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Sparse foliage conceal the entrance. A sloping wooden passageway leads down to a brightly lit reception area. There is a operating ward, outfitted with gurneys, heart rate sensors and ventilators. And shelves stocked of medical equipment, medications and organized stacks of extra garments. Within a staff room with a laundry appliance and hot water heater, physicians keep an eye on a display. It shows the flight patterns of Russian surveillance UAVs as they weave in the sky above.

Medical staff at an underground hospital observe a screen showing Russian kamikaze and reconnaissance UAVs in the region.

Welcome to Ukraine’s covert below-ground medical facility. The facility began operations in August and is the second of its kind, located in the eastern part of the country close to the frontline and the city of a key location in the Donetsk region. “We are 6 metres under the ground. This is the most secure way of delivering care to our wounded military personnel. It also ensures medical personnel safe,” stated the facility's lead doctor, Major the chief surgeon.

This medical station handles thirty to forty patients a day. Their conditions vary. Some have catastrophic limb trauma requiring surgical removal, or serious abdominal injuries. Others can walk. Almost all are the victims of enemy FPV aerial devices, which release explosives with lethal precision. “Ninety per cent of our cases are from first-person view drones. We encounter few bullet injuries. It’s an age of unmanned aircraft and a new type of war,” the doctor explained.

Maj the senior surgeon at the subterranean facility for caring for wounded troops in eastern Ukraine.

During one afternoon last week, three soldiers limped into the facility. The least severely hurt, twenty-eight-year-old Artem Dvorskyi, reported an FPV blast had ripped a small hole in his leg. “War is terrible. The guy beside me, Vasyl, was fatally wounded,” he said. “He fell down. Subsequently the Russians dropped a second grenade on him.” He continued: “Everything in the settlement is demolished. We see drones everywhere and casualties. Ours and theirs.”

The soldier explained his unit spent 43 days in a wooded zone close to the city, which enemy forces has been trying to seize since last year. Sole access to get to their position was on foot. Necessary provisions arrived by drone: rations and water. A week after he was injured, he walked 5km (about 3 miles), taking several hours, to where an military transport was able to pick him up. At the clinic, a medical staff checked his physical condition. Following care, a nurse provided him with fresh civilian clothes: a T-shirt and a pair of pale jeans.

Artem Dvorskiy, twenty-eight, said a first-person view drone ripped a minor injury in his lower limb.

A different casualty, thirty-eight-year-old a serviceman, recounted a UAV explosion had resulted in a head injury. “My position was in a dugout. Suddenly it became black. I lost sensation anything or any sound,” he explained. “I think I was fortunate to survive. My cousin has been killed. There are continuous detonations.” A builder working in Lithuania, he said he had come back to Ukraine and volunteered to serve days before Vladimir Putin’s full-scale invasion in early 2022.

A third soldier, Taras Mykolaichuk, had been hit in the back. He groaned as medical staff laid him on a medical cot, took off a stained dressing and cleaned his recent shrapnel wound. Wrapped in a foil blanket, he used a mobile phone to call his sister. “A fragment of artillery struck me. It was a ricochet. I’m OK,” he informed her. What comes next for him? “To recover. This may require a few months. After that, to go back to my unit. Someone must protect our country,” he affirmed.

Doctors care for the wounded soldier, who was hit in the dorsal area by a fragment of artillery shell.

Over the past years, enemy forces has repeatedly attacked hospitals, health facilities, obstetric units and ambulances. According to human rights groups, over two hundred medical personnel have been killed in almost 2,000 attacks. The underground facility is built from four steel bunkers, with timber beams, soil and sand placed above reaching the surface. It can withstand impacts from large-caliber artillery shells and even three 8kg explosive devices released by aerial means.

The Ukrainian steel and mining company, which financed the building, intends to build 20 facilities in all. A senior official of Ukraine’s security agency and ex- defence minister, Rustem Umerov, said they would be “vitally essential for saving the survival of our armed forces and supporting troops on the frontline.” The company referred to the initiative as the “most ambitious and challenging” it had undertaken after Russia’s invasion.

An example of the facility's surgical rooms.

The surgeon, said certain injured soldiers had to wait many hours or even multiple days before they could be transported because of the threat of aerial attacks. “We had two severely injured casualties who arrived at the early hours. It was necessary to carry out a double amputation on a patient. The soldier's bleeding control device had been applied for such an extended period there was no alternative.” What is his method with traumatic surgeries? “My career in healthcare for 20 years. One must focus,” he remarked.

Medical assistants transported the soldier up the passage and into an emergency vehicle. The vehicle was parked beneath a shrub. He and the other soldiers were taken to the city of Dnipro for additional medical care. The subterranean medical team paused for rest. The facility's ginger cat, the mascot, walked toward the entrance to await the incoming patients. “Our facility operates active around the clock,” the surgeon said. “The work is continuous.”