new evidence emerged when the General Staff building in Rostov was seized, indicating that the number of casualties had been vastly underestimated. What are the actual figures for the losses?

Analysts from the BBC Russian Service and Meduza have found evidence of the deaths of 26,000 Russian military personnel. However, they admit that this number represents less than half of the actual casualties, suggesting that the true figure could exceed 50,000 deaths. The American Center for Strategic and International Studies estimates Russian losses at 200,000 to 250,000, specifying that 60,000 to 70,000 of them are fatalities.

Thus, within the first year and a half following the full-scale invasion of Ukraine, the number of casualties exceeded the number of Soviet soldiers killed in Afghanistan over nine years by approximately five times.

It's not surprising that frontline hospitals are overwhelmed. Approximately a quarter of the servicemen admitted to hospitals are in critical or extremely critical condition, according to Dmitry Trishkin, the head of the military medical directorate of the Ministry of Defense. Furthermore, about half of the casualties are in a moderate state of severity. However, these data are from December of the previous year, prior to the start of Ukraine's counteroffensive and even before the escalation of hostilities around Bahmut. Information regarding the wounded is also classified. Nevertheless, it is known that the low level of first aid training significantly contributes to the mortality rate among Russian servicemen. Artem Katulin, the founder and head of the Tactical Medicine Center at the Kalashnikov Concern, has stated that over 50% of deaths were not caused by life-threatening injuries, and more than 30% of amputations were performed due to improper application of tourniquets. Ukrainian forces have better indicators in this regard, thanks to their higher-quality overall training of paramedics and better medical support.