Combat Medicine: A New Era in Ukraine

Russia’s war in Ukraine is not only transforming the battlefield, it is also rewriting the rules of battlefield medicine.

By David Kirichenko

July 16, 2025

CEPA

 

More than three years into Russia’s full-scale invasion, Ukraine has pioneered the use of drones to hold back a numerically superior force. But as unmanned aerial systems evolve into the dominant weapon of attrition, they have also created enormous challenges for combat medics.

As with so much in the war against Ukraine, there are valuable lessons to be learned by the militaries of NATO armies, because the new environment is radically different from anything seen before. Western doctors should be taking notes.

Current medical training is often outdated, particularly when it comes to tourniquet use, says Rima, a medic in the International Legion of the Defense Intelligence of Ukraine (HUR). “It doesn’t prepare you for the kind of catastrophic injuries we’re seeing from drone-dropped munitions. Close-quarters combat is rare now; it’s almost all shrapnel and blast trauma,” she said.  “Medics out here are forced to learn on the fly because we have no other choice. And nine times out of 10, it’s not just one or two wounded, it’s a full-blown mass casualty situation.”

“Almost all the injuries we see now are drone-related injuries,” says Colonel Kostiantyn Humeniuk, Chief Surgeon of the Medical Forces of Ukraine. “It’s not artillery, it’s not mortars, it’s drones.” Humeniuk added that “up to 85% of those diagnosed with tourniquet syndrome ultimately required amputation.”

Douglas Davis, an Assistant Professor of Radiology at the Medical College of Wisconsin and a frequent medical volunteer in Ukraine, warns that most Western doctors would be unprepared for the realities of Ukraine’s frontline medicine. “The scale and nature of trauma we see, especially in cases involving suspected chemical agents used by Russian forces, is beyond anything most hospitals in the West are equipped to manage,” he said.

One element of the new warfare is that Russia completely disregards the law of war and focuses fire on medical personnel. A Ukrainian paramedic said: “Being a medic doesn’t guarantee you any safety. Markings just identify you as a primary target. Kill the medic of a platoon, and the platoon will be beyond help.”

Throughout Russia’s full-scale invasion, targeting Ukrainian medical evacuation teams with drones has become a deliberate and deadly tactic, forcing paramedics to operate under extreme risk even 10–15 km (6-9 miles) from the front lines. In recent months, the kill zone has been expanding as far as 40km from the front.

One Ukrainian doctor who leads a front-line hospital scoffed at the idea that Russia follows the Geneva Conventions. “They see medics as force multipliers,” he says, valuable targets who send troops back into battle. As a result, Ukrainian medics are told to remove identifying symbols like red crosses. “Mark an ambulance, and it’ll be hit within 15 minutes.”

Meanwhile, evacuation delays caused by drones often mean the difference between life and death, especially when tourniquets are left on too long and lead to permanent damage. “Evacuating a wounded soldier from the battlefield using any kind of armored vehicle is practically impossible. The wounded often remain on the battlefield for six, eight, or 12 hours — or even several days,” Humeniuk says. “That’s the biggest issue: extracting the wounded.”

But many are defenseless against fiber-optic drones, which cannot be jammed. These drones, which don’t rely on radio signals, have longer battery life and can loiter silently on key logistical routes, striking vehicles as they pass.

To adapt, Ukraine has built underground Role-2 hospitals near the front line — reinforced with wood to absorb shrapnel — where advanced surgeries are performed under constant threat from Russian attack.

Still, facing a much larger military that can afford to expend far greater human resources, Ukraine is forced to rely on technology and ingenuity wherever it can.

In cases when human evacuation is impossible, Ukrainian units have begun using small and hard-to-spot uncrewed ground vehicles (UGVs) to retrieve the wounded from the battlefield. But because of the high risk of signal loss and leaving soldiers isolated in exposed areas, these robotic evacuations were a last resort until recently.

As connectivity for UGVs improves, they can evacuate wounded soldiers from the front with greater ease, reducing risk to Ukrainian medics. Eugene, a UGV company commander in 92 Assault Brigade, has improved the communication systems used onboard to minimize signal loss for remote operators, enabling successful evacuations of wounded soldiers even when human teams could not reach them.

As the technology matures, ground robots are expected to see wider use. They’re already proving effective in transporting supplies across the front lines, reducing the need to expose soldiers to direct fire. Russian channels claim 65% of Ukrainian losses occur behind the front line, where logistics are strained, about 20km away from the contact line.

Lyuba Shipovich, CEO of Dignitas and head of the Victory Robots project, believes these robots are still in their early stages and will increasingly take over frontline tasks, including the majority of medical evacuations. “Ukraine is one of the first countries to implement drones for medical evacuation, on land, by air, and even by water. They’re low-visibility and almost silent,” says Humeniuk. “They can carry the wounded one to three kilometers from the front.”

Ukraine’s First Separate Medical Battalion recently developed a ground evacuation drone called Maul to overcome key UGV limitations. Powered by a gasoline engine, Maul can reach speeds

up to 65 km/h (40 mph) — far faster than typical electric models. But there are tradeoffs as engines can produce heat and can be more easily detected.

The ground robots have already proven life-saving in extreme situations, in one case evacuating three wounded soldiers over 17km under enemy fire. However, most are repurposed logistics platforms lacking key features like medical stabilization, protective suspension, or onboard monitoring. To compensate, operators often pair them with aerial drones for navigation. “Ground drones are very small, and fairly difficult to detect by aerial drone,” said Heiner Philipp, an engineer with Technology United for Ukraine. “They do not give off much heat, so thermal detection is also very difficult. I do anticipate they will play a bigger and bigger role over time.”

The growing infusion of technology into frontline medical operations highlights just how rapidly the battlefield is evolving. “European countries, and the United States too, are simply not ready for this kind of war,” Humeniuk argues.  “Civilian surgeons don’t understand the nature of modern battlefield injuries,” Humeniuk says. “We need to train all surgeons, military and civilian, under a unified strategy. That’s crucial.”

 

David Kirichenko is a freelance journalist and an Associate Research Fellow at the Henry Jackson Society. He can be found on X/Twitter @DVKirichenko. 

Europe’s Edge is CEPA’s online journal covering critical topics on the foreign policy docket across Europe and North America. All opinions expressed on Europe’s Edge are those of the author alone and may not represent those of the institutions they represent or the Center for European Policy Analysis. CEPA maintains a strict intellectual independence policy across all its projects and publications.