Missing medical mobilization in Ukraine

Don't go there, warned Andrei, a Ukrainian police paramedic, as he stubbed out his cigarette and scratched his beard. He and his boss, another paramedic named Andrei, then got back into their car and left for work. (Both men did not give their last names to protect their anonymity.)

Six kilometers away: Pokrovsk, a Ukrainian mining town that is currently one of Russia's main war targets. The two Andreis are police paramedics in Donetsk Oblast, which has been violently contested since 2014. Driving an unarmored civilian car with a life-size rubber severed hand stuck in the dashboard like a macabre gag, the two men brave shells, rockets and Russian fire. are attacking drones daily in order to treat and evacuate injured civilians and soldiers from Pokrovsk and the rest of Donetsk. Like virtually all Ukrainian medical staff, both Andreis are volunteers.

Don't go there, warned Andrei, a Ukrainian police paramedic, as he stubbed out his cigarette and scratched his beard. He and his boss, another paramedic named Andrei, then got back into their car and left for work. (Both men did not give their last names to protect their anonymity.)

Six kilometers away: Pokrovsk, a Ukrainian mining town that is currently one of Russia's main war targets. The two Andreis are police paramedics in Donetsk Oblast, which has been violently contested since 2014. Driving an unarmored civilian car with a life-size rubber severed hand stuck in the dashboard like a macabre gag, the two men brave shells, rockets and Russian fire. are attacking drones daily in order to treat and evacuate injured civilians and soldiers from Pokrovsk and the rest of Donetsk. Like virtually all Ukrainian medical staff, both Andreis are volunteers.

Ukraine's frontline combat medics perform valiant work as the first line of casualty care. But almost three years after the start of a large-scale war, there are still too few of them. Ukrainian medics typically receive only four weeks of training, a quarter of what U.S. Army medics receive. This limits them to providing the essentials: medication administration, fluid resuscitation, and stabilization of traumatic injuries. And Ukraine's armed forces currently have less than 50 percent of the combat medics they need, according to staffing reports from dozens of senior medics provided to us during a research trip to Ukraine in September.

The limits of Ukrainian medical mobilization are even more acute at the top level of military clinicians: the doctors, nurses and other medical professionals who determine the life or death of seriously injured soldiers brought to them by front-line paramedics like the two Andrei. They provide what the NATO military calls Role 3 and Role 2 care: field hospitals and advanced surgical support, respectively.

As with many things in the Ukrainian army, the situation varies greatly from unit to unit. In Donetsk, the chief doctor of one brigade told us how lucky he was to have a full complement of 30 doctors and nurses. But an adjacent brigade, he said, had to make do with just three clinicians and not a single surgeon or anesthetist. Several senior doctors told us that around 1,000 additional doctors would be needed to meet the demands of frontline units alone.

A major problem lies in the refusal of the Ukrainian authorities to systematically mobilize medical personnel. An old regulation dating from the days of the Soviet Union requires all Ukrainian clinicians to be registered in the event of a military emergency. But Ukraine does not currently enforce this law; doctors and other medical personnel are only drafted if they are involved in the broader, corruption-riddled conscription to which all men over the age of 25 are now subject. As a result, clinicians are not systematically mobilized or used to assist close to the front. Most of those who serve are volunteers, including a small corps of foreign medical volunteers numbering several hundred at most. But Ukraine's dependence on domestic and foreign volunteers is unsustainable.

One reason the government is reluctant to take action is that Ukraine's civilian health system is already grappling with a critical shortage of doctors, driven by low salaries and decades of brain drain as healthcare professionals health were looking for better opportunities abroad. Although Ukraine is a renowned training center for foreign medical studentsnational retention of its doctors remains a struggle. A brigade surgeon told us that when medical school graduates were sent to him via the mobilization system, they were invariably doctors in name only: they had the diploma but no practical experience, having moved on to more promising professions. after obtaining their diploma.

Medical care is often hailed as a Ukrainian advantage over Russia. Despite the lack of personnel and often inadequate training, Ukraine is experimenting and innovating to save as many lives as possible. He has hardened hospitals (which Russian forces are deliberately targeting) and became the first country to conduct combat medical evacuations with drones. Although the total number of casualties on both sides is a closely guarded secret, by all estimates Ukraine is losing people at a much lower rate than Russia, in part due to Moscow's preference for deploying his infantry in atavistic meat grinder attacks.

If Ukraine's medical evacuation capabilities are short of manpower, the situation on the Russian side is incomparably worse. On Russian Telegram channels and elsewhere, there are widespread reports of wounded soldiers being left to die on the battlefield. THE Numbers speak for themselves: Ukraine has about five wounded soldiers for every soldier killed. On the Russian side, this ratio was estimated at 2 to 1, indicating a huge number of preventable deaths from battlefield injuries. Western armies have not experienced a similar ratio of wounded to killed in over a century.

On the Russian side, frontline medical capacity is low on the priority list; In the Kremlin, life is cheap. Russia's abandoned brigades are made up mainly of men considered unusable in Russian society: ethnic minorities from the country's outskirts, prisoners, poor people from rural areas. They are not enlisted but attracted by huge bonuses or, in the case of prisoners, promises of freedom. In the Russian system, medical care for these men is, at best, an afterthought.

Ukrainian military doctors and clinicians are better than those in Russia, but their need is also much greater. The total number of Ukrainian casualties may be approaching half a million dead or wounded, and an estimated 40 percent of wounded Ukrainian soldiers suffer permanent injuries. Soldiers are a valuable resource, especially given Ukraine's small population, lack of full mobilization, and the higher value the country places on the lives of its citizens. With an average age on the front line of between 43 and 45soldiers fit enough to face the rigors of combat are even rarer. Prompt, skilled medical care can mean the difference between a soldier severely disabled for life and one capable of returning to combat.

The speed and quality of front-line medical care are essential not only to save lives, but also for the morale of populations. Competent care is a motivational boon, strengthening Soldiers' resolve by giving them confidence that they are in good hands and will recover if injured. The lack of quality medical care, easily publicized in the age of social media, has the opposite effect, demoralizing soldiers and providing the enemy with a huge psychological weapon.

There is no miracle solution, technological or logistical. Medical supplies to frontline units are now better and more consistent than in the past, despite the difficulties of Ukraine's military medical bureaucracy. Further from the front, well-equipped and fortified hospitals saved many lives. But during the first critical hour of trauma care, the most important factor is having adequately trained medical personnel available where they are needed.

Ukraine's foreign supporters helped from the sidelines. Although a small corps of foreign medical volunteers demonstrated courage and valuable workthey now number in the hundreds at most. Ukraine's dependence on volunteers, both local and foreign, is unsustainable.

Ukraine's Western partners can help, although NATO countries will oppose the idea of ​​deploying their military doctors and surgeons to Ukraine's battlefields. European military or civilian clinicians could relieve some of the pressure on Ukrainian civilian hospitals far from the front, freeing up Ukrainian medical personnel who could be mobilized. It would also be a good way for European NATO members, whose military stockpiles are largely depleted, to show the new Trump administration in Washington that they are serious about supporting Ukraine.

But Ukraine's Western partners cannot resolve the fundamental problem of Ukraine's refusal to mobilize.

Ukraine's lack of medical mobilization parallels the much larger failure of its military mobilization. Although kyiv has gradually increased the scale of its conscription efforts, it has remained well short of a general mobilization and still refuses to conscript men under the age of 25. As kyiv looks ahead to a second Trump administration that appears likely to push for negotiations on Russia. In other words, Ukraine faces difficult choices. Raising sufficient troops could be the deciding factor in the fourth year of the war.

The immense courage and sacrifices of Ukrainian soldiers and civilians, many of them volunteers, covered up the failures of the mobilization and allowed Ukrainian President Volodymyr Zelensky to delay an unpopular but necessary intensification of conscription and coercion. If Ukraine is to survive, let alone win, it needs many more soldiers and doctors and nurses to stay in the fight.