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Scrubby trees hide the entryway. One descending timber passageway descends to a well-illuminated welcome zone. Inside lies a surgery unit, equipped with gurneys, cardiac monitors and breathing machines. And cabinets stocked of medical equipment, medications and organized stacks of extra garments. In a staff room with a washing machine and hot water heater, physicians monitor a screen. It shows the movements of Russian spy drones as they zigzag in the sky above.

Medical personnel at an subterranean medical center observe a screen displaying enemy kamikaze and reconnaissance drones in the area.

Welcome to Ukraine’s secret below-ground medical facility. This center opened in the eighth month and is the second of its kind, situated in eastern Ukraine not far from the frontline and the urban area of Pokrovsk in the Donetsk region. “Our facility sits 6 metres under the earth. This is the most secure method of delivering care to our wounded military personnel. It also ensures healthcare workers safe,” stated the clinic’s lead doctor, Maj Oleksandr Holovashchenko.

This medical station treats 30-40 casualties a day. Cases differ widely. Some have devastating limb trauma requiring amputations, or serious abdominal injuries. Others can move on their own. Almost all are the casualties of Russian first-person view (FPV) aerial devices, which release grenades with deadly accuracy. “Ninety per cent of our cases are from first-person view drones. We see few gunshot wounds. This is an era of drones and a different kind of war,” the surgeon said.

Maj Oleksandr Holovashchenko at the underground installation for treating injured soldiers in eastern Ukraine.

On one afternoon recently, three soldiers walked with difficulty into the facility. The most lightly injured, 28-year-old Artem Dvorskyi, said an first-person view drone blast had ripped a small hole in his limb. “War is terrible. The guy next to me, a fellow soldier, was killed,” he stated. “He fell down. Then the enemy forces dropped a another explosive on him.” He continued: “Everything in the village is destroyed. We see UAVs everywhere and bodies. Ours and theirs.”

The soldier said his unit endured over a month in a wooded zone near Pokrovsk, which Russia has been trying to seize since last year. Sole access to get to their location was by walking. Necessary provisions came by quadcopter: rations and water. Seven days following he was hurt, he walked 5km (about 3 miles), requiring three hours, to a point where an military transport was able to pick him up. At the clinic, a medical staff checked his physical condition. Following care, a medical attendant gave him fresh non-military attire: a shirt and a pair of pale denim trousers.

The soldier, 28, stated a first-person view drone caused a minor injury in his leg.

Another patient, thirty-eight-year-old a serviceman, recounted a UAV explosion had left him with concussion. “My position was in a dugout. Suddenly it went dark. I lost sensation anything or any sound,” he explained. “I believe I was fortunate to remain alive. My cousin has been lost. There are ongoing detonations.” A construction worker working in a neighboring country, Filipchuk said he had come back to his homeland and enlisted to serve days before the Russian leader's full-scale invasion in early 2022.

Another military member, a serviceman, had been hit in the back. He expressed pain as doctors laid him on a bed, removed a bloody bandage and treated his recent shrapnel wound. Covered in a foil blanket, he borrowed a mobile phone to ring his sister. “A piece of mortar hit me. It was a ricochet. I’m OK,” he told her. What comes next for him? “To get better. This may require a few months. Subsequently, to return to my military group. Someone must defend our nation,” he said.

Medical staff care for Taras Mykolaichuk, who was hit in the back by a fragment of mortar.

Over the past years, Russia has consistently targeted hospitals, clinics, maternity wards and emergency vehicles. Per human rights groups, over two hundred health workers have been fatally attacked in almost two thousand assaults. The underground facility is constructed from multiple steel bunkers, with wooden supports, soil and sand laid on top reaching ground level. It can withstand impacts from large-caliber artillery shells and even multiple eight-kilogram TNT charges released by aerial means.

A major industrial group, which funded the construction, plans to erect twenty units in all. The head of Ukraine’s security agency and former military leader, Rustem Umerov, declared they would be “vitally essential for saving the lives of our armed forces and assisting defenders on the frontline.” The organization referred to the initiative as the “largest-scale and challenging” it had undertaken after the enemy's invasion.

An example of the centre’s operating theatres.

The surgeon, said certain injured personnel had to wait hours or even days before they could be evacuated because of the danger of aerial attacks. “We had a pair of critically ill patients who came at the early hours. It was necessary to perform a double amputation on a patient. His tourniquet had been on for so long there was no other option.” What is his method with traumatic surgeries? “I’ve been medicine for two decades. One must concentrate,” he said.

Orderlies transported the soldier through the tunnel and into an emergency vehicle. The transport was parked under a shrub. The patient and the two other soldiers were taken to the urban center of a major city for additional medical care. The subterranean hospital staff took a break. The facility's orange feline, Vasilevs, walked toward the doorway to greet the next arrivals. “Our facility operates active around the clock,” the surgeon stated. “It doesn’t stop.”