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Scrubby foliage hide the entryway. A sloping timber tunnel descends to a well-illuminated welcome zone. Inside lies a surgery unit, outfitted with gurneys, cardiac monitors and breathing machines. Plus shelves full of healthcare supplies, medications and neat piles of spare clothes. In a staff room with a laundry appliance and kettle, physicians monitor a display. It shows the movements of enemy surveillance UAVs as they weave in the sky above.

Medical personnel at an subterranean medical center observe a monitor displaying Russian kamikaze and surveillance drones in the region.

This is Ukraine’s secret below-ground medical facility. This center opened in August and is the second of its kind, situated in eastern Ukraine close to the frontline and the urban area of a key location in the Donetsk region. “We are 6 metres under the ground. This is the most secure method of providing help to our wounded military personnel. It also ensures medical personnel safe,” said the facility's lead doctor, Maj the chief surgeon.

This medical station handles thirty to forty patients a day. Their conditions vary. Certain individuals suffer from devastating limb trauma requiring amputations, or serious abdominal injuries. Some patients can walk. The vast majority are the casualties of enemy first-person view (FPV) drones, which release grenades with lethal accuracy. “Ninety per cent of our cases are from first-person view drones. We encounter minimal bullet injuries. This is an era of drones and a new type of war,” the doctor explained.

Major Oleksandr Holovashchenko at the underground installation for caring for wounded troops in eastern Ukraine.

During one afternoon last week, three military members walked with difficulty into the hospital. The most lightly injured, twenty-eight-year-old one soldier, reported an FPV explosion had ripped a small hole in his limb. “Conflict is terrible. My comrade beside me, a fellow soldier, was killed,” he stated. “He collapsed. Subsequently the enemy forces dropped a another grenade on him.” He continued: “All structures in the village is demolished. There are UAVs everywhere and casualties. Ours and the enemy's.”

The soldier explained his unit endured over a month in a forest area near Pokrovsk, which enemy forces has been trying to seize for many months. The only way to get to their position was by walking. Necessary provisions came by drone: rations and drinking water. A week after he was injured, he traveled five kilometers (about 3 miles), taking three hours, to a point where an military transport was able to pick him up. At the clinic, a medic assessed his physical condition. After treatment, a medical attendant provided him with new non-military attire: a shirt and a pair of light-colored denim trousers.

Artem Dvorskiy, twenty-eight, stated a first-person view drone ripped a small hole in his lower limb.

Another patient, thirty-eight-year-old Pavlo Filipchuk, said a drone blast had resulted in a head injury. “My position was in a dugout. It suddenly went dark. I couldn’t feel anything or hear anything,” he explained. “I think I was fortunate to remain alive. My cousin has been killed. We face ongoing explosions.” A builder working in a neighboring country, Filipchuk said he had returned to Ukraine and enlisted to fight shortly before Vladimir Putin’s full-scale invasion in early 2022.

Another military member, a serviceman, had been hit in the upper body. He expressed pain as doctors placed him on a medical cot, took off a stained bandage and cleaned his recent injury from fragments. Covered in a thermal sheet, he used a mobile phone to ring his sister. “A fragment of artillery struck me. It was a deflected projectile. I’m OK,” he told her. What comes next for him? “To get better. That will take a few months. After that, to return to my military group. Our forces has to protect our country,” he said.

Doctors treat Taras Mykolaichuk, who was injured in the dorsal area by a fragment of mortar.

Over the past years, Russia has consistently attacked hospitals, health facilities, maternity wards and emergency vehicles. According to human rights groups, over two hundred medical personnel have been fatally attacked in nearly two thousand attacks. The underground facility is built from multiple reinforced shelters, with timber beams, earth and granular material placed above up to ground level. It is designed to resist direct hits from 152mm projectiles and even multiple 8kg explosive devices released by drone.

The Ukrainian steel and mining company, which financed the construction, intends to build 20 facilities in total. The head of the nation's security agency and former military leader, Rustem Umerov, said they would be “vitally important for saving the survival of our armed forces and assisting defenders on the frontline.” The organization referred to the project as the “largest-scale and demanding” it had undertaken since Russia’s military offensive.

An example of the centre’s operating theatres.

The surgeon, said some injured soldiers had to endure delays hours or even multiple days before they could be evacuated due to the threat of aerial attacks. “Our facility received a pair of severely injured patients who came at the early hours. It was necessary to perform a double amputation on one of them. The soldier's tourniquet had been on for such an extended period there was no other option.” What is his method with traumatic operations? “I’ve been healthcare for two decades. One must concentrate,” he said.

Medical assistants transported Mykolaichuk up the tunnel and into an emergency vehicle. The vehicle was parked beneath a bush. The patient and the other soldiers were transferred to the urban center of Dnipro for further treatment. The subterranean medical team took a break. The hospital’s orange feline, the mascot, walked up to the doorway to await the incoming patients. “We are open around the clock,” the surgeon said. “It doesn’t stop.”