Ukraine is building 20 hospitals underground to avoid Russian bombardments
By Alistair MacDonald and Ievgeniia Sivorka
October 24, 2024
The Wall Street Journal
Artillery thudded nearby one recent evening as medics rushed a soldier with blast wounds into a new type of Ukrainian field hospital buried underground.
In the relative safety of their bunker, which lies under 10 feet of sandbags, earth, steel and pine logs, surgeon Yevhen Antoniuk and his team got to work. After 30 minutes, they had stabilized the soldier and sent him farther from the front line for additional treatment.
Antoniuk’s field hospital on the southern front is the first of 20 such underground medical facilities Ukraine plans to build to protect patients and staff from Russia’s military, which Kyiv says has targeted hospitals throughout this war.
Its seven rooms, including two operating theaters, are packed with supplies and the latest medical technology, and can handle up to 100 patients a day. Ukraine’s combat care has improved dramatically since Russia invaded, as medics adopt Western practices, such as a better division of labor and different drugs, and those drafted from civilian life get used to dealing with war casualties.
The Ukrainian medical profession is also under strain. Critical positions are unfilled and staff face burnout after 2½ years of fighting. Members of Antoniuk’s team have at times worked close to two weeks with less than three hours of sleep a day. Many in this close-knit team are haunted by one patient they couldn’t save—a member of their own crew who died in a Russian missile strike.
Yevhen Antoniuk, a surgeon and the underground hospital’s commander, with Oksana, a lab technician, and other medical staff. Serhiy, the chief anesthesiologist, and other medics talk about their roles at the underground hospital. “It is a different world in care” since 2022, said Antoniuk, who in addition to being a surgeon is also the underground hospital’s commander. “But the biggest problem is the mental health of the staff.”
The hospital acts as a so-called stabilization point, where patients are patched up before going on to more treatment. They are typically small and don’t contain operating theaters.
This one was constructed underground out of six large steel bunkers supplied by Ukrainian steel company Metinvest. Its corridors and some rooms are lined by newly cut pine logs, giving parts of the facility the smell and feel of a country cabin. The site is so well hidden that a visitor’s car parked on top of it by mistake.
The hospital should be able to withstand a direct artillery hit, but would likely not survive one from larger glide bombs, the highly explosive ordnance dropped from warplanes.
During a recent visit by The Wall Street Journal, the hospital was warned that two glide bombs were heading in its direction. Staff waited in silence before the bombs landed elsewhere, sending a tremor down the thick plastic curtain through which ambulances enter. The hospital is the first of 20 such facilities Ukraine plans to build to protect patients and staff from Russia’s military.
The World Health Organization has charted more than 2,000 attacks since the start of the war on Ukraine’s medical facilities and transport, including children’s and maternity hospitals, leading to 186 deaths. Kyiv says that this is deliberate targeting. Russia’s Ministry of Defense didn’t respond to a request for comment.
Standards in Ukraine’s combat medical care have improved significantly. Many medics have been trained abroad. Now every doctor knows how to administer local anesthetics and all know how to perform an ultrasound, said Serhiy, the chief anesthetist.
Civilian doctors have gotten used to the very different circumstances, wounds and treatments in military medical care. But Ukraine faces shortages of staff, including nurses.
In Ukraine, nurses are mainly women, who haven’t been drafted, said Roman Kuziev, deputy commander of Ukrainian medical forces on the eastern front. Anesthetists, who administer pain relief, are in particularly short supply.
Antoniuk’s team of around 10 have worked together since he recruited them at the start of the invasion. During a lull, laughter bounced around the center’s walls. The hospital has two dogs, as well as three puppies they are trying to get adopted.
This stabilization point can see as many as 30 patients a day, but with Ukraine in defensive mode, and Russia applying more pressure on the eastern front line, it can be fewer.
At around 10 p.m. an ambulance arrived and a man was brought into surgery. Shrapnel from a drone had broken one leg, left him with a head wound and torn a large hole through one buttock.
A nurse wound several feet of dressing out of his injured buttock, where it had been packed to soak up the blood, and dressed the wound. A medic administered pain relief, while doctors examined the head wound. Still, the patient called out in agony. “Please try to relax,” a nurse said. “How can I relax?” he shouted, using an expletive. Soon another ambulance arrived and three severely dazed patients got out with concussion and flesh wounds. One was missing part of his cheek. All were patched up and moved on. Amid the hubbub, Antoniuk projects calm. “You learn to abstract from the situation,” he said.
Many staff members have had to work long stretches with little sleep.
That sense of distance broke down when a team member became the patient.
Last October, the facility they were working in was hit by a Russian ballistic missile. Among those badly wounded was a medical orderly named Denys Vusharovskiy. His father worked as the team’s driver.
The extent of his injuries meant that Vusharovskiy would struggle to live. Serhiy, the team’s chief anesthetist, said Antoniuk couldn’t accept that his fellow medic was going to die and fought to save him, traveling in an ambulance to keep working on him as they rushed to another hospital.
When he died, it was Antoniuk who broke the news to his father. While the team has seen many deaths, this one was a particular blow. Oksana, a lab technician, showed on her phone a compilation of photos of a smiling Vusharovskiy set to music.
Antoniuk said he sometimes worries about the mental health of his team, particularly when there are mass casualties on the front and they work for days with little rest.
Oksana keeps a sleeping bag behind the fridge where blood and plasma are stored. She says she now looks back at her civilian life differently. “The realization comes that we used to have a good life, and we really want to return to that in the nearest future,” she said.
Alistair MacDonald is a senior reporter for The Wall Street Journal in London, where he covers European defense companies and Ukraine, in particular stories related to arms supply, corruption and the war’s effects on the global food chain. Alistair also takes an interest in the intellectual and developmental disabilities community, writing about the effects of the Covid-19 pandemic and war in Ukraine on people with autism, Down syndrome and other conditions. Alistair has won several awards, including six Sabews and an OPC. He has held a variety of jobs at the Journal, including markets editor for EMEA, senior Canada correspondent, and U.K. politics and general news reporter in London. Alistair has also worked at Reuters and outlets in his native North East of England