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Scrubby foliage conceal the entrance. One sloping timber passageway leads down to a brightly lit welcome zone. There is a surgery unit, equipped with gurneys, heart rate sensors and breathing machines. Plus shelves full of medical equipment, medications and organized stacks of spare clothes. Within a staff room with a washing machine and hot water heater, physicians monitor a screen. It shows the flight patterns of Russian surveillance UAVs as they weave in the sky above.

Medical personnel at an underground medical center look at a screen showing enemy kamikaze and reconnaissance UAVs in the area.

This is Ukraine’s secret below-ground hospital. This center began operations in August and is the second such installation, situated in the eastern part of the country close to the combat zone and the urban area of Pokrovsk in Donetsk oblast. “Our facility sits 6 metres below the earth. This is the safest way of providing help to our wounded military personnel. And it keeps medical personnel protected,” stated the facility's lead doctor, Maj the chief surgeon.

This medical station treats thirty to forty casualties a each day. Cases differ widely. Certain individuals suffer from devastating limb trauma requiring amputations, or severe stomach wounds. Others can move on their own. The vast majority are the casualties of Russian FPV aerial devices, which drop explosives with deadly accuracy. “Ninety per cent of our cases are from first-person view drones. We encounter minimal bullet injuries. This is an age of unmanned aircraft and a different kind of conflict,” the doctor explained.

Major the senior surgeon at the underground facility for treating injured soldiers in the eastern region.

During one day recently, a group of three soldiers walked with difficulty into the facility. The least severely hurt, twenty-eight-year-old Artem Dvorskyi, reported an FPV blast had ripped a small hole in his leg. “Conflict is horrific. The guy next to me, a fellow soldier, was killed,” he stated. “He fell down. Then the enemy forces released a second grenade on him.” He continued: “Everything in the settlement is destroyed. We see drones all around and casualties. Our side's and the enemy's.”

The soldier explained his unit endured 43 days in a forest area near the city, which Russia has been trying to seize for many months. The only way to reach their location was on foot. All supplies arrived by quadcopter: rations and water. Seven days after he was injured, he walked 5km (about 3 miles), taking three hours, to a point where an armoured vehicle was able to evacuate him. Upon arrival, a medical staff checked his vital signs. After treatment, a nurse gave him new non-military attire: a T-shirt and a pair of pale denim trousers.

Artem Dvorskiy, 28, stated a first-person view aerial device caused a small hole in his leg.

Another patient, 38-year-old Pavlo Filipchuk, recounted a UAV explosion had resulted in concussion. “I was in a trench shelter. It suddenly became black. I couldn’t feel any feeling or any sound,” he explained. “I believe I was lucky to remain alive. A relative has been killed. We face continuous detonations.” A builder employed in Lithuania, he said he had come back to Ukraine and volunteered to fight days before the Russian leader's full-scale invasion in early 2022.

A third soldier, Taras Mykolaichuk, had been hit in the upper body. He expressed pain as doctors placed him on a medical cot, removed a stained bandage and treated his recent injury from fragments. Wrapped in a foil blanket, he borrowed a mobile phone to call his family member. “A piece of artillery hit me. It was a ricochet. My condition is stable,” he informed her. What were his plans now? “To recover. This may require a few months. After that, to return to my unit. Our forces has to defend our country,” he said.

Doctors treat the wounded soldier, who was hit in the back by a piece of artillery shell.

Since 2022, enemy forces has consistently attacked medical centers, health facilities, obstetric units and ambulances. Per international monitors, 261 medical personnel have been fatally attacked in nearly 2,000 attacks. The underground facility is constructed from multiple reinforced shelters, with timber beams, earth and granular material placed above up to the surface. It can withstand direct hits from large-caliber projectiles and even multiple eight-kilogram TNT charges released by aerial means.

A major steel and mining company, which financed the construction, plans to build twenty units in total. The head of Ukraine’s security agency and ex- defence minister, Rustem Umerov, declared they would be “vitally essential for preserving the survival of our military and assisting defenders on the frontline.” The organization described the initiative as the “most ambitious and challenging” it had undertaken since Russia’s military offensive.

One of the centre’s operating theatres.

The surgeon, explained some wounded soldiers had to wait many hours or even days before they could be evacuated due to the danger of air assaults. “Our facility received two critically ill casualties who came at 3am. It was necessary to perform a double amputation on one of them. The soldier's tourniquet had been applied for such an extended period there was no alternative.” How did he cope with traumatic operations? “I’ve been healthcare for two decades. You have to focus,” he said.

Orderlies wheeled Mykolaichuk through the tunnel and into an ambulance. The transport was stationed under a shrub. He and the other soldiers were taken to the urban center of a major city for additional medical care. The underground medical team took a break. The hospital’s orange feline, the mascot, padded toward the entrance to await the next arrivals. “Our facility operates active 24 hours a day,” the surgeon stated. “The work is continuous.”