We Need a Medic!

Executive Summary

In early 2022, Russia’s military health system faced unprecedented circumstances. Russian military medical staff transitioned from supporting the civilian sector in the battle against the COVID-19 virus to supporting major combat operations in Ukraine. This occasional paper identifies several challenges the Russian military medical system has faced as Russia sustains its protracted campaign in Ukraine and examines several efforts undertaken by the Russian government to provide care for the wounded. It does not aim to offer a comprehensive account of the Russian military medical system; rather, it provides an initial exploration of the Russian military medical system in Ukraine.

The paper finds that Russia’s war on Ukraine has stressed the Russian military medical system and that the system continues to be at major risk of being overburdened because of the demands of the protracted conflict and Russia’s casualty-heavy approach to the fighting in Ukraine. The Kremlin’s political assumptions about a quick victory in Ukraine, the geographical scale of the front line in Ukraine, the lack of preparation of its medical staff, and preexisting personnel and material shortages have significantly affected Russia’s ability to provide care for the wounded in Ukraine.

Russian soldiers in Ukraine have mainly suffered shrapnel wounds from exploding shells and blast wounds in the extremities. Soldiers are either underequipped in battlefield medicine and/or medical supplies run out quickly, which forces them to improvise first aid. Challenges in casualty evacuation from the point of injury has led to a reliance on battlefield self- and buddy-aid as well as placing mobile medical units closer to the fighting.

Facing shortcomings in Ukraine, Moscow is establishing policies to improve care for the wounded, including the following: (1) using Belarusian medical capacity to relieve overcrowded hospitals in mainland Russia, (2) improving the training of its personnel and updating its procedures, (3) involving the civilian health care system to augment the military medical system’s capacity by exploring legal frameworks to shorten the bureaucratical process for volunteers and having soldiers treated in civilian hospitals, (4) increasing various types of military medical facilities, (5) involving volunteer groups to rectify material shortages, and (6) placing medical personnel closer to the front line to stabilize the wounded before casualty evacuation.

Although there are signs that the mitigating measures put in place by the Russian government have achieved some objectives—Russian troops seem to be better trained and equipped in battlefield medicine than during the earlier periods of the conflict—Russian leadership often overstates how these measures have affected the war effort. Some at the Ministry of Defense posit that Russia’s peacetime medical infrastructure is not large enough to meet the medical demand of prolonged large-scale combat operations (LSCO). The weaknesses in Russia’s military medical system are compounded by weaknesses in the Russian civilian medical system.

Extracting preliminary lessons from the Russian military medical experience can provide a guide to the difficulties the US military may encounter when providing care for the wounded during LSCO. Key implications include the following:

1. In protracted LSCO, the risk of the military medical service becoming seriously overburdened is significant. Establishing a framework to increase collaboration between the civilian and military medical health sectors may ease the burden on military medical personnel.
2. Providing a robust medical response in LSCO requires that medical planning be integrated with the planning of operations. Although Russian forces set up tents for medical care near the Ukrainian border in January 2022, military medical leadership and personnel were still unsure of whether Russia would launch another campaign in Ukraine. This confusion—along with the political assumptions about the conflict—led to a lack of integrated planning to meet the demands of the conflict.
3. Institutionalizing and adapting Tactical Combat Casualty Care training can likely make a crucial difference in lifesaving care during active conflicts. Although Russian soldiers struggle with first aid, certain measures have improved discernment at the front line of who should be medically evacuated. These measures include institutionalizing training, promoting self-aid, having fellow soldiers participate in the wounded’s first aid process, stationing medical detachments near the fighting, and having these medical detachments stabilize patients before evacuation.
4. Medical forces will be targeted by modern enemies, whether deliberately or accidentally. When moving closer to the front, medical detachments will be forced to find creative ways to protect personnel from being targeted. To protect its mobile medical personnel, Russia has opted to disguise its ambulance vehicles, and set up medical detachments in protected structures.
5. Emerging technology is likely to play a crucial role in medical evacuations in the future. Integrating innovative technology into casualty evacuation can plug critical capacity gaps, given that mobile detachment units might be overwhelmed by casualties.

This initial exploration yielded valuable insights into the Russian military medical experience in Ukraine, but it remains an understudied topic. Little is available in the English language about the history or the general organization of Russia’s military-medical system; most studies focus on the Ukrainian military medicine experience, and there is little research on sanitation or disease in the war. Future studies should delve deeper into these and adjacent topics to learn lessons for the joint force.