Medics treat shrapnel wounds on a soldier injured by a grenade dropped from a Russian drone, inside Ukraine’s first underground field hospital. Reinforced with metal structures — nicknamed “barrels” by medics — the facility allows surgeries some 20 feet underground. (Serhiy Morgunov for The Washington Post)
Just a few miles from the front line in eastern Ukraine, almost 20 feet below the surface, the day begins with a brief five-minute exchange between two surgeons — a father and his son.
They embrace, swap a few words about the night shift and that evening’s Champions League soccer match, then part ways again — one to rest, the other to begin another 48-hour shift in the underground field hospital where they work.
Viacheslav, the father, is a trauma specialist with combat experience dating back to 2015 and the war against Russian-backed separatists in Luhansk. His son Andriy joined his medical unit in 2023. Once they worked together in a district hospital to the west, in a small town near the Moldovan border.
Now they work underground.
When Andriy arrived for his first stint as a combat surgeon, there was little time for reflection. “I just worked,” he said. It was here that he performed his first amputations — sometimes five in a row. “After the fifth one, it really got to me. But people adapt. Then shelling starts, and you don’t even flinch. You just think, ‘It won’t hit here.’”
But often it does, and that’s why they sought safety in the earth.
The hospital is a prototype, a new approach, after years of what the Ukrainians characterize as the systematic Russian targeting of their medical facilities. Everyone there had stories of medical colleagues killed after a field hospital was hit: Denis, killed by an Iskander ballistic missile; Kolya, killed by a guided bomb.
“Medics are especially vulnerable,” said Lt. Col. Yuriy Palamarchuk, the head of the hospital’s surgical unit. “They’re not hiding behind armor. In field evacuations, they think of no one but the wounded. The Russians know this — they hunt medics. It’s targeted terror.”
Russia’s Defense Ministry did not respond to a request for comment about targeting field medical facilities, which is a war crime.
Capt. Oleksii oversees the facility, which he said they built on their own with the help of donations after other facilities near the front lines were hit. He commented ruefully that they should have done this years ago. Like the surgeons, he spoke on the condition that his last name not be used to preserve his and the hospital’s anonymity.
“If we’d assumed from the start that Russia wouldn’t fight by the rules, maybe we’d have built differently. Back then, we used NATO-style field hospitals — modular, clean, visible. Too visible. They were easy targets.”
“Command centers have long been underground v with generators, comms, protection. We asked: If that works for battle control, why not for saving lives? And it does — no one had done it systematically,” Oleksii said. He hoped the example of his hospital would be picked up by the government and built elsewhere. For now it is the exception.
The structure is a combination of wood and metal barrels sunk into the ground — but not with concrete, which the medics fear would have attracted too much attention from Russian surveillance drones.
Palamarchuk said the hospital has endured several near misses — explosions within 10 to 20 yards. “We felt the shock wave from the front row — doors skewed, floors sagged — but we kept working.” He noted that the damage around the site is extensive: “Six bombs fell nearby last month. All surrounding buildings are destroyed - but the hospital stands.”
Not for lack of Russian effort, however. They believe the Russians know something is here. Already a flight of the dreaded glide bombs — massive Soviet-era ordnance with crude guidance systems and immense destructive power, known as KABs — landed nearby.
“Either it was random, or a very precise coincidence,” Oleksii said. “No direct hit.” But they know the structure can’t withstand a KAB with its more than 500-pound warhead. “That would destroy everything. But artillery, shrapnel, near misses — that we can handle.”
At the heart of the hospital lies the triage platform flanked by two operating theaters and then a recovery area. There are no beds as the patients don’t stay for long and are sent on as soon as they are stable.
A service member steps out of an evacuation vehicle after suffering a shrapnel wound to the thigh from a drone-dropped munition. The hospital’s fortified access route allows soldiers to be brought directly into the underground medical complex. (Serhiy Morgunov for The Washington Post)
“We stabilize, operate and resuscitate. But we don’t hospitalize. No beds. No overnight stays. You wake the patient up — and send them out,” Oleksii said. “If we have enough vehicles, we can take 200 to 400 people a day.”
That night, everything was calm. The silence underground was so deep it was easy to forget that war raged just a few miles away. In the rest area, someone was on the PlayStation. Another medic read a book in the freshly cleaned operating room. A few were already settling into bed.
Just as darkness fell, a signal announced an incoming evacuation vehicle, but it was being tailed by a Russian drone. The team waited calmly as the vehicle maneuvered to lose the tracker.
Inside the vehicle were three lightly wounded soldiers. They walked on their own into the intake area. Their uniforms were removed — whether stained with blood or caked in mud — and replaced with pajamas and soft pink slippers. The slippers drew laughter, even amid the pain.
Andriy Dmytruk described his unit’s narrow escape from a drone strike. Ordered to retreat, he fled through one house. Just as he got inside, an explosion shook the walls. Smoke and dust filled the room. Lights cut out. “I couldn’t breathe,” he said. He fled to another building and then another as explosions went off around him. Inside, he threw a rug over a table and crawled underneath. Drones buzzed overhead. He powered off his phone to avoid detection.
Then came the smell — sharp and acrid. He wet a scarf with bottled water, tied it over his mouth and nose, and stayed still. His eyes burned. He thinks he lay there for at least two hours.
When the noise faded, Dmytruk escaped and found his comrades. It took nearly a full day for them to reach the evacuation point, where they were finally transported to the hospital.
They arrived courtesy of 58‑year‑old paramedic Oleksandr Smolyar, who before the war spent 31 years in prison medicine and since 2022 has worked on front lines in Donetsk, Kherson and Zaporizhzhia. He appreciated the new underground hospital.
“You drive in for a second or two — you’re indoors. Above ground, you’re visible — a target,” he said. His profession was running out of people, he lamented, and where once two medics would handle an evacuation, now it was just one.
When everything quieted, distant explosions resumed — walls trembled, earth fell from wooden beams above. The medics were already asleep, as though they hadn’t treated half a dozen wounded just minutes before.
Everyone knew, however, that more casualties would be on their way as the weather warmed and the summer fighting season began once more.
“Everyone says Russia will try again, but they already are. As soon as the weather warmed up — the pressure started,” Oleksii said. “Everything is shifting in our direction. And not in a good way.”
Yet amid all the fighting, whispers of peace talks persist — statements of ceasefires or negotiations. Meanwhile, shifts in global politics are destabilizing supplies. “One charity told me plainly: Since the new U.S. president, purchases have gotten harder,” he said. “They can still send bandages, syringes. But advanced, higher‑tech gear? Not anymore. There’s no money.”
The hospital has a laparoscope, allowing for minimally invasive surgeries — but sterilizing its delicate camera requires a plasma sterilizer, not a conventional autoclave. “A regular autoclave can be found. But plasma sterilizer? Without it, the camera needs replacing every year.”
“These high‑tech items are outside the standard budget,” Oleksii said. “There was a time when those same funds could help with things like this. Now they can’t. We haven’t stopped, but it’s become much harder to move forward.”
Natalia Chernokoz, an operating room nurse, wants the war to end — but not at any cost. “Maybe negotiations,” she said, “but only on normal terms. Not just surrender.” She fears a premature peace could lead to another cycle of violence.
“Like we make a deal — and then in a year, it starts again. There need to be some guarantees.” She thinks of the children already affected by the war. “We can’t let it touch another generation,” she said.
“They need to see strength,” she added, referring to the Russians. “I don’t think anything else gets through.”
An anesthesiologist examines medication on a shelf. (Serhiy Morgunov for The Washington Post)
Viacheslav admits he’s nearly out of strength — but as long as he’s still here, it means there’s something left. He dreams of returning home with his son. Waiting for them are his wife, two daughters, elderly mother — and a house in need of some care.
“A gate that needs fixing. A faucet that leaks. Something to prop up by the porch,” he said, smiling.
Since 2023, he’s kept a ritual: a daily game of solitaire. “If the cards fall right — it’s time for demobilization.” This year, they seem to be falling into place. “If not,” he said with a laugh, “then next year. It’s already the third year like that.”
“Today was my daughter’s last day of school,” he added. “I watched the video. And it was enough.”
