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Sparse foliage conceal the entryway. A sloping timber passageway leads down to a brightly lit reception area. Inside lies a surgery unit, outfitted with gurneys, cardiac monitors and breathing machines. And shelves stocked of medical equipment, drugs and neat piles of extra garments. Within a staff room with a laundry appliance and kettle, physicians keep an eye on a display. The screen reveals the movements of enemy spy drones as they weave in the air above.

Medical personnel at an subterranean hospital observe a monitor displaying enemy kamikaze and reconnaissance UAVs in the area.

This is Ukraine’s secret below-ground hospital. The facility 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 city of Pokrovsk in Donetsk oblast. “We are six meters under the earth. It’s the safest way of providing help to our injured soldiers. It also ensures healthcare workers protected,” said the facility's lead doctor, Major the chief surgeon.

This medical station treats thirty to forty casualties a day. Cases differ widely. Certain individuals suffer from devastating leg injuries necessitating surgical removal, or serious abdominal injuries. Some patients can walk. Almost all are the casualties of enemy FPV drones, which drop explosives with lethal accuracy. “90% of our cases are from first-person view drones. We encounter few gunshot wounds. It’s an age of unmanned aircraft and a new type of war,” the doctor said.

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

On one day last week, a group of three soldiers limped into the facility. The least severely hurt, twenty-eight-year-old one soldier, said an FPV explosion had ripped a small hole in his leg. “Conflict is terrible. My comrade next to me, a fellow soldier, was killed,” he said. “He fell down. Subsequently the enemy forces dropped a another explosive on him.” He continued: “All structures in the village is demolished. There are drones all around and casualties. Ours and the enemy's.”

Dvorskyi explained his unit endured over a month in a wooded zone close to Pokrovsk, which Russia has been trying to seize since last year. The only way to reach their location was by walking. Necessary provisions arrived by drone: rations and drinking water. Seven days following he was injured, he traveled 5km (roughly three miles), taking several hours, to a point where an military transport was able to pick him up. At the clinic, a medic assessed his vital signs. After treatment, a nurse provided him with new civilian clothes: a shirt and a pair of pale denim trousers.

Artem Dvorskiy, twenty-eight, said a FPV aerial device caused a minor injury in his lower limb.

A different casualty, thirty-eight-year-old Pavlo Filipchuk, said a UAV explosion had left him with a head injury. “My position was in a trench shelter. It suddenly became black. I lost sensation any feeling or hear anything,” he explained. “I think I was lucky to survive. A relative has been killed. There are ongoing explosions.” A builder working in Lithuania, Filipchuk said he had come back to his homeland and enlisted to fight days before the Russian leader's large-scale attack in February 2022.

A third soldier, Taras Mykolaichuk, had been struck in the upper body. He expressed pain as medical staff laid him on a medical cot, took off a stained dressing and treated his two-day-old injury from fragments. Covered in a foil blanket, he borrowed a cellphone to call his family member. “A fragment of mortar hit me. It was a deflected projectile. My condition is stable,” he told her. What were his plans now? “To recover. That will take a few months. Subsequently, to return to my military group. Someone must protect our country,” he affirmed.

Doctors care for Taras Mykolaichuk, who was injured in the dorsal area by a fragment of artillery shell.

Since 2022, Russia has consistently attacked hospitals, health facilities, obstetric units and emergency vehicles. According to human rights groups, over two hundred medical personnel have been killed in almost two thousand assaults. This subterranean hospital is constructed from four reinforced shelters, with timber beams, earth and sand placed above up to the surface. It can withstand impacts from 152mm projectiles and even multiple eight-kilogram TNT charges released by drone.

A major industrial group, which financed the construction, intends to erect twenty facilities in total. A senior official of the nation's security agency and ex- defence minister, Rustem Umerov, said they would be “vitally essential for preserving the lives of our armed forces and assisting troops on the frontline.” The company described the initiative as the “most ambitious and demanding” it had undertaken since Russia’s military offensive.

One of the facility's operating theatres.

Holovashchenko, said some injured personnel had to wait many hours or even days before they could be transported because of the threat of aerial attacks. “We had two severely injured casualties who arrived at 3am. I had to perform a removal of both limbs on a patient. The soldier's tourniquet had been on for so long there was no alternative.” How did he cope with severe operations? “I’ve been healthcare for 20 years. One must concentrate,” he said.

Orderlies wheeled Mykolaichuk through the passage and into an ambulance. The transport was parked beneath a shrub. The patient and the other soldiers were transferred to the urban center of Dnipro for additional medical care. The underground medical team paused for rest. The facility's ginger cat, the mascot, walked up to the doorway to greet the incoming patients. “Our facility operates active 24 hours a day,” Holovashchenko stated. “The work is continuous.”